Rheumatology Flashcards Preview

MP: MSK > Rheumatology > Flashcards

Flashcards in Rheumatology Deck (70):
1

what is rheumatoid arthritis?

most prevalent sero-psotive inflammatory arthropathy

2

how does RA present?

symmetrical sinovium - doughy swelling
MCPs, PIPs - affected

3

what are the extra-articular presentations of RA?

rheumatoid nodules - lesions on extensor surfaces
lung involvement - pleural effusion s
keratoconjunctivitis sicca

4

how is RA diagnosed?

rheumatoid factor + anti-CPP factor

5

what can be seen on XR in RA?

peri-articular osteopenia and soft tissue swelling

6

what can be see on USS in RA?

good at detecting synovial inflammation

7

how is RA treated?

NSAIDS - within first 3 months of onset
short term relief - simple analgesia

DMARD - methotrexate

8

when is biologic therapy (anti-TNF alpha) justified?

DAS 28 score - patient must have a high score to qualify for this treatment

measures disease progression

9

what is ankylosing spondylytis?

chronic inflammatory disease of the spine and sacroiliac joints which can lead to eventual fusion of the intervertebral joints

10

how does AS present?

spinal stiffness in the morning which improves on exersize
loss of lumbar lordosis and increased thoracic kyphosis

11

what does AS look like on XR?

development of a question mark sign

bamboo spine

12

what causes AS?

90% - HLA-B27 positive

13

what are the tests that can be performed in AS?

schober's test - measuring lumbar flexion
normal = 20cm +

14

what is the treatment for AS?

physiotherapy
NSAIDs, anti-TNF

15

when is DMARDS used in AS?

peripheral joint inflammation

16

what is psoriatic arthritis?

occurs in 30% of those who suffer from arthritis

17

how does psoriatic arthritis present?

pitting + onychlosysis - lifting of nail from nail bed

18

what does psoriatic arthritis look like on XR?

pencil in cup

19

how is psoriatic arthritis treated?

NSAIDS - within first 3 months of onset
short term relief - simple analgesia

DMARD - methotrexate

20

what is enteropathic arteritis?

inflammatory arthritis involving peripheral joints an sometimes the spine, occurring in patients with inflammatory bowel disease e.g. US or Coeliac

21

how does enteropathic arthritis present?

large joint asymmetrical oligoarthritis

22

what is reactive arthritis?

in response to an infection in another part of the body, most commonly GU infections

23

what is the triad for reactive arthritis?

urethritis
conjunctivitis
arthritis AKA Reiter's syndrome

24

what is SLE?

chronic autoimmune which involves skin, kidneys, blood cells and nervous system

25

how does SLE present?

fatigue, fever, weight loss
arthralgia, increased risk of AVN
butterfly malar rash

26

what causes SLE?

defect in apoptosis causes increased cell death and disturbance in immune tolerance

27

how is SLE diagnosed?

urinalysis - GN
anti-nuclear antibody, Anti-dsDNA

28

what is low in SLE?

C3/4

29

how is SLE treated?

skin - hydroxchloroquine
inflammatory disease - azathioprine, corticosteriods
severe organ disease - IV steroids

30

what is Sjrogens syndrome?

autoimmune condition characterised by lymphatic infiltration in exocrine organs

31

how does Sjrogens syndrome present?

dryness in eyes/mouth
parotid gland swelling
peripheral neuropathy

32

how is Sjrogens syndrome diagnosed?

schimers test
anti-ro/la antibodes

33

how is Sjrogens syndrome treated?

lubricating eye drops
regular dental appointments

34

what aids with fatigue and arthraligia in Sjrogens syndrome?

hydroxychloroquine

35

what stimulates salivary production and what is the SE?

pilocarpine

SE - flushing

36

what is limited systemic sclerosis?

skin involvement tends to be confined to face, hands, forearms and feet

organ involvement tends to be later

37

what is positive in limited systemic sclerosis?

anti-centromere

38

what is diffuse systemic sclerosis?

skin changes develop more rapidly and can involve the trunk

early significant organ involvement

39

what is positive in diffuse systemic sclerosis?

anti-70 antibody

40

what is the cutaneous presentation of systemic sclerosis?

raynauds - cold peripheries which turn white, blue then red
central skin sclerosis - pinched beak face

41

how is systemic sclerosis treated?

raynauds - CCBs e.g. nifedipine
renal involvement - ACEi
GI - PPIs for reflex

42

what is anti-phosopholipid syndrome?

disorder than manifests clinically as recurrent rhombuses or foetal loss

43

how does anti-phosopholipid syndrome present?

increased frequency of stroke/MI in young patients
recurrent PE

44

how is anti-phosopholipid syndrome diagnosed?

thrombocytopenia and prolonged APTT
anti-cardiolipin antibodies
anti-beta 2glycoprotein

45

how is anti-phosopholipid syndrome treated?

anti-coagulation for those with an episode of thrombosis - life long warfarin
LWMH in those with pregnancy loss

46

what is gout?

crystal arthropathy caused by deposition of urate crystals within the joint due to increased levels of uric acid

47

how does gout present?

affecting the 1st metatarsophalangeal joint
intensely painful reed hot swollen joint

48

what causes gout?

deposition of urate crystals - uric acid = final compound in breakdown of purines in DNA metabolism

49

how is gout diagnosed?

polarised microscopy

needle shaped negative birefringence

50

how are acute attacks of gout treated?

colchicine

51

how are recurrent attacks of gout treated?

allopurinol

52

wha tis gouty trophi?

painless white accumulation of uric acid which can occur in the soft tissue which can erupt through the skin

53

what is pseudo gout?

crystal arthropy causing acute arthritis

54

what causes pseudo gout?

calcium pyrophosphate crystals

55

how does pseudo gout present?

chondocalcinosis - when calcium pyrophosphate deposition occurs in cartilage and other soft tissues in absence of acute inflammation

56

how is pseudo gout diagnosed?

rhomboid shaped crystals, weakly positive birefringence

57

what is polymyalgia rheumatic?

common inflammatory condition affecting elderly

58

how does polymyalgia rheumatic present ?

proximal myalgia of hip and shoulder girdles
morning stiffness >1 hour
symptoms improve as day goes on

59

how is polymyalgia rheumatic diagnosed?

no specific test
increased CRP and ESR

60

how is polymyalgia rheumatic treated?

low dose steroids (prednisolone)

61

what is polymyositis?

idiopathic inflammatory myopathy that causes proximal muscle weakness

62

how does polymyositis present?

symmetrical proximal muscle weakness
dysphagia 2o to oestrophngeal involvement

63

what causes polymyositis?

t cell mediated cytotoxic process directed against unidentified muscle antigens

64

what is positive in polymyositis?

anti-jo, ANA, Anti-SPR

65

how is polymyositis diagnosed?

prednisolone combined with methotrexate

66

what is dermatomyositis?

clinical similar to polymyositis with additional typical cutaneous features

67

how does dermatomyositis present with?

V shaped rash over the chest
gottron's papules
heliotrope rash

68

what should be screened when diagnosing dermatomyositis?

malignancy

69

what is fibromyalgia?

unexplained condition causing widespread muscle pain and fatigue

70

how does fibromyalgia present?

persistent >3 months of widespread pain
associated with depression, IBS and migraines