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Year 4 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the presentation of rheumatoid arthritis

A
  • symmetrical swollen, stiff painful joints, typically starting with small joints eg of the hand
  • worse on the morning
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2
Q

What deformities of the fingers might be seen in rheumatoid arthritis

A
  • boutonniere deformity

* swan neck deformity

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3
Q

What blood tests could you order for RA

A
  • anti-CCP

* rheumatoid factor

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4
Q

Which blood test is most specific for rheumatoid arthritis

A

anti CCP

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5
Q

What might you see on x-ray of a joint affected by rheumatoid arthritis

A
  • loss of joint space
  • bony erosion
  • juxta-articular osteopenia
  • soft tissue swelling
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6
Q

What is the treatment for rheumatoid arthritis

A
  • NSAIDs
  • steroids (oral or steroid injections)
  • DMARDs (methotrexate, hydroxycloroquine, sulfasalazine)
  • anti-TNFalpha biologics (infliximab, etanercept)
  • anti-b cell biologics (rituximab)
  • physio
  • surgery
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7
Q

What is the typical presentation of osteoarthritis

A
  • pain and stiffness of one (usually large) joint, typically the knee or hip
  • pain on movement
  • crepitus
  • worse at end of day
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8
Q

Osteoarthritis and rheumatoid arthritis differ on which time of the day the pain is worse - which is which?

A
  • osteoarthritis pain worse at end of day

* rheumatoid pain worse in morning

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9
Q

What will you see on x ray of an osteoarthritic joint

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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10
Q

What is treatment for osteoarthritis

A
  • physio
  • NSAIDs
  • steroid injections
  • surgery
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11
Q

What is psoriatic arthritis highly associated with

A

psoriatic nail disease

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12
Q

What is the presentation of psoriatic arthritis

A
  • symmetrical polyarthritis similar to RA

* spondylarthropathy

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13
Q

What is treatment of psoriatic arthritis

A

NSAIDs and DMARD if necessary

most commonly used medication is methotrexate

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14
Q

What treatment should be avoided in psoriatic arthritis

A

oral and IM steroids

intra-articular steroids may be used

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15
Q

What are the two ways a joint may become septic

A
  • contiguous spread

* haematogenous spread

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16
Q

What are the common causative pathogens in septic arthritis

A

contiguous spread

  • straph A
  • strep

haematogenous spread
* neisseria gonococcus

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17
Q

What are risk factors for septic arthritis

A
  • immobility
  • recent surgery
  • recent injury
  • immunosuppression
  • IVDU
  • prosthetic joint
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18
Q

When should you suspect septic arthritis

A
  • red, hot swollen joint acute onset
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19
Q

What investigation must be done for septic arthritis

A
  • joint aspiration - MCS (microscopy, culture and sensitivity)
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20
Q

What treatment should be done for septic arthritis

A
  • start empirical antibiotics after joint aspirate and fine tune treatment when sensitivity results get back
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21
Q

Where is the most common site for gout

A

first MTP joint (podagra)

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22
Q

what causes inflammation in gout

A

monosodium urate crystals accumulating at the joint capsule causing inflammation

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23
Q

What might increase risk of gout

A
  • alcohol intake
  • diet high in purines
  • stress eg surgery
  • low water intake
  • starvation
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24
Q

How is gout diagnosed

A

joint aspiration with light microscopy

- will show urate crystals

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25
Q

How is gout treated

A
  • high dose NSAID
  • colchicine
  • 3 weeks after flare up prescribe allopurinol to prevent future flare ups
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26
Q

Why wouldn’t you prescribe allopurinol during a gouty attack?

A

allopurinol should be given three weeks after attack because it can cause a flare up

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27
Q

What causes temporal arteritis?

A

giant cell arteritis - vasculitis of the temporal artery

  • fibrosis and wall weakening of this artery
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28
Q

What are the symptoms of temporal arteritis

A
  • headache
  • scalp tenderness
  • unilaterall blindness
  • jaw claudication
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29
Q

What should you do if you suspect temporal arteritis?

A
  • do ESR

* start prednisolone immediately

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30
Q

What blood result would you expect in GCA

A
  • VERY elevated ESR
  • platelets elevated
  • alk phos elevated
31
Q

What investigation should you do in GCA? When should you order it?

A

temporal artery biopsy - within 7 days

32
Q

What is the main cause of death and morbidity in GCA?

A

long-term steroid use - so titrate when appropriate

33
Q

What is polymyalgia rheumatica

A

a condition that causes neck, shoulder and hip stiffness and pain

34
Q

Which condition does polymyalgia rheumatica commonly occur with

A

giant cell arteritis

35
Q

What is the treatment of polymyalgia rheumatica

A

prednisolone

36
Q

What is the creatinine kinase level like in polymyalgia rheumatica?

