Rheumatology conditions Flashcards
(119 cards)
1
Q
Rheumatoid arthritis is HLA____ mediated?
A
- HLA-DR4
2
Q
What are potential triggers of rheumatoid arthritis?
A
- Smoking
- Infection
- Stress
3
Q
What is the main structure involved in rheumatoid arthritis?
A
- synovium
4
Q
What classification system is used in rheumatoid arthritis?
A
- ACR/EULAR
- DAS 28
5
Q
Clinical features of rheumatoid arthritis?
A
- morning stiffness lasting greater than 1 hour
- relieved by exercise
- involvement of small joints of hands and feet
- symmetrical
6
Q
What are the 2 auto-antibodies in rheumatoid arthritis?
A
- Rheumatoid factor
- Anti-CCP antibodies
7
Q
What scoring system is used in rheumatoid arthritis?
A
- DAS 28
8
Q
What DAS28 score indicates remission?
A
- DAS less than 2.6
9
Q
Treatment of rheumatoid arthritis?
A
- DMARDs
- NSAIDs
- steroids
10
Q
Describe swan-neck deformity in rheumatoid arthritis?
A
- hyperextension at the PIP joint and flexion of the DIP joint
11
Q
Describe boutonniere deformity of the thumb in rheumatoid arthritis?
A
-flexion of the PIP joint and hyperextension of the DIP joint)
12
Q
Define osteoarthritis?
A
- chronic disease characterised by cartilage loss and accompanying periarticular change
13
Q
Where are the most commonly affected joints in osteoarthritis?
A
- knees
- hands (TMC, PIP, DIP)
- Hips
14
Q
What is an osteophyte?
A
- New bone formation
15
Q
What are risk factors for osteoarthritis?
A
- genetic
- age
- female
- obesity
- joint injury
16
Q
What are some features of osteoarthritis on x-ray?
A
- bone erosion
- osteophytes
17
Q
What is generalised OA?
A
- At either the spine or the hand joints and in at least 2 other joint regions
18
Q
Where are heberdens nodes seen?
A
- DIP joints
19
Q
Where are Bouchards nodes seen?
A
- PIP joints
20
Q
What is the clinical presentation of OA?
A
- Pain worse with joint use
- morning stiffness less than 30 mins
- poor grip
21
Q
Pain felt at the hip region may be pain originating from where?
A
- lower back
22
Q
Where may pain from the hip radiate to?
A
- the groin or knee
23
Q
Occipital headaches may be characteristic of what?
A
- spine involvement of OA
24
Q
How do you diagnose OA?
A
- clinical
- x-ray (joint space narrowing, sclerosis, cysts)
25
Pharmacologic treatment of OA?
- Analgesia
| - Local intra-articular steroid injections
26
What is the definition of a crystal arthropathy?
- deposition of various minerals in joints and soft tissues leading to inflammation
27
What are the 2 main causes of gout?
- increased urate production
| - reduced urate excretion
28
Hyperuricaemia may be a risk factor for what?
- gout
29
What are causes of increased urate production?
- increased dietary intake
| - alcohol
30
What are causes of reduced urate excretion?
- chronic renal impairment
| - hypothyrodism
31
What is the most common site of gout?
- 1st MTP
32
What crystals are associated with gout?
- monosodium urate crystals
33
What crystals are associated with pseudogout?
- calcium pyrophosphate crystal deposition
34
What crystals are associated with hydroxyapatite?
- basic calcium phosphate deposition
35
Chronic tophaceous gout is characterised by what?
- granulomatous inflammation around urate crystals
| - tophaceous
36
What is the single best investigation of gout?
- Polarised microscopy of synovial fluid
37
What will polarised microscopy of synovial fluid in gout appear like?
- negative birefringent urate crystals.
38
What test can be done to rule out septic arthritis?
- joint aspiration
39
What blood test can be performed to investigate gout?
- uric acid levels
40
What is the treatment of acute gout?
