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Clinical Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Patients with autoimmune CTDs are at an increased risk of what malignancy?

A

Lymphoma - increased B cell activity

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2
Q

Management of SLE

A

Mild - NSAIDs and hydroxychloroquine

Moderate - Corticosteroids, Azathioprine, Methotrexate

Severe - Cytotoxic drugs e.g. cyclophosphamide

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3
Q

Autoantibodies in SLE

A

Anti-dsDNA

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4
Q

Presentation of SLE

A

Women
15-40yrs
Asian & Afro Caribbean
90% arthritis
60% photosensitivity & butterfly rash
CV, Lung, renal, neuro, haem & GI manifestations

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5
Q

Presentation of Sjogren’s

A

Women
20% are RA patients
Dry eyes, mouth, genitalia

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6
Q

Autoantibodies in Sjogren’s

A

Anti RO
Anti La
Rheumatoid Factor
ANA

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7
Q

Management of Sjogren’s

A

Artificial tears and saliva
Dental hygiene support

Hydroxychloroquine & corticosteroids if systemic effects

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8
Q

Presentation of limited scleroderma

A

Skin fibrosis on hands, feet and face

CREST Syndrome 
Calcinosis - white deposits 
Raynaud's 
Esophageal dysmotility 
Sclerodactyly
Telangiectasia

PLUS Pulmonary HTN and arthralgia

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9
Q

Presentation of diffuse scleroderma

A

Skin fibrosis of hands, feet, face and trunk

PLUS Raynaud’s, cardiac abnormality, pulmonary fibrosis, myenteric plexus ischaemia, rapidly progressive renal failure

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10
Q

Management of Scleroderma

A

Monitoring: Lung function tests & echocardiogram

Management of symptoms and systemic illness

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11
Q

Autoantibodies in limited scleroderma

A

Anticentromere

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12
Q

Autoantibodies in diffuse scleroderma

A

Anti Topoisomerase-1 (Scl-70)

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13
Q

Presentation of myositis

A

Symmetrical, proximal muscle weakness
+/- dermatological changes

Raised CK
Myopathic EMG

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14
Q

Autoantibodies in Myositis

A

Anti-Jo-1

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15
Q

Management of Myositis

A

Steroids & Steroid-sparing drugs
IVIg
Rituximab

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16
Q

Features of Marfan’s

A 
Tall
High arched palate
Arachnodactyly
Pectus excavatum
Pes planus
Scoliosis 
Dilatation of aortic sinuses
Repeated pneumothoraces 
Upward lens dislocation, blue sclera and myopia 
Dural ectasia (ballooning of dural sac at lumbosacral level)
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17
Q

Features of Ehler-Danlos Syndrome

A

Elastic, fragile skin
Join hypermobility
Easy bruising

Aortic Regurg
Mitral valve prolapse
Aortic Dissection

SAH

Angioid retinal streaks

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18
Q

Features of Osteogenesis Imperfecta

A 
Childhood
Fractures following minor trauma 
Blue sclera
Otosclerosis
Dental imperfections
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19
Q

Drugs associated with drug-induced lupus

A

Procainamide

Hydralazine

20
Q

Autoantibodies seen in drug-induced lupus

A

Anti-histone (80-90%)

21
Q

Management of Fibromyalgia

A

Education & reassurance
Physiotherapy
CBT
Amitryptiline can improve sleep, fatigue and pain

22
Q

Features of fibromyalgia

A

Females 30-50yrs
Diffuse, chronic pain and fatigue

O/E: Soft tissue tenderness at multiple sites

23
Q

Monitoring in Methotrexate

A

FBC, LFT and U&Es before starting
Every 2 weeks until therapy stabilised
Then every 2-3 months

24
Q

Marker for PMR

A

HLA-DR4

25
Q

Features of PMR

A

Morning stiffness in proximal muscles esp shoulders and hip girdle
> 60 yrs
Females > Males
+/- Systemic symptoms inc B symptoms

