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Flashcards in Rheumatology Deck (74):
0

Antibodies most commonly seen in SLE

Anti-dsDNA

1

Features of Reiter's syndrome

Triad of:
Urethritis
Conjunctivitis
Arthralgia

2

Features of ankylosing spondylitis

Young male
Buttock / sacroiliac pain
Worse in the morning
Relieved by exercise

3

X-ray Features of ankylosing spondylitis

Syndesmophytes
Bamboo spine

4

Associated conditions of ankylosing spondylitis

Arthritis
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation

5

What is meant by 'seronegative arthritis'

Arthritis not associated with rheumatoid factor production.
E.g. Reiter's syndrome, ankylosing spondylitis, psoriatic arthritis, enteropathic arthropathy

6

Features of Raynaud's phenomenon

Usually F
cold, cyanosed fingers
Normal --> white --> blue --> pink

7

Features of systemic sclerosis

Calcinosis
Raynaud's is common
Oesophageal dysmotillity
Sclerodactly
Telengiectasia

8

Features of Bechets disease

More common in Turkish/Iranian patients
Oro-genital ulceration
Uveitis
Arthritis
Pathergy reaction = pathognomonic

9

Features of polymyositis

Proximal muscle weakness
Pain and tenderness
Raised CK

10

Features of dematomyositis

Proximal muscle weakness
Pain and tenderness
Raised CK
Heliotrope (purple) rash

11

Features of Sjögren's syndrome

Dry eyes
Dry mouth
Positive schirmers test

Corneal ulcers
Oral candida
Vaginal dryness
Dyspareunia
Respiratory hoarseness

12

What is anti-double stranded DNA antibody most commonly s associated with?

SLE

13

What are anti-Jo antibodies most commonly associated with?

Polymyositis

14

What are anti-centromere antibodies most commonly associated with?

Limited systemic sclerosis

15

What are anti-topoisomerase antibodies most commonly associated with?

Diffuse systemic scerosis

16

What are cANCA and anti-PR3 antibodies most commonly associated with?

Wergener's granulomatosis

17

What is alpha-endomysial antibody most commonly associated with?

Coeliac

18

What are anti-cyclic citrunillated peptide antibodies most commonly associated with?

Rheumatoid arthritis

19

What is feltys syndrome

Splenomegally
Neutropenia
In a pt with RA

20

Clinical features of pseudogout

acute monoarticular or oligoarticular arthritis.
Commonly knees - or wrists, shoulders, ankles, hands and feet.
Acute joint pain and swelling.
Effusion, warmth, tenderness and pain on movement.

21

Positively birefringent crystals occur when....

Pseudogout
(Rhomboid shaped crystals)

22

Negatively birefringent crystals occur in....

Gout
(Needle shaped crystals)

23

Features of psoriatic arthritis

DIPJ involvement
Dactylitis

(Arthritis mutilans = severe form)

24

Features of a septic arthritis

Hot
swollen
tender joint
Unwell patient
restricted range of movement

25

Most common cause of a septic arthritis

Staph aureus

26

Risk factors for septic arthritis

Old
very young
IVDU
diabetes
Pre-existing joint condition

27

Management of septic arthritis

Surgical washout
IV flucloxacillin and benzylpenicillin
Few weeks oral antibiotics

28

Complications of septic arthritis

Joint destruction
osteomyelitis
bony fusion across to joint (ankylosis)

29

Features of Reiter's syndrome

Arthritis
urethritis
iritis

30

What causes osteoarthritis

Wear and tear of articular surfaces of the joint

31

Risk factors osteoarthritis

Female
obesity
Hyper mobility
trauma
Repetitive use

32

Clinical presentation of osteoarthritis

Joint pain worse with movement
relieved by rest
stiffness
joint instability
deformity

33

Examination findings in osteoarthritis

Bony swellings
Joint effusion
crepitus

34

Where do heberdens nodes occur

DIPJ

35

Where do Bouchards nodes occur

PIPJ

36

Management of osteoarthritis

Weight loss
physiotherapy
NSAID
intra-articular steroid injection
arthrodesis
joint replacement

37

What is tennis elbow

Inflammation of the insertion of the tendon into the lateral epicondyle of the elbow
Usually due to repetitive strain
Exacerbated by wrist extension

38

What is golfers elbow

Inflammation of the insertion of the tendon into the medial epicondyle of the elbow
Usually due to repetitive strain
Exacerbated by wrist flexion

39

Typical patient with gout

Male
Older
Obese
Drinks alcohol
Hypertension
Ischaemic heart disease
Diabetes

40

Presentation of acute gout

Sudden pain, swelling and redness of joint (commonly 1st metatarso-phalangeal)