- NSAIDs + PPI
- Colchicine
- Steroids
41
When can preventative treatment of gout be introduced?
- wait 1 week after acute attack
42
What is the preventative treatment of gout?
- lifestyle modification
| - allopurinol
43
What are some causes of calcium pyrophosphate deposition disease (CPPD)
- Age
- OA
- hyperparathryodism
- haemochromatosis
44
calcium pyrophosphate deposition disease (CPPD) will have a ___ -ve/+ve___ birefringent
- positive
45
Treatment of hydroxyapatite?
- NSAIDs
| - intra articular steroid injections
46
What scoring system can be used to diagnose joint hypermobility syndrome
- modified beighton score
47
What type of hypersensitivity reaction is SLE/
- Type III hypersensitivty
48
Who is most likely to be effected by SLE?
- Female
- childbearing ages
- Afro-caribbean
49
What are some environmental triggers of SLE?
- Silica
- Smoking
- UV light
- Infection
50
What scoring system is used for SLE?
- EULAR/ACR
51
What are symptoms of SLE?
- Fever
- fatigue
- malar rash
- discoid rash
- serositis
52
What is serositis?
- pleural or pericardial inflammation (effusion)
| - seen in SLE
53
What are the 3 most common SLE antibodies?
- ANA
- dsDNA
- Complement
54
What is an example of a specific antibody in SLE?
- dsDNA
55
Treatment of SLE?
- Sun protection
| - Hydroxychloroquine
56
Explain sjogrens syndrome?
- Autoimmune condition that affects the exocrine glands
| - leads to dry mucous membranes
57
What are the symptoms of sjogrens syndrome?
- dry gritty eyes
- dry mouth and throat
- joint pains
58
What antibodies are associated with sjogrens syndrome?
- Anti Ro
| - Anti La
59
What test can be performed in sjogrens syndrome?
- Schirmer test
60
What are some complications of sjogrens syndrome?
- increased risk of lymphoma
| - eye infections
61
What is systemic sclerosis also called?
Scleroderma
62
What is systemic sclerosis?
- multi-systemic autoimmune disease
63
What are symptoms of systemic sclerosis?
- Raynauds
- skin thickening and tightening
- dysphagia
- GORD
64
What antibodies are associated with scleroderma?
- Anticentromere
| - Anti-Scl70
65
Small mouth with puckering may be a facial change seen in what condition?
- Scleroderma (systemic sclerosis)
66
What is the classic triad of Raynauds' phenomenon?
- Blanching (white)
- acrocyanosis (purple)
- reactive hyperaemia (redness)
67
Treatment of Raynaud's phenomenon?
- Calcium Channel Blockers
| - Nitrates
68
What are the 4 different types of spondyloarthropathies?
- Ankylosing spondylitis
- Psoriatic arthritis
- Reactive arthritis
- Enteropathic arthritis
69
What is the similarities between the spondyloarthropathies?
HLA B27
70
How is mechanical back pain described?
- Worse after activity
- Worse at end of day
- Better with rest
71
How is inflammatory back pain described?
- Worse with rest
- Better with activity
- significant early morning stiffness
72
Descrive enthesitis
-Inflammation at insertion of tendons into bone
73
Describe Dactylitis
- inflammation of an entire digit
74
What are some extra-articular features of spondyloarthropathies
- occular inflammation
- mucocutaneous lesion
- rare aortic incompetence or heart block
75
Describe Ankylosing spondylitis
- chronic systemic inflammatory disorder
76
Where does Ankylosing spondylitis primary affect?
- spine
77
What classification systems are used in Ankylosing spondylitis?
- ASAS classification
78
Investigations into Ankylosing spondylitis
- bloods (inflammatory, HLA B27)
- X ray
- occiput to wall test
- schobers test
79
Symptoms of Ankylosing spondylitis
- limited lumbar motion
- lower back pain not relieved by rest
- reduced chest expansion
- question mark posture
80
Clinical features of psoriatic arthritis?
- nail involvement
- dactylitis
- enthesitis
81
What causes reactive arthritis?
- infection induced systemic illness
| - 1-4 weeks post infection
82
What are the most common infections that trigger reactive arthritis?
- urogenital (chlamydia)
| - eneterogenic (salmonella)
83
Reiters syndrome is also called?
- Reactive arthritis
84
What is the classical Reiters (Reactive arthritis) triad?
- urethritis
- conjunctivitis
- arthritis
85
What should be performed before commencing treatment for reactive arthritis?
- joint aspiration to rule out septic arthritis
86
Symptoms of enteropathic arthritis?
- GI loose, watery stools
- Weight loss
- Fever
87
Investigations into enteropathic arthritis
- Upper and lower GI endoscope
| - joint aspirate
88
Management of spondyloarthropathy
- NSAIDs
- corticosteriods
- physio
- OT
89
What is a myopathy?
- Disease of the muscle in which the muscle fibres do not function properly
- results in muscular weakness
90
What are the 2 types of inflammatory myopathies?
- polymyositis
| - dermatomyositis
91
Describe the clinical features associated with inflammatory myopathies?
- Muscle weakness
- Gradual onset
- Reduced muscle strength
92
What are the most common muscles affected in inflammatory myopathies?
- proximal muscles (shoulders and hips)
93
What investigations would you carry out for inflammatory myopathies?
- CK levels
- EMG
- Muscle biopsy
94
What is the treatment of inflammatory myopathies?
- Corticosteroids
| - Immunosuppression
95
What is polymyalgia rheumatica characterised by?
- pain and stiffness
96
What are associated effects of polymyalgia rheumatica
- temporal arteritis
| - giant cell arteritis
97
What are the symptoms of polymyalgia rheumatica?
- ache in shoulders and hip
- movement limited
- muscle strength normal
- morning stiffness
98
Polymyalgia rheumatica is associated with _____ muscle strength?
- normal muscle strength
99
Inflammatory myopathies is associated with ____ muscle strength?
- reduced muscle strength
100
What is temporal arteritis?
- Granulomatous arteritis of large vessels
101
What are the symptoms of temporal arteritis?
- Headache
- Scalp tenderness
- Potential visual loss
102
What is used in the diagnosis of temporal arteritis?
- Raised ESR
- USS of temporal artery
- temporal artery biopsy
103
What is the treatment of temporal arteritis/giant cell arteritis?
- steroid
- Prednisolone 40-60mg
- higher dose given due to the potential vision loss
104
What is fibromyalgia characterised by?
- Pain and fatigue
105
What are the most common muscles affected in fibromyalgia?
- Proximal muscles
106
What are the symptoms of fibromyalgia?
- Muscle pain (pins and needles)
- fatigue
- headaches
- anxiety
107
What criteria is used in the diagnosis of fibromyalgia?
- ACR diagnostic criteria
108
What is vasculitis?
- inflammation of the blood vessels
109
What are some consequences of vasculitis?
- inflammation
- ischamia
- necrosis
110
What is primary vasculitis?
- results from an inflammatory response
| - no known cause
111
What is secondary vasculitis?
- triggered by an infection, drug, toxin
112
What should always be checked in vasculitis?
- urinalysis
113
What are the main causes of large vessels vasculitis?
- Takayasu arteritis (TA)
| - Giant cell arteritis (GCA)
114
Where is a common site for a bruit in takayasu arteritis?
- carotid artery
115
What are investigations of giant cell arteritis?
- ESR
- CRP
- Temporal artery biopsy
- USS
116
Renal features of Granulomatosis with polyangiitis?
- necrotising glomerulonephritis
117
What is Henoch-Schonlein Purpura (HSP)?
- Acute immunoglobulin IgA mediated disorder
| - Pre-ceding URTI (Strep A)
118
HSP management?
- self limiting
| - essential to perform urinalysis
119
Localised AAV management
- methotrexate + steroids
