Rheumatology Flashcards by David Ferreira

Classification Criteria for SLE

Needs 4 and at least one from either group

Clinical Criteria

acute or subacute cutaneous lupus
chronic cutaneous lupus
oral or nasal ulcers
non scarring alopecia
synovitis of two or more joints
serositis
renal involvement
neurological involvement
haemolytic anaemia
leukopenia <4
thrombocytopenia <100

Immunological Criteria

ANA
anti ds-DNA
Anti- Smith
low complement
direct Coombs positive
anti phospholipid antibodies

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Mechanism of ustekinumab

IL 12/23 inhibitor

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Abatacept Mechanism

CD80/86 inhibitor preventing T cell activation

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Tofacitinib mechanism

JAk STAT inhibitor

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What HLA is associated with the development of anti-HMG antibodies?

HLA DRB1 11:01

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What is the main cell found in the synovial fluid of a patient with RA?

Neutrophil

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What proportion of patients with RA are seronegative?

One third

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What are the radio graphic features of RA of the hands?

Juxtaarticular osteoporosis
Joint space narrowing
Marginal erosions
DIP sparring

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Radiographic hand X-ray findings of Gout.

joint effusion
joint space preservation
punched out erosions
tophi
DIP joint involvement

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Hand X-ray findings in SLE?

Normal
Preserved joint spaces
Can have passively correctable deformity (secondary to tendon damage)

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Hand xray changes in psoriatic arthritis?

DIP joints involved 
Pencil in cup deformity 
Dactylitis 
Periostitis 
Arthritis mutilans

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Hand X-ray changes in scleroderma.

Acro-osteolysis 
Subcutaneous calcification 
Joint space narrowing 
Juxtaarticular osteoporosis 
Erosions 
First CMC joint subluxation

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What is the main contraindication to abatacept?

Bowel perforation

Diverticulitis

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What are the criteria for inflammatory back pain?

4/5 of the following

age <40
insidious onset
improvement with exercise
no improvement with rest
pain at night with improvement on movement

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What is the differential diagnosis of dactylitis.

Reiters Syndrome 
Sarcoidosis 
Psoriatic arthritis 
Flexor tendon sheath infections 
Gout

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What are the features of sacroilitis?

Early

sclerosis
joint space narrowing
small erosions

Late

severe sclerosis
joint space widening
large erosions
fusion (very late)

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Clinical criteria for Ankylosing spondylitis?

Clinical Criteria (need 1)
- lower back pain and stiffness for >3 months which improves with exercise
- limitation of lumbar spine motion
- limitation of chest expansion
Radiologic Criteria (need 1)
- sacroiliitis of grade 2 bilaterally
- or 3 unilaterally

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Radiographic findings of ankylosing spondyliitis of the spine?

Shiny corners (Romanus Lesion)
Syndesmophyte formation
Bamboo spine (fusion of bodies by syndesmophytes)
Dagger spine (calcification of interspinous ligaments)

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What are the different types of spondyloarthritis?

Ankylosing spondylitis
Psoriatic Arthritis
Reactive Arthritis
Enteropathic Arthritis

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What are the five clinical patterns of psoriatic arthritis?

Distal Arthritis 
Asymmetric Oligoarthritis 
Symmetric Polyarthritis 
Arthritis mutilans 
Spondyloarthritis

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What proportion of patients with psoriatic arthritis have a history of psoriasis?

70-85%

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Treatment of psoriatic arthritis?

Study These Flashcards

NSAIDs
Dmards (methotrexate, sulphasalazine, hydroxychloroquine)
Biological agents
Small molecules (apremilast)

Mechanism of sekukinumab?

Study These Flashcards

IL 17 inhibitor

What is the expected clinical course for reactive arthritis?

Study These Flashcards

70% resolve in 6 months
Chronic course in 25%
Destructive arthritis 5%

What medication can precipitate scleroderma real crisis?

Prednisone | Cyclosporine

What is the treatment of secondary raynauds?

1. Cold avoidance 2. Amlodipine/Nifedipine 3. Topical GTN Or PDE 5 inhibitors or IV prostanoids

Mechanism of belimumab?

B lymphocyte stimulator protein inhibitor.

What are the histological features of Polymyositis and Inclusion body myositis?

Scattered necrotic muscle fibres with CD8 infiltration

What are the histological features of dermatomyositis?

Perifascicular atrophy and fibrosis with CD4 infiltration

What is the median survival of limited sclerosis with pulmonary hypertension?

11 months

What is the strongest genetic factor for Behçet's disease?

HLA B 51

What is the most common ILD pattern in scleroderma?

NSIP

What is the treatment of scleroderma associated lung disease

1. MMF preferred 2. Cyclo and azathioprine can also be used 3. Rituximab And experimental agents (if refractory) 4. Lung transplantation

What are the predictors of mortality for pulmonary hypertension related to scleroderma?

``` Right heart failure Low DLCO Male Age >60 Poor exercise capacity Anti U1RNP negative Pericardial effusion ```

What is the treatment of WHO class 2-3 SSc PAH?

1. Combination oral therapy (ambrisentan and tadaladil) 2. Atrial Septostomy (bridge to lung tx) No role for Calcium channel blocker.

What is the management of WHO class 4 SSc PAH?

1. Combination IV prostanoid and oral therapy 2. Atrial Septostomy (bridge to lung tx) 3. Lung transplantation No role for Calcium channel blocker.

What is the treatment of SSc associated raynauds ulcers?

Iloprost infusion | Cessation of agents which worsen disease (beta blockers)

How do you treat scleroderma associated skin disease?

1. MMF | 2. Methotrexate second line

What is topoisomerase 1?

Scl-70

How does duration of raynauds inform on the likely subtype of scleroderma?

Long standing - likely limited Scleroderma Short history - likely diffuse scleroderma

Diagnostic criteria for sjogrens.

1. Ocular dryness - schooner and Saxon test | 2. Blood/histo evidence of autoimmunity - anti Ro or anti La or anti centromere or salivary biopsy

What is the most specific US imaging finding of Gout?

Double contour sign

Mechanism of raburicase?

recombinant urate-oxidase enzyme, which converts uric acid to allantoin

What is the serum urate aim for 1) non tophaceous gout and 2) tophaceous gout?

1) <0.36 | 2) <0.3

What is the treatment of psoriatic arthritis?

1. NSAIDs 2. DMARDS (methotrexate, leflunomide) 3. TNF alphas 4. Anti interleukins

What clinical presentation of RA is associated with a good prognosis?

Acute onset arthritis in a few large joints

What are the negative prognostic factors in RA?

``` Age <20 or >60 High titre RF Anti CCP positive Early erosive joint disease High inflammatory markers ```

What is the most common extraarticular manifestation of Ank Spon.

Uveitis

What is the most common first site of disease in knee OA?

Patellofemoral joint

What are the features of rheumatoid arthritis related arthropathy?

MCP joint involvement Hook like osteophytes Squared off bone ends Joint space loss

What are the extra-articular features of AS?

``` Anterior Uveitis Av Node Block Aortic Regurg Apical Fibrosis Amyloidosis Achilles tendinitis ```

What is the HLA associated with RA?

HLA DR4

Ehlers Danlos is most commonly associated with a defect in which type of collagen?

Type 3

What are anti srp antibodies associated with?

Polymyositis

Rheumatology Flashcards

(54 cards)