Rheumatology

Question 1

What are some causes of symmetrical polyarthritis?

Answer 1

Rheumatoid

Osteoarthritis

Question 2

What are some causes of asymmetrical polyarthritis?

Answer 2

Reactive

Psoriatic

Question 3

What are the x-ray findings of osteoarthritis?

Answer 3

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 4

What are some risk factors for osteoarthritis?

Answer 4

Age
High BMI
Female
FH 
Overuse 
Previous surgery

Question 5

What should be done for suspected septic arthritis?

Answer 5

Joint aspiration, blood cultures

Ortho referral, IV antibiotics, joint washout

Question 6

What are the categories for diagnostic criteria in RA?

Answer 6

Number of joints involved 
Serology 
Acute phase reactants
Duration of 6 weeks 
Over 6 = diagnostic

Question 7

What are the serology diagnostic criteria in RA?

Answer 7

RF and anti-CCP
Negative = 0
Low positive = 2
High positive = 3

Question 8

What are the acute phase reactants diagnostic criteria in RA?

Answer 8

CRP and ESR
Normal = 0
High = 1

Question 9

What are the joint involvement diagnostic criteria in RA?

Answer 9

1 large = 0 
2-10 large = 1
1-3 small = 2
4-10 small = 3
Over 10 = 5

Question 10

What is the initial management of RA?

Answer 10

1. Urgent referral to rheumatology
2. High dose NSAID + PPI
3. Do DAS28 to measure severity
4. 2 x DMARD
5. Physio and OT
6. Control CVS risk factors

Question 11

What are some extra-articular features of RA?

Answer 11

Felty's syndrome 
Atlanto-axial subluxation
Caplan's syndrome (pulmonary nodules)
Effusions 
Blood - normocytic anaemia 
Olecranon bursitis 
Oral dryness 
Kidneys - amyloid 
Sensory neuropathy

Question 12

What are some risk factors for gout?

Answer 12

Male, alcohol, high purine intake, metabolic syndrome, diuretics, CKD

Question 13

What investigations should be done for suspected gout?

Answer 13

FBC, CRP, ESR
Joint aspiration and synovial fluid analysis
UEs, LFTs

Question 14

When should gout prophylaxis be considered?

Answer 14

Over 2 attacks in a year
Tophi
CKD II
Urolithiasis

Question 15

What are some features of gout prophylaxis?

Answer 15

Introduce 2-4 weeks after acute attack
Cover with NSAIDs for 6 months
Aim urate <300 micromoles/L
Alternative = febuxostat

Question 16

What is pseudo gout?

Answer 16

Calcium pyrophosphate deposition
Acute monoarthropathy - usually large joints
Rhomboid crystals on light microscopy

Question 17

What are some features of ankylosing spondylitis?

Answer 17

Disease of spine and SI joints
Typically men under 30
Gradual onset low back pain and stiffness
Neck hyperextension and kyphosis

Question 18

What are the x-ray findings in ankylosing spondylitis?

Answer 18

SI narrowing
Sclerosis
Erosions
Fusion

Question 19

What is Reiter’s?

Answer 19

Urethritis
Arthritis
Conjunctivitis

Question 20

What is the triad of systemic sclerosis?

Answer 20

1. Scleroderma - skin fibrosis
2. Internal organ fibrosis
3. Microvascular abnormalities

Question 21

What antibodies should be done for systemic sclerosis?

Answer 21

ANA, anti-Scl 70 (diffuse)

Anti-centromere (limited)

Question 22

What are limited and diffuse systemic sclerosis?

Answer 22

Limited - face, hands and feet, pulmonary hypertension

Diffuse - can involve whole body, control BP, annual echo and spirometry

Question 23

What is myositis?

Answer 23

Inflammation of muscles
Insidious onset
Progressive symmetrical proximal muscle weakness
Can be secondary to malignancy

Question 24

What antibodies are associated with myositis?

Answer 24

JO1, anti Mi2

CK

Question 25

What is Sjogren's syndrome?

Answer 25

Often secondary to CTD Dry eyes and dry mouth Ro and La antibodies

Question 26

What is SLE?

Answer 26

Multisystemic autoimmune disease Formation of immune complexes Inadequate clearance, immune response, tissue inflammation & damage

Question 27

What are the 11 diagnostic criteria for SLE? (need over 4)

Answer 27

1. Malar rash 2. Discoid rash 3. Photosensitivity 4. Oral ulcers 5. Arthritis 6. Serositis - pleuritis or pericarditis 7. Renal disorder 8. Neurological disorder 9. Haematological disorder 10. Immunologic disorder 11. ANA

Question 28

What antibodies are associated with SLE?

Answer 28

Anti-DNA Anti-Smith Antiphospholipid ANA

Question 29

What is the treatment for SLE?

Answer 29

``` Avoid sunlight Hydroxychloroquine NSAIDs Lupus nephritis - azathioprine + steroid Pregnancy planning ```

Question 30

What is the anatomy of the boutonniere deformity?

Answer 30

Rupture of central slip of extensor expansion Button hole formed by intact lateral slips Rheumatoid tenosynovitis

Question 31

What is rheumatoid factor?

Answer 31

IgM against your own IgG

Question 32

What signifies active disease in RA?

Answer 32

Active synovitis | Red and swollen joints

Question 33

What are some side effects of methotrexate?

Answer 33

Bone marrow suppression - neutropenia Liver and renal toxicity Pneumonitis/pulmonary fibrosis FBC, LFTs, UEs every 4-6 weeks

Question 34

What is the cause of atlanto-axial subluxation?

Answer 34

Weakened cervical spine tendons Odontoid peg of axis subluxes backwards Can compress upper cervical cord

Question 35

What are the x-ray findings in RA?

Answer 35

``` Soft tissue swelling Peri-articular osteoporosis Absent osteophytes Deformity Erosions Subluxation ```

Question 36

What is CREST syndrome?

Answer 36

Calcinosis, Raynaud's, (o)esophageal involvement, sclerodactyly, telangiectasia

Question 37

What are the blood findings in osteomalacia?

Answer 37

Raised ALP, raised PTH, low vitamin D, low calcium, low phosphate