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Rheumatology Flashcards

(110 cards)

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1
Q

What is the commonest seropositive inflammatory condition?

A

Rheumatoid arthritis

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2
Q

Who is RA common in?

A

Women aged 35-50, genetic association

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3
Q

What is the pathophysiology of RA?

A

Autoimmune destruction of the synvoium ultimately leading to joint destruction

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4
Q

How does RA present?

A

Symmetrical swollen stiff joints, worse in the morning, better after use

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5
Q

What are signs of RA?

A

Symmetrical synovitis, pain, lymphadenopathy, lung fibrosis, pleural effusion, Raynauds, carpal tunnel, episcleritis, scleritis

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6
Q

What antibodies are positive in RA?

A

Rf +ve

Anti CCP +ve

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7
Q

What does an x-ray in RA show?

A

Soft tissue swelling, bony erosions, subluxation, destruction, peri-articular osteopenia

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8
Q

How is disease monitored in RA?

A

DAS28 score

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9
Q

When should DMARDs be initiated in RA?

A

Within 3 months of onset

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10
Q

What DMARDs are used in RA normally?

A

Methotrexate and sulphasalazine

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11
Q

What drugs are used for flare ups in RA?

A

Steroids

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12
Q

What drugs may be used for symptomatic relief in RA?

A

NSAIDs

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13
Q

What can be used if DMARDs do not work well?

A

Biologics (e.g. Anti-TNF)

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14
Q

What are the 4 seronegative arthropathies?

A

Ankylosing spondylitis
Psoriatic arthritis
Enteropathic arthritis
Reactive arthritis

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15
Q

What are the seronegative arthropathies characterised by?

A

Inflammation and/or arthritic disease of the spine

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16
Q

Who commonly gets ankylosing spondylitis?

A

Males aged 20-40

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17
Q

What are symptoms of ankylosing spondylitis?

A

Lower back pain, stiffness of insidious onset, worse in mornings, improves with exercise

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18
Q

What are signs of ankylosing spondylitis?

A

Loss of spinal movement - reduced lateral flexion and forward flexion, reduced chest expansion. Question mark spine - loss of lumbar lordosis and increased thoracic kyphosis

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19
Q

What are some associated features of ankylosing spondylitis?

A

Anterior uveitis, achilles tendonitis, pulmonary fibrosis, amyloidosis,

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20
Q

What will investigations show in Ank Spond?

A

Raised ESR and CRP

HLA B27 +ve

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21
Q

What does an x-ray in ank spond show?

A

Sacroilitis, squaring of lumbar vertebrae, bamboo spine

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22
Q

What is the management of ank spond?

A

Physiotherapy/exercise
NSAIDs
DMARDs - only useful in peripheral joint disease
Anti-TNFs reserved for if severe

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23
Q

How many people with psoriasis have psoriatic arthritis?

A

30%

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24
Q

How does psoriatic arthritis present?

A

Asymmetrical oligoarthritis. Rheumatoid like. Spondylitis. Dactilitis. Pitting and onycholysis of the nails