O/E: Reduced range of movement in affected joints, puffy oedematous hand syndrome, normal neurology

ESR > 40
CK and EMGG normal

26
Q

Joints affected in RA

A

MCP, PIP, wrist, MTP

27
Q

Hand X-ray in late RA

A 
Soft tissue swelling 
Juxta Articular osteopenia 
Reduced joint space 
Bony erosion 
Subluxation 
Complete carpal destruction
28
Q

Tuck sign

A

Tenosynovitis, fold of skin seen on dorsal aspect of wrist on wrist extension.
At rest there is a well-defined swelling on dorsum of wrist

29
Q

Common Extraarticular manifestations of RA

A

Lung - fibrosing alveolitis
Cardiac - IHD
Eye - Keratoconjunctivitis Sicca (comorbid Sjogren’s)
Osteoporosis

30
Q

Autoantibodies in RA

A

RF positive in 70%

Anticyclic citrullinated peptide antibodies (98% specific, 70-80% sensitive)

31
Q

Management of RA

A

Physio and OT. Smoking cessation.

DMARDs - Methotrexate, Sulfasalazine or Hydroxychloroquine

NSAIDs & Steroids for acute exacerbations

Surgery

32
Q

Important ADR of Hydroxychloroquine

A

Retinopathy

33
Q

Marker of Spondyloarthropathy

A

HLA-B27

34
Q

Features of Ankylosing Spondylitis

A

LBP
Early morning stiffness
Pain in sacroiliac joints
Question mark posture: Loss of lumbar lordosis & hyperkyphosis of T and C spine

+ Anorexia, fever, weight loss, fatigue

35
Q

Extra articular features of Ank Spond

A

Acute Anterior Uveitis - red, painful eye
Aortic incompetence + AV block
Apical lung fibrosis
Amyloidosis

36
Q

Spinal X-ray in Ank Spond

A

Sclerosis and erosions
Lumbar spine: squaring of vertebrae, formation of syndesmophytes (ossification of longitudinal ligaments, bamboo appearance)

37
Q

Management of Ank Spond

A

Physio

NSAIDs

DMARDs - Methotrexate or sulfasalazine
Anti TNF - Infliximab

Surgery

38
Q

Features of Reactive Arthritis

A

Hx of GI or GU infection
Symptoms last 4-6 months

Arthritis - weight bearing joints, entheses & dactylitis (sausage digit)

Urethritis - urinary symptoms

Conjunctivitis/Uveitis

+/- Skin lesions (Circinate balanitis, keratoderma blenorrhagica

39
Q

X-ray changes in reactive arthritis

A

Initially normal
Fluffy periostitis in calcaneus, digits or pelvis

Plantar spurs

40
Q

Management of Reactive Arthritis

A

NSAIDs

Local steroid injections for enthesitis or synovitis

Sulfasalazine, azathioprine or methotrexate for persistent severe disease

41
Q

MSK features of Enteropathic Arthritis

A

Peripheral arthritis - worse with flare ups of IBD
Spondylitis and sacroiliitis - unrelated to disease activity
+/- Enthesopathy

42
Q

Features of psoriatic arthritis

A 
5 common patterns of joint disease:
DIP joints - pitting and onycholysis of nail
Asymmetrical oligoarthritis 
Symmetrical polyarthritis (indistinguishable from RA)
Spondylitis - milder than classic AS 
Arthritis mutilans - severe inflammation causing deformation. ‘Telescoping’ - reabsorption of bone at metacarpals and phalanges. Pencil-in-cup deformity on X-ray
43
Q

Management of psoriatic arthritis

A

NSAIDs
DMARDs
AntiTNF

44
Q

Features of temporal arteritis

A 
> 60 yrs 
Headache
Jaw claudication
Visual blurring 
Assoc with PMR
Raised ESR
Normal CK and EMG
45
Q

Management of Temporal Arteritis

A

Urgent ophthalmology review

USS & temporal biopsy

High-dose prednisolone

Clinical Medicine (9 decks)

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