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Year 2 MSK > Rheumatology > Flashcards

Rheumatology Flashcards

(86 cards)

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1
Q

Anti CCP

A

Linked to rheumatoid arthritis

Very specific but 70% sensitive so -ve find doesn’t exclude.

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2
Q

Anti-nuclear antibody (ANA)

A

SLE, Sjogrens Systemic sclerosis

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3
Q

What titre of ANA is required for +ve significant result

A

1:160

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4
Q

Ant-double stranded DNA antibody (dsDNA)

A

SLE

Specific but not sensitive

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5
Q

Anti-Sm

A

Very specific to SLE

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6
Q

Anti-Ro

A

Significant is SLE as liked to foetal heart block if pregnant

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7
Q

Anti-phospholipid

A

Significant in SLE as increased risk of PE stroke etc

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8
Q

If Anti Phospholipid is +ve what is the next step?

A

Put on aspirin and low molecular weight heparin

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9
Q

Anti centromere antibody

A

Systemic sclerosis (limited)

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10
Q

Anti-Scl-70 antibody

A

Systemic sclerosis (diffuse)

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11
Q

Anti-neutrophil cytoplasmic antibody (ANCA)

A

Small vessel vasculitis

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12
Q

Osteoarthritis

A

Most common form due to ageing and biomechanics stress.

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13
Q

Primary OA

A

Idiopathic no overt cause simply age related.

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14
Q

Secondary OA

A

Predisposing condition

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15
Q

List some cause of secondary OA

A

Cogenital dislocation of the hip.
Osteochondral formation
Crystal arthropathies
Extra articular fracture with malunion.

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16
Q

Signs of OA on an X-Ray

A

Loss of joint space
Osteophytes
Subchondral cysts
Sclerosis

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17
Q

Early sign of OA

A

Very difficult to see, fissure and fibrillation of the synovium, clusters of chondrocytes

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18
Q

Difficulty of using X-ray for diagnosis?

A

You have to match the imaging to the patient substantial changes aren’t always symptomatic!!

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19
Q

Common joints affected OA

A

Unsymmetrical

Hips, Knees, cervical vertebrae, PIP and DIP joints

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20
Q

Treatment for OA

A

Analgesics NSAIDS
Physiotherapy to strengthen surrounding muscles and tendons.
Interarticular steroid injections for flare ups.
Hyaluronic Acid interarticular injectios

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21
Q

What is Hyaluronic Acid

A

This is the lubrication found within synovial In Oa this becomes thin.

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22
Q

Are there blood tests required for OA

A

NO

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23
Q

OA presentation

A

Worse on activity, improvement with rest

Stiffness in the morning for few minutes

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24
Q

OA examination

A

Often very little to see.
Hard swellings especially at DIP.
Reduced range of movement.
Squaring of thumb

