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MSK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Arthralgia

A

Pain in a joint

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2
Q

Arthritis

A

Inflammation in a joint

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3
Q

Arthropathy

A

disease in a joint

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4
Q

Non-inflammatory arthritis

A

Osteoarthritis

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5
Q

Seronegative arthritis

A

Ankylosing spondylitis
Enteric Arthritis
Reactive arthritis
Psoriatic Arthritis

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6
Q

Seropositive Arthritis

A 
RA
SLE
sjogren's 
systemic sclerosis 
vasculitis
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7
Q

What do the seronegative arthritis conditions have in common?

A

Strong predisposition with HLA -B27 gene

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8
Q

What do the seropositive conditions all have in common?

A

auto-antibody production

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9
Q

Potential triggers for RA

A

Smoking
stress
infection

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10
Q

Genetics and RA

A

HLA DR4 genetic predisposition. also associated with increased severity.

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11
Q

Pathophysiology of RA

A

Inflamed synovium and tenosynovium. Formation of locally invasive synovial fluid is characteristic and causes RA erosions. Osteoclasts stimulated.

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12
Q

Link between RA and Osteoarthritis

A

RA can cause cartilage cells to be destroyed and not rebuilt so can stimulate osteoarthritis.

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13
Q

Presentation of RA

A

Symmetrical, swollen, painful, stiff SMALL joints for >6 weeks. Morning stiffness >1 hour that gets better as the day goes on.

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14
Q

3 joints most commonly affected by RA

A

1) metacarpophalangeal
2) proximal interphalangeal
3) metatarsophalangeal

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15
Q

less common joints in RA

A

C1 and c2 of spine (only ones from spine that can be affected)
wrists, elbows, ankles

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16
Q

Most specific test for RA

A

anti-ccp antibody

17
Q

Tests done in RA

A 
Anti-CCP
RF
Anaemia of chronic disease
X-ray: erosions (cannot detect early disease)
Ultrasound and MRI more sensitive
18
Q

1st line management of RA

A

Methotrexate +NSAIDS

methotrexate takes a while to work so may need steroid to bridge gap

19
Q

Use of steroids in RA

A

Flare-ups and bridge gap between starting DMARD and DMARD being effective

20
Q

Treatment pathway in RA

A

1) Methotrexate
2) Methotrexate +Sulfasalazine
3) Methotrexate +Sulfasalazine +hydroxychloroquine
4) Biological agents

21
Q

When can Biological agents be used?

A

If DAS 28 > 5.1 despite 2 DMARDs and methotrexate must be 1 of the 2 in combination e.g.
methotrexate and sulfasalazine used in combo and DAS 28>5.1 then qualify for biologics

22
Q

Categories of DAS 28

A

<2.6: remission
2.6-3.2 low disease activity
3.3-5.1: moderate disease activity
>5.1: high disease activity… BIOLOGICS

23
Q

Causes/Risk factors of osteoarthritis

A 
Risk factors:
Inc age
Obesity
Triggers:
previous trauma
RA
crystal deposition
24
Q

Pathophysiology of Osteoarthritis

A

loss of cartilage due to homeostatic imbalance between cartilage synthesis and degradation.
wear and tear.

25
Q

Presentation of Osteoarthritis

A

mechanical pain, especially of weight bearing joints/joints used excessively (thumb, cervical/lumbar spine, knee and hip). Morning stiffness <30 mins.

26
Q

Signs of Osteoarthritis

A 
crepitus 
joint swelling 
bony enlargement 
squaring of the hands
Heberdens nodes 
Bouchards nodes
27
Q

Difference between heberdens nodes and Bouchards nodes

A 
Heberdens nodes (DIP) 
Bouchards nodes (PIP)
28
Q

Diagnosis of Osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

29
Q

Management of Osteoarthritis

A 
Surgery is the only definitive management (joint replacement)
Exercise
analgesia: paracetamol + topical NSAID
topical capsican 
Amitriptyline: nerve pain
Gabapentin: muscle relaxant
30
Q

what do you need to be before starting biologics?

A

TB, HIV, Hep C and Hep B
risk of reactivation of TB

IGRA blood test checks for latent or active TB.

31
Q

Features of RA on X-ray

A

erosions, osteopaenia
Does not show early disease.
joint space narrowing

32
Q

Features of RA on ultrasound

A

shows its the synovium inflamed not the bone. The synovium is hypervascularized etc.

33
Q

If a patient is pregnant and on methotrexate what happens?

A

methotrexate goes to sulfasalazine. cannot conceive within 3 months of stopping methotrexate. Cannot breastfeed while on methotrexate.

34
Q

What is methotrexate co-prescribed with and why?

A

Folic acid, because methotrexate is a folic antagonist. Low folic causes nausea, mouth ulcers and hair to fall out.

MSK (6 decks)

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