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25
What is the management of psoriatic arthritis?
Treated the same as RA - DMARDs, NSAIDs, steroids, anti-TNFs
26
What is enteropathic arthritis?
Inflammatory arthritis inolving peripheral joints and occasionally spine in patients with IBD
27
How does enteropathic arthritis present?
Asymmetrical large joint oligoarthritis
28
How is enteropathic arthritis managed?
Immunosuppressive drug that manages both IBD and arthritis
29
What is reactive arthritis?
An arthritis occurring in response to infection in another part of the body
30
What infections does reactive arthritis commonly occur in?
STIs (chlamydia, gonorrhoea) or GI infections (salmonella)
31
How does reactive arthritis present?
Develops within 4 weeks of getting infection. Lasts around 4-6 months. Large joint oligoarthritis. Also get balanitis, conjunctivitis, urethritis etc
32
What is the triad of Reiters syndrome?
Arthritis, Conjunctivitis, Urethritis
33
How is reactive arthritis managed?
``` Treat underlying infection Symptomatic relief (IA/IM steroids) Occasionally DMARDs in chronic cases ```
34
What are connective tissue diseases?
Multisystem disorders that cause organ pathology
35
What is systemic lupus erythematosus?
Chronic autoimmune condition which presents highly variably. More common in women
36
What is the pathogenesis of SLE?
Immune system dysregulation leading to immune complex formation and deposits
37
What are constitutional symptoms of SLE?
Fever, fatigue, weight loss
38
What are MSK symptoms of SLE?
Arthralgia, myalgia, inflammatory arthritis
39
What skin manifestations are seen in SLE?
Malar rash, photosensitivity, discoid lupus, oral/nasal ulceration, Raynauds
40
What are renal manifestations in SLE?
Lupus nephritis
41
What are respiratory manifestations of SLE?
Pleurisy, pleural effusion, pneumonitis, PE, pulmonary hypertension, ILD
42
What are cardiac manifestations of SLE?
Pericarditis, effusion, accelerated IHD
43
What are GI manifestations of SLE?
Autoimmune hepatitis, pancreatitis, mesenteric vasculitis
44
What investigations do you do for SLE?
FBC - anaemia, leucopenia, thrombocytopenia Immunology Urinalysis (for GN) Imaging for organ involvement
45
What antibodies are positive in SLE?
ANA Anti-DsDNA (key one) Anti-Sm, Anti Ro, Anti La, Anti-RNP, complement
46
How is SLE managed?
Hydroxychloroquine, NSAIDs, Azaithioprine, Mycophenolate | IV steroids and biologics if severe
47
How is SLE monitored?
Anti-DsDNA and complement Urinalysis Evaluation of cardiac risk
48
What is sjogrens syndrome?
Autoimmune disorder causing lymphocytic infiltration of exocrine glands, resulting in dry mucosal surfaces
49
What are features of sjogrens?
Keratoconjuncitivis sicca, dry mouth, vaginal dryness, arthralgia, raynauds, myalgia, sensory polyneuropathy
50
What investigations are done for sjogrens syndrome?
Immunology, schirmers test, tissue biopsy
51
What does immunology show in sjogrens?
Anti-Ro/Anti-La positive | RF +ve ANA +ve
52
How is sjogrens syndrome managed?
Symptomatic relief - lubricating eye drops, saliva replacement Hydroxychloroquine for arthralgia and fatigue
53
What is systemic sclerosis?
Condition characterised by hardened skin and collagen deposition in connective tissues
54
How does systemic sclerosis present?
Raynauds, skin sclerosis, sclerodactyly, finger tip atrophy, telangactasia, calcinosis, pulmonary fibrosis, hypertension, dysphagia, malabsorption, arthritis, myositis
55
What is limited systemic sclerosis?
Skin involvement of face and limbs and minimal organ involvement (CREST syndrome)
56
What is diffuse systemic sclerosis?
Skin changes on trunk and diffuse organ involvement
57
What antibodies are positive in systemic sclerosis?
Anti-centromere (limited) | Anti-scl-70 (diffuse)
58
How is systemic sclerosis treated?
Raynauds = calcium channel blockers Renal involvement = ACE inhibitors GI upset = PPIs ILD = cyclophosphamide
59
What is mixed connective tissue disease?
Condition featuring a mixture of different symptoms from other connective tissue diseases
60
What antibody is positive in mixed connective tissue disease?
Anti-RNP
61
What is antiphospholipid syndrome?
Autoimmune condition presenting as recurrent thrombosis and fetal loss
62
How does antiphospholipid syndrome present?
Recurrent thrombosis, fetal loss, migraine, livedo reticularis
63
What immunology is positive in antiphospholipid syndrome?