41

Management of acute gout

NSAIDS - indometacin or diclofenac

42

Prophylaxis for gout

Allopurinol (xanthine oxidase inhibitor)
Do not prescribe during or within 1 month of an acute attack.
It can precipitate and acute attack initially

43

What is chronic tophaceous gout

Where the urate crystals accumulate in cartilage - often in the ear and Achilles' tendon

44

What is gout nephropathy

Urate deposition in the kidney causing acute renal failure and urate stones

45

Symptoms of ankylosing spondylitis

Insidious onset low back pain
Stiffness worse in morning - better with exercise
Poor spinal flexion
Question mark posture

+ extra articular features = apical lung fibrosis, anterior uveitis, Achilles tendinitis, plantar fasciitis, aortic regurgitation, amyloidosis

46

Management of ankylosing spondylitis

Physiotherapy
Exercise
Slow release NSAIDs

47

Presentation of enteropathic arthritis

Asymmetrical oligoarthrits
Mostly affects large joints of lower limb
Occurs with IBD

Management = treat IBD

48

Classical presentation of RA

Symmetrical arthritis of small joints of the hand
Worse in the morning
Boggy swelling

49

Common deformities in RA

Swan neck
Boutonnières deformity
Z thumb
Atlanto-axial subluxation
Spindling of fingers
Ulnar deviation

50

Features of juvenile idiopathic arthritis

Joint inflammation >6 weeks
Onset <16yo

51

Types of juvenile idiopathic arthritis

Mono articular = single joint
Pauciartiular = 4 or less joints
Polyarticular = > 4 joints

52

Complications of juvenile idiopathic arthritis

Chronic anterior uveitis
Flexion contraction of joints
Amyloidosis

53

Management of juvenile idiopathic arthritis

Physiotherapy
NSAIDs
Intra-articular steroids
DMARDs

54

What is stills disease

A systemic form of juvenile idiopathic arthritis - autoimmune.

Intermittent high pyrexia
Salmon pink rash
Arthralgia
Myalgia
Hepatosplenomegally
Lymphadenopathy
Pericarditis

55

Diagnosis of Polymyositis

Serum raised creatinine kinase
Muscle biopsy demonstrates information and necrosis

56

What is polymyositis

Rare
inflammatory disorder of skeletal muscle
Associated with underlying malignancy

57

What is the name given to features of dermatomyositis without muscle weakness

Amyopathic Dermatomyositis

58

Symptoms of antiphospholipid syndrome

Recurrent arterial venous thrombosis
PE
DVT
stroke
Recurrent miscarriage
thrombocytopenia

59

Antibodies in antiphospholipid syndrome

Anti-cardiolipin antibodies

60

Management of antiphospholipid syndrome

Avoid smoking / COCP
Treat hypertension
treat hyperlipidaemia
treat diabetes

After thrombosis a lifelong warfarin - INR 2.5
Substitute s/c heparin if planning pregnancy

61

Features of limited cutaneous scleroderma

Scleroderma limited to distal limbs
Beaked nose
small furrowed mouth (Microstomia)
CREST Syndrome

62

Features of diffuse cutaneous scleroderma

Involved skin of whole-body
Involvement of internal organs (Renal impairment, lung fibrosis)
Worse prognosis

63

Antibodies associated with Sjögren's syndrome

Anti-Ro
anti-La

64

Treatment of Sjögren's syndrome

Artificial tears
artificial saliva

65

Diagnosis of SLE

Four or more of:
Arthralgia
renal disease - Nephrotic syndrome
antinuclear Ab
Serostitis - Pleurisy, pleural effusion, pericarditis
Haematological disorder - Pancytopenia
photosensitivity
Oral ulcer
immunology - Anti-dsDNA, Anti-Smith
Neurological problems- depression, psychosis
Malar rash
Discoid rash

66

Management of SLE

Analgesia, steroids, immuno-suppression

67

What are overlap syndromes

Cases in which patient have more than one connective-tissue disease simultaneously

68

What drugs can induce lupus

Isoniazid
penicillamine

69

What is the 1st line DMARD in the UK

Sulfasalazine

70

Why should patients with rheumatoid arthritis with rheumatoid nodules NOT receive methotrexate

Causes accelerated nodule growth

71

Management of anti phospholipid syndrome

Not suffered thrombosis yet - daily low dose aspirin
Previous thromboses - warfarin
Previous thromboses + pregnancy - enoxaparin

72

Diagnostic test for dematomyositis

Muscle biopsy
Demonstrates inflammation and necrosis

73

Osteoporosis prophylaxis for patients on steroids

Lifestyle - Stop smoking, limit alcohol and exercise
Calcium and vitamin D supplements
Oral bisphosphonates