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25
With regards to the hip in OA, where can the pain radiate too?
Can radiate to the groin.
26
What are the calcific nodes located on the DIP in OA
Heberden's Nodes | Think of outer Hebrides
27
What are the calcific nodes located on the PIP called?
Bouchards Nodes
28
What features indicate an inflammatory Arthritis
``` Joint pain associated with swelling Prolonged Morning stiffness Improvement with movement Synovitis on inspection Raised CRP and plasma viscosity Systemic symptoms ```
29
Rheumatoid arthritis
Most common inflammatory arthropathy. | Clear genetic risk accounting for 50% of cases
30
Population presentation - RA
Women 3x more likely than men. | Prevalence approximately 1%
31
Triggers for rheumatoid arthritis flares
Infection, trauma and smoking are common, however still require a genetic predisposition
32
Synovitis
Inflammation of the synovium resulting in thickening and excess fluid production.
33
Pathogenesis of RA
Within susceptible genes arginine is swapped for citruline. The gene becomes denatures and tertiary structure is altered. New shape acts as a antigen for Anti-CCP. Immune complexs form which activate immune system.
34
What is the affect of immune system activation by immune complexes within the joints.
Degradation and destruction of the articular cartilage and surrounding soft tissue. Joint instability and subluxation.
35
RA diagnosis
Prolonged morning stiffness >30mins. Symmetrical joint distribution. Tender joints when squeezed especially MCP and MTP.
36
Where does RA typically appear first?
Generally within the feet.
37
Where does RA not affect?
No affect on the DIP this is because there is no synovium only a tendon attachment.
38
Use of Anti-CCP in RA
Can present prior to articular symptoms. | Presence correlates to severity off the disease.
39
X-Ray in RA
Severe/Late - Erosions and subluxations. | Early - Often look normal, shows signs I=of synovitis, periarticular osteopenia
40
US usage in RA
Increased sensitivity for early disease. | Doplar can be used to show increased blood flow which is sign of inflammation.
41
Systemic effects of RA
Pleural effusions, rheumatoid nodules, osteopenia/osteoporosis, interstitial lung disease, increased CDV similar to diabetes.
42
Risk of RA in cervical vertebrae
Atlanto-axial subluxation can result in cervical spinal chord compression.
43
Treatment for RA
1st line- DMARD 2nd line - Biologics Steroids are used to bridge gap and control flare ups.
44
What scoring system is used in RA
DAS 28 | Takes into account the number of affected joints and how the patient perceives their illness to be.
45
What DAS 28 score is required for biologic therapy?
>5.1
46
What are the four types of seronegative inflammatory arthropathies?
Ankylosing spondylitis. Enteropathic arthritis. Psoriatic arthritis Reactive arthritis
47
What are characteristic of seronegative inflammatory arthropathies?
Asymmetrical Oligoarthropathies. Uveitis HLA-B27 positive
48
What are most patients with seronegative inflammatory arthropathies positive for?
HLA-B27
49
Ankylosing spondylitis
Chronic inflammatory condition affecting the spine and scar-iliac joints. Can lead to spinal fusion.
50
Occurrence within the population - Ankylosing spondylitis
M:F = 3:1 | Age 20-40 years
51
Ankylosing spondylitis presentation
Spinal pain and stiffness with gradual loss of spinal movement. Patients will develop question mark spine and some kyphosis.
52
Ankylosing spondylitis associated conditions
``` Anterior Uveitis Amyloidosis Axial Athritis Apical Fibrosis Aortic Regurgitation Achilles tendonitis ```
53
Name the bony developments that fuse the spine together?
Syndesmophytes
54
Treatments for ankylosing spondylitis?
Infliximab Anti TNF Seukinimab Anti IL17 NSAIDS Physiotherapy
55
Are DMARDS used in ankylosing spondylitis?
Only to treat any associated peripheral arthritis.
56
What test can be used to measure lumbar spine flexion?
Schobers test
57
What should be the normal flexion in schobers test?
>20cm
58
X-Ray in ankylosing spondylitis
"Bamboo Spine" Sclerosis fusion and bony spurs from vertebral body. At time presentation often normal x-ray
59
MRI in ankylosing spondylitis
Can show earlier features such as bone marrow oedema and enthesitis of spinal ligaments.
60
What is an oligoarthropathy?
Affects between 2-4 joints
61
Psoriatic arthritis
30% of patients with psoriasis present with arthritis
62
Psoriatic arthritis presentation
Asymmetrical Oligoarthritis. Psoriatic nail pitting and onchylosis. Dactylisis Enthesitis
63
Psoriatic Arthritis Treatment
DMARDs Methotrexate Steroids to bridge gap Anti-TNF for resistant arthritis.
64
Enteropathic Arthritis
9-20% of all IBD patients will have this asymmetrical arthritis affecting peripheral joints. Linked to flare ups of IBD
65
Enteropathic arthritis presentation
Loose watery stools +/- blood or mucus. Pyoderma gangrenous Apthous ulcers Low grade fever
66
Enteropathic Arthritis treatment
``` Linked at finding medication for both conditions. Steroids Methotrexate Sulfasalazine Anti TNF ```
67
Reactive Arthritis
Occurs in response to a preluding infection usually 1-3 weeks prior.
68
What infection commonly lead to reactive arthritis?
Genitourinary (Chlamydia, Neisseria) Gi infections (Salmonella, Camplyobacter)
69
What joints are commonly affected? Inflammatory
Large joints e.g. Knee Hip etc
70
Reiters syndrome
Uveitis (conjunctivitis), Urethritis and Arthritis
71
Reactive Arthritis presentation
``` Inflamed large joint Reiters syndrome Fever Fatigue Malaise Painless Oral ulcers Hyperkeratotic nails Ocular lesions ```
72
Reactive Arthritis Treatment
Most are self limiting Antibiotic aimed at underlying infection Steroid IM or IA DMARDs for chronic cases
73
SLE Epidemiology
F/M = 9:1 Genetic and environmental factors Age 20-30 years
74
SLE pathogenesis
Loss of immune regulation and defective apoptosis. Necrolysed cell materials act as antigens. Immune complex's form and are deposited throughout the body. Perpetuated inflammation throughout body leads to scarring and fibrosis.
75
SLE systemic affects
Fever fatigue and malaise
76
SLE musculoskeletal
Arthralgia Myalgia | Arthritis- synovitis and tenderness in 2+ joints with >30 mins of morning stiffness.
77
Muco-cutaneous SLE
``` Malar rash (butterfly) Photosensitivty Oral ulceration Raynauds Alopecia ```
78
SLE Haematological
Leukopenia | Haemolytic aenemia
79
SLE renal
Proteinuria >0.5g in 24 hrs | Urgent biopsy required to determine if glomerular nephritis..
80
SLE cardio
Pleural or pericardial effusion acute pericarditis
81
SLE Investigations | -FBC
Aenemia, increased plasma viscosity, low white blood cell count (particularly B cells)
82
SLE investigations Immunology
``` ANA- postive in 95% not specific Anti dsDNA Anti SM Anti Ro Low C3,C4 ```
83
SLE investigations | Imaging
Echocardiogram for pericardial effusion | CT - Interstitial lung disease
84
SLE management | Skin and arthralgia
Hydroxychloroquine Topical steroid NSAIDs
85
SLE management | Inflammatory Arthritis or organ involvement
Azathioprine or Mycophenolate Mofetil | Moderate dosage Corticosteroids.
86
SLE management | Severe organ damage
IV steroids | Cyclophosphamide

Year 2 MSK (19 decks)

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