Positive Anti-cardiolipin antibodies
64
How is anti-phospholipid syndrome managed?
Anti-coagulation (only if have had thrombosis not just if positive antibodies)
65
What is gout?
Crystal arthropathy characterised by deposition of urate crystals within a joint
66
What causes gout?
Increased uric acid due to dietary purines (seafood, red meat), alcohol excess, diuretics, leukaemia, CKD
67
How does gout present?
Acute monoarthropathy, usually 1st MTP. Intensely red hot and swollen
68
What does light microscopy show in gout?
Negatively birefringent needle shaped crstals
69
What may be seen on x-ray in gout?
Joint effusion, punched out lesions, soft tissue tophi
70
How is gout treated acutely?
NSAIDs, corticosteroids, colchicine (if NSAIDs contraindicated)
71
How is gout treated prophylactically?
Allopurinol
72
How long after an acute gout attack should allopurinol be started?
2 weeks after
73
What is pseudogout?
Crystal arthropathy caused by deposition of calcium pyrophosphate
74
What are causes of pseudogout?
Old age, OA, diabetes, hypothyroidism, hyperparathyroidism, haemochromatosis, Wilsons disease
75
How does pseudogout present?
Monoarthropathy, red hot swollen joint, usually larger joints than gout e.g. knee
76
What does light microscopy show in pseudogout?
Positively birefringent rhomboid shaped crystals
77
How is pseudogout treated?
Analgesia, NSAIDs, steroids
78
What is polymyalgia rheumatica?
Common inflammatory condition of unknown aetiology of the elderly
79
How does PMR present?
Subacute onset of symmetrical proximal myalgia of the hip and shoulder girdles and accompanying morning stiffness
80
What do investigations show in PMR?
Raised inflammatory markers (CRP, PV, ESR) | Normal CK
81
How is PMR managed?
Low dose steroids should show a dramatic response
82
What is PMR associated with?
Giant cell arteritis
83
How does GCA present?
Visual disturbance, headache, scalp tenderness, jaw claudication
84
What is polymyositis?
Inflammatory muscle condition causing symmetrical proximal muscle weakness
85
What is the pathogenesis of polymyositis?
T cell mediated process against muscle antigens
86
How does polymyosisits present?
Symmetrical proximal weakness, insidious onset, often noticed when doing particular activities e.g. walking up and down stairs
87
What do investigations show in polymyosisits?
Raised inflammatory markers (ESR, CRP, PV) Raised CK EMG abnormal Muscle biopsy shows irregular findings
88
What antibodies are seen in polymyositis?
Anti-Jo-1
89
How is polymyositis managed?
Steroids and immunusuppressants
90
What should all patients with polymyositis be investigated for?
Underlying malignancy (25%)
91
What are the cutaneous manifestations in dermatomyositis?
V shaped chest rash Heliotrope rash Gottrons papules
92
What are side effects of methotrexate?
Interstitial pneumonitis Myelosuppression Liver cirrhosis
93
What are side effects of sulphasalazine?
Rashes Oligospermia Interstitial lung disease
94
What are side effects of hydroxychloroquine?
Retinopathy | Corneal deposits
95
What is side effect of Gold?
Proteinuria
96
What are the side effects of penicillamine?
Proteinuria | Exacerbation of myaesthenia gravis
97
What are side effects of biologics (e.g. infliximab, rituximad, etanacept)?
Reactivation of TB
98
What does methotrexate + trimethoprim cause?
Marrow aplasia
99
What does azaithioprine + allopurinol cause?
Bone marrow suppression
100
What is Feltys syndrome?
RA Neutropenia Splenomegaly
101
Which rheumatoid drug should patients with an allergy to aspirin not take?
Sulphasalazine
102
What Schobers test result is indicative of Ankylosing spondylitis?
<5cm
103
What condition is cANCA +ve?
Wegners granulomatosis
104
What condition is pANCA +ve?
Churgg-Strauss
105
What is found in Takyasu's vasculitis?
Upper limb claudication, absent upper limb pulses, ESR raised
106
What is found in Buergers disease?
Occlusions of lower limbs, absent distal pulses, tortuous corkscrew shaped collateral vessels on angiography
107
'pencil in cup appearance'
Psoriatic arthritis
108
What antibodies are associated with drug induced lupus?
Antihistone
109
What type of hypersensivity reaction is lupus?
Type 3
110
What are the classic features of Bechets disease?
Oral ulcers, genital ulcers, anterior uveitis, arthritis,

Finals Revision (22 decks)

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