A

Normal

37
Q

What is osteoporosis

A

decreased bone density

38
Q

What is the DEXA score that diagnoses osteopenia?

A

T score between -1 and -2.5

39
Q

What is the DEXA score for osteoporosis

A

-2.5

40
Q

What are risk factors for osteoporosis

A
  • early menopause
  • steroid use
  • smoking
  • increased age
  • low BMI
  • low calcium intake
  • low vitamin D
41
Q

Where are the three most common sites of frailty fracture

A
  • radius
  • vertebrae
  • neck of femur
42
Q

What pharmacological treatment can be given for osteoporosis

A
  • bisphosphonates (eg alendronate)
  • calcium and vitamin D
  • HRT
43
Q

What non-pharmacological treatment can be given for osteoporosis

A
  • physiotherapy

* exercise

44
Q

What advice must be given to patients about bisphosphonates

A

they must be taken sitting upright and after meals - causes oesophagitis

45
Q

What is ankylosing spondylitis

A

chronic inflammation of the IV discs of the spine and the sacroiliac joints

46
Q

How does ankylosing spondylitis present

A
  • gradual onset of stiff, painful back and buttock pain

* progressive loss of spinal movement

47
Q

How is ankylosing spondylitis diagnosed

A

it is a clinical diagnosis supported by MRI

48
Q

How is ankylosing spondylitis treated

A
  • exercise
  • TNF-alpha blockers
  • local steroid injections
49
Q

What virus might trigger SLE

A

epstein barr virus

50
Q

What is SLE

A

an autoimmune condition that causes production of anti-nuclear antibodies that can deposit in tissue and cause inflammation

51
Q

What is the presentation of SLE

A

remitting and relapsin illness presenting with noon-specific constitutional symptoms (malaise, fatigue, fever)

  • possibly also lymphadenopathy, erythematous skin, weight loss
52
Q

What is the diagnostic test for SLE

A

ANA (anti-nuclear antibody) (95% +ve)

53
Q

What inflammatory marker will be raised in SLE

A

ESR

54
Q

What is Sjogren’s syndrome

A

inflammatory autoimmune disorder that causes lymphocytic infiltration and fibrosis of exocrine glands, particularly the salivery and lacrimal glands

55
Q

What does Sjogren’s syndrome cause

A
  • reduced tear production
  • reduced saliva
  • parotid gland swelling
56
Q

What is polymyositis

A

autoimmune inflammation of (typically large) muscle groups

57
Q

How does polymyositis present

A

With weakness and wasting typically of large muscle groups

58
Q

What is vasculitis

A

Inflammation of blood vessels (usually arteries) causing weakness (and aneurysms) and fibrosis, which can cause organ ischaemia

59
Q

What is the most common type of vasculitis

A

Kawasaki disease

60
Q

What are the large vessel vasculitides

A
  • GCA

* Takayasu’s arteritis

61
Q

When should you consider vasculitis?

A

In any unidentified multisystem disorder

62
Q

What tests should you consider in vasculitis

A
  • ESR/CRP may be raised

* may be ANCA-positive

63
Q

What are the main causes of reactive arthritis

A
  • STIs

* gastroenteritis

64
Q

What is reactive arthritis

A
  • sterile arthritis
65
Q

What is the investigation of reactive arthritis

A

must joint aspirate to rule out septic arthritis

66
Q

What is treatment of reactive arthritis

A
  • NSAIDs
  • consider local steroid injection
  • consider DMARDs if chronic
67
Q

When does reactive arthritis usually occur after an infection

A

1-2 weeks

68
Q

What causes Paget’s disease of bone

A

excessive bone remodelling

69
Q

What are the symptoms of Paget’s

A
  • may be asymptomatic
  • deep, boring bone pain
  • bony deformity and enlargement

may cause

  • deafness/blindness
  • leonitis of facial features
  • fractures
70
Q

Which bones are typically affected in Paget’s

A
  • skull
  • lumbar spine
  • pelvis
  • femur
  • tibia
71
Q

What is the investigations of Paget’s

A
  • X-ray for deformities and sclerotic lesions
  • bone scan may reveal ‘hot spots’
  • alk phos will be raised
72
Q

What is treatment for Paget’s

A
  • analgesia

* bisphosphonates

73
Q

What malignancies commonly metastasise to bone

A
  • breast
  • thyroid
  • prostate
  • lung
  • renal
  • lymphoma
74
Q

What are the primary cancers of the bone

A
  • osteosarcoma
  • chrondrosarcoma
  • Ewing’s sarcoma

Year 4 (13 decks)

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