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Rheumatology Flashcards

(46 cards)

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1
Q

Arthritis is chronic if it lasts for how long?

A

> 6 weeks

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2
Q

What are the 7 seropositive causes of inflammatory arthritis

A 
Rheumatoid arthritis
SLE
Scleroderma
Sjogrens
Vasculitis
Polymyositis
Dermatomyositis
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3
Q

What are the 4 seronegative causes of inflammatory arthritis

A

Psoriatic arthritis
Reactive arthritis
Ankylosing spondylitis
Enteropathic arthritis

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4
Q

Generalised features of seropositive arthritis

A

Affect women more than men
Symmetrical polyarticular small and large joints
DIP spared
+ve RF/CCP
No pelvic/spinal involvement
Nodules, vasculitis, Raynauds, scleritis/episcleritis, photosensitivity, pulmonary involvement

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5
Q

Generalised features of seronegative arthritis

A 
Affect men more than women
Asymmetrical oligoarticular large joints
-ve RF/CCP
DIP affected in psoriatic
Pelvic and spinal involvement common
Iritis, uveitis, oral ulcers, enthesitis, GI, GU and derm pathology
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6
Q

Hand/wrist examination findings in rheumatoid arthritis

A

Symmetrical small joint polyarthritis affecting wrists, MCPs, PIPs, ankles, elbows
Swan neck deformity
Boutinniere’s deformity
Ulnar deviation
Rheumatoid nodules on extensor surfaces of tendons
Subluxation
Dorsal muscle wasting/guttering

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7
Q

Extra-articular features of rheumatoid arthritis

A

Lungs, heart, eyes, blood, hands, spleen
Pleuritis/pleural effusion
Pericarditis/pericardial effusion
Scleritis/episcleritis/scleromalacia perforans/keratoconjunctivitis sicca
Palmar erythema, nail fold infarcts
Caplans syndrome - pulmonary nodules, splenomegaly and low blood count (RBC, WBC, both)
Felty’s syndrome - RA, splenomegaly and neutropenia
Sjogrens syndrome
Carpal tunnel/neuropathies

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8
Q

What is the name of the criteria classification system used to diagnose rheumatoid arthritis

A

ACR classification criteria

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9
Q

What tool can be used to assess severity of rheumatoid arthritis

A

DAS-28 score

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10
Q

Management of rheumatoid arthritis

A 
Refer to rheumatology
Manage CVD risk factors (at increased risk)
NSAIDs
Steroids
DMARDs/biologics
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11
Q

Typical presentation of reactive arthritis

A

Young male a few weeks after GU/GI infection

Uveitis/conjunctivitis + Urethritis + Arthritis

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12
Q

What is the pattern of joint involvement for reactive arthritis

A

Asymmetrical oligoarticular large joints of lower limbs/back

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13
Q

What is the pattern of joint involvement for psoriatic arthritis

A

Asymmetrical mono/oligoarticular larger joints
5 patterns:
1. DIP arthritis
2. Asymmetrical oligoarticular
3. Symmetrical polyarticular
4. Arthritis mutilans
5. Psoriatic spondylitis + sacroiliitis + spinal involvement

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14
Q

Clinical findings of ankylosing spondylitis

A 
Asymmetrical mono/oligoarticular large joints
Sacroiliac tenderness
Loss of lumbar lordosis
Kyphosis
Iritis/uveitis
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15
Q

Clinical feature of SLE

A

Symmetrical arthritis and chronic arthralgia
Malar butterfly rash, discoid rash, photosensitivity
Fatigue, weight loss, fever, lymphadenopathy
Raynauds
Jacouds arthritis
Pleuritis/ILD
Peri/myo/endocarditis
Hypertension
Oral ulcers, nasal ulcers, alopecia
Nephritic syndrome
VTE (APS)
CNS signs - seizures, psychosis, cognitive defects
Anaemia, lymphopenia, neutropenia, thrombocytopenia
Abdo pain, diarrhoea, vomiting

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16
Q

What is the name of the classification system used to help diagnose SLE

A

ACR criteria

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17
Q

Which special blood tests are positive in SLE

A

Double stranded DNA
ANA
Anti-phospholipid antibodies

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18
Q

Management of SLE

A 
Rheumatology referral
CVD risk factor management
Sun protection
NSAIDs
Steroids
Hydroxychloroquine, MTX
Renal assessment/involvement
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19
Q

What is CREST syndrome

Study These Flashcards
A 
Limited scleroderma
Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactyly
Telangiectasias
20
Q

Which antibody is associated with scleroderma limited to the skin

Study These Flashcards
A

Anti-centromere

21
Q

Secondary causes of Sjogren’s syndrome

Study These Flashcards
A

SLE
RA
Systemic sclerosis

22
Q

What is sicca complex

Study These Flashcards
A

Decreased lacrimal and salivary gland secretion

23
Q

How can you test for lacrimal secretion

Study These Flashcards
A

Schirmer’s test

24
Q

Two antibodies associated with Sjogren’s syndrome

Study These Flashcards
A

Anti-Ro

Anti-La

25
Findings associated with dermatomyositis
``` Heliotrope rash Gottron's papules Symmetrical proximal myopathy V shaped rash on chest/neck Photosensitivity ```
26
Diagnosis of fibromyalgia
Pain index score and symptom severity score raised for at least 3 months + no other disorder that wound explain the pain
27
Clinical features of fibromyalgia
11/18 tender points Fatigue unrelieved by sleep Neuropathic pain
28
How could you explain fibromyalgia to a patient
Its not inflammation it's chemical changes in pain pathways
29
Risk factors for developing gout
``` Male Alcohol Purine diet - steak, oily fish Loop and thiazide diuretics DM HTN Decreased renal function Metabolic syndrome ```
30
Two findings that can result from chronic gout
``` Tophi Renal disease (stones/interstitial nephritis) ```
31
Describe the crystals seen in gout
Monosodium urate crystals are needle shape and have strong negative birefringe
32
Describe the crystals seen in pseudogout
Calcium pyrophosphate rhomboid shape crystals with a weakly positive birefringe
33
Side effects of steroids
``` Skin - atrophy, stretch marks, purpura HTN Weight gain, increased appetite Hyperglycaemia Hypocalcaemia (secondary osteoporosis) Mood disorders Dyspepsia Myalgia and proximal muscle weakness ```
34
How long do DMARDs take to help symptoms
6-12 months
35
What life threatening risk associated with DMARDs do you need to tell patients about
Risk of myelosuppression and neutropenia --> sepsis
36
Large vessel vasculitis
Takayasu | GCA
37
Medium vessel vasculitis
Polyarteritis nodosa | Kawasaki disease
38
ANCA positive small vessel vasculitis
Microscopic polyangitis Granulomatosis with polyangitis Eosinophilic gransulomatosis with polyangitis
39
ENT involvement is common in which type of vasculitis
Granulomatosis with polyangitis
40
Antibody associated with drug-induced SLE
Antihistone
41
What score measures disease activity in rheumatoid arthritis
DAS-28
42
Upper limb claudication with diminished/absent reflexes can be due to which vasculitis
Takayasu's
43
Segmental thrombotic occlusions of the small and medium sized lower limb vessels Commonest in young male smokers Proximal pulses usually present, but pedal pulses are lost Tortuous corkscrew shaped collateral vessels may be seen on angiography
Buergers disease
44
First line medication for Raynaud's phenomenon
Calcium channel blockers e.g. nifedipine
45
Antibody associated with dermatomyositis
Anti-Jo1
46
Test for drug-induced lupus
Anti-histone antibodies

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