Rheumatology Diagnostics

Question 1

What are the 3 main diagnostic pathways in rheumatology?

Answer 1

Blood tests
Joint fluid analysis
Imaging tests

Question 2

How often are blood tests needed in rheumatology? If they are, how are they ordered?

Answer 2

They may not be needed if the diagnosis is clear from the history and examination, if they are start with simple ones before ordering fancy ones

Question 3

What do basic rheumatology blood tests include?

Answer 3

FBC
Urea and electrolytes
Liver function tests
Bone profile
ESR
CRP

Question 4

Describe expected Hb, MCV, WCC and PLT in inflammatory arthrtis

Answer 4

Hb= low if anaemic or normal
MCV= normal
WCC= usually normal
PLT= normal or raised

Question 5

Describe expected Hb, MCV, WCC and PLT in osteoarthritis

Answer 5

Hb=normal
MCV=normal
WCC=normal
PLT=normal

Question 6

Describe expected Hb, MCV, WCC and PLT in septic arthritis

Answer 6

Hb= usually normal
MCV=normal
WCC= high due to leucocytosis
PLT= normal or high

Question 7

What is encompassed in urea and electrolytes?

Answer 7

Creatinine
Sodium
Potassium

Question 8

What does high creatinine indicate?

Answer 8

Worsening renal clearance

Question 9

Why are urea and electrolytes relevant in rheumatology diagnostics?

Answer 9

Rheumatological disease can effect the kidneys
NSAIDs can cause kidney impairment
Chronic inflammation can lead to serum amyloid a deposits in the kidney

Question 10

What do LFTs encompass?

Answer 10

Bilirubin
Alanine aminotransferase (ALT)
Alkaline phosphatase (ALP)
Albumin

Question 11

Why are LFTs relevant in rheumatology diagnostics?

Answer 11

DMARDs can cause liver damage

Question 12

What do patients on methotrexate need regularly?

Answer 12

Blood tests every 8 weeks (to check LFTs and ensure there isnt liver damage)

Question 13

What can low albumin indicate?

Answer 13

Problem of synthesis (in liver) or problem of leak from kidney (eg in lupus nephritis)

Question 14

What does bone profile encompass?

Answer 14

Calcium
Phosphate
Alkaline phosphotase

Question 15

What diagnostic component is present in both the LFT and bone profile?

Answer 15

ALP

Question 16

What will ALP levels be in Paget’s disease?

Answer 16

High

Question 17

What is Paget’s disease?

Answer 17

Disease caused by abnormality of high bone turnover

Question 18

Describe calcium, phosphate and ALP levels in someone with osteomalacia

Answer 18

Calcium low or normal
Phosphate low or normal
ALP high or normal

Question 19

What are clinical features of Paget’s disease

Answer 19

Bone pain, excessive pain growth, fracture through area of abnormal bone

Question 20

Describe calcium, phosphate and ALP levels in someone with osteoporosis

Answer 20

All normal

Question 21

What are ESR and CRP useful markers of?

Answer 21

Inflammation

Question 22

What are reasons beside inflammation ESR could be up?

Answer 22

Elevated immunoglobulin level
Paraprotein (myeloma)
Anaemia
Tends to rise with age

Question 23

What are ESR and CRP in SLE?

Answer 23

ESR is usually high, CRP is usually normal

Question 24

When may CRP be high in SLE?

Answer 24

If there is significant synovitis or there is an inflammatory pleural or pericardial effusion

Question 25

What are the 3 main types of arthritis?

Answer 25

Osteoarthritis Inflammatory Septic

Question 26

What are the 2 autoantibodies in RA?

Answer 26

``` Rheumatoid factor (RF) Cyclic citrullinated peptides (CCP) antibodies ```

Question 27

What are anti nuclear antibodies?

Answer 27

Antibodies directed at nuclear component of the cell

Question 28

Other than in RA, when might ANAs be high?

Answer 28

They increase with age | Sometimes high after infection

Question 29

When is ANA used in rheumatology?

Answer 29

When you suspect an autoimmune condition and to support the diagnosis, its not helpful if used only to diagnose as a lot of people will have a high ANA

Question 30

What are clinical manifestations of SLE?

Answer 30

``` Arthritis Skin rash Mouth ulcers Kidney disease Pleural effusion Pericardial effusion ```

Question 31

What are clinical manifestations of Sjorgen's syndrome?

Answer 31

Dry eyes Dry mouth Extra articular features

Question 32

What are clinical manifestations of polymyositis?

Answer 32

Muscle inflammation Weakness High CK

Question 33

What are clinical manifestations of scleroderma?

Answer 33

Vasculopathy eg Reynaud's Skin thickening Organ fibrosis

Question 34

How is strength of ANA reported?

Answer 34

As the maximal dilution at which its still detectable

Question 35

What does a negative ANA mean?

Answer 35

SLE can be ruled out

Question 36

What does a positive ANA mean?

Answer 36

Doesn't necessarily mean SLE can be diagnosed but means it is more likely if other clinical features are present

Question 37

What is done after ANA comes out positive?

Answer 37

Other more specific antibody tests are ordered to see what condition the patient has

Question 38

What are double stranded DNA antibodies specific to?

Answer 38

Lupus

Question 39

What antibodies are useful for tracking lupus over time?

Answer 39

Double stranded DNA

Question 40

What will C3 and C4 levels be in lupus?

Answer 40

Low

Question 41

What are indications for joint aspiration?

Answer 41

Diagnostic: to obtain synovial fluid for analysis Therapeutic: to relief symptoms

Question 42

Why is synovial fluid analysis useful for septic arthritis?

Answer 42

It enables the causative organism to be identified and can guide antibiotic choice

Question 43

What is synovial fluid analysis used to diagnose?

Answer 43

Crystal arthritis

Question 44

Is joint lavage used for septic arthritis and reactive arthritis?

Answer 44

It is for septic arthritis but not for reactive

Question 45

What is the first line imaging in rheumatology

Answer 45

X rays

Question 46

When is MRI useful for imaging in rheumatology?

Answer 46

When looking at soft tissue in small joints, but its not useful for large joints

Question 47

What are some radiographic features of osteoarthritis?

Answer 47

Joint space narrowing Subchondral bony sclerosