Rheumatology

Question 1

What are the RFs for sciatica?

Answer 1

Age 40-65
Smoking
Tall
Occupation - strenuous job, vibrations

Question 2

Causes of sciatica?

Answer 2

90% d/t disc herniation
Malignancy
Infection
Rarely due to a sciatic nerve disorder

Question 3

What are the S+S in sciatica?

Answer 3

Pain in the distribution of the sciatic nerve in the thigh and below the knee (if not felt below the knee, it’s not sciatica)
Often accompanied by numbness and paraesthesia
Pain is exacerbated by coughing, straining, sneezing, laughing

Question 4

Treatment of sciatica?

Answer 4

See notes

Question 5

What are the two pain symptoms of Anky Spon?

Answer 5

Back pain and stiffness

Question 6

What are the signs on clinical exam of Ank Spon?

Answer 6

Schobers test positive
Reduced lateral flexion
Reduced chest expansion

Question 7

What is the Tx of Ank Spon?

Answer 7

Medical:
NSAIDs (diclofenac/naproxen)
Steroids (for surrounding disease)
Anti-TNF (infliximab, etanercept)
DO NOT USE DMARDS

Physio/hydrotherapy
Stop smoking
Support groups
Encourage exercise

Question 8

What are the extra-articular symptoms of RA?

Answer 8

See notes

Question 9

Other than RA, what disease is RF positive in?

Answer 9

SLE
Sjogrens
Hep C
Acute viruses/infections

Question 10

What supplement need to be taken with DMARDs?

Answer 10

Folic acid

Question 11

How to treat reactive arthritis?

Answer 11

No cure
Splint joint
NSAIDs/IA steroid injections
Consider DMARDs if >6 months

Question 12

What are the nail changes in psoriatic arthritis?

Answer 12

Pitting, yellowing, onycholysis

Question 13

What is seen on X-ray in psoriatic arthritis?

Answer 13

Pencil in cup deformity

Question 14

How to treat psoriatic arthritis?

Answer 14

NSAIDs
Steroids
DMARDs
TNF-alpha

Question 15

How long to wait after gout attack to start allopurinol? What is the alternative?

Answer 15

3 weeks

Febuxostat (more expensive)

Question 16

What precipitates a gout flare up?

Answer 16

Infection, trauma, surgery, starvation, diuretics

Question 17

Gout RFs

Answer 17

Male, meat + seafood (high in purines), alcohol, diuretics, obesity, HTN, coronary heart disease, DM, CKD, heart failure

Question 18

Which blood is raised in pseudogout?

Answer 18

Neutrophils

Question 19

Things that precipitate pseudogout attack?

Answer 19

dehydration, intercurrent illness, haemochromatosis (high iron), hyperparathyroidism, long-term steroids

Question 20

Which Ca is more common in Sjogrens?

Answer 20

non-hodgkins lymphoma

Question 21

Which Abs are positive in Sjogrens?

Answer 21

ANA, RF, Ro, La

Question 22

Ix for Sjogrens?

Answer 22

Salivary gland USS

Schirmer’s test

Question 23

Management of Sjogrens?

Answer 23

Tear and saliva replacement
Hydrochloroquine for fatigue, myalgia, arthralgia, rashes
Corticosteroids/immunosuppressants for organ-threatening extra-glandular disease
Biological therapies

Question 24

Which immunosuppressant drug is given for systemic sclerosis?

Answer 24

IV cyclophosphamide

Question 25

What is the pathophysiology of dermatomyositis?

Answer 25

Capillary obliteration cause ischamia and muscle infarction

Question 26

What are the Ix for dermato/polymyositis?

Answer 26

``` Check autoantibodies o Anti-Jo1 (poly), anti-Mi-2 (derm), ANA Raised serum muscle enzymes – CK, aldolase Muscle biopsy Screen for malignancy ```

Question 27

What is the Tx for dermato/polymyositis?

Answer 27

Steroids | Methotrexate

Question 28

What is the Tx of SLE?

Answer 28

To treat flares -> cyclophosphamide + steroids Maintenance -> NSAIDs + hydroxychloroquine Biologics -> rituximab Suncream, topical steroids

Question 29

Investigations for GCA?

Answer 29

``` Raised CRP/ESP Raised ALP (inflammatory marker) Low Hb Temp art biopsy Temp art USS - halo sign ```

Question 30

How long for steroids in GCA?

Answer 30

Minimal - 1 year, usually 2

Question 31

What are the blood results like for PMR?

Answer 31

Raised CRP Raised/normal ESR Raised ALP CK is normal

Question 32

Characteristic presentation in PMR?

Answer 32

Tenderness + morning stiffness in the shoulders and proximal limb muscles (no weakness)

Question 33

What type of cells can be seen on a blood film in myeloma?

Answer 33

Rouleaux cells (RBC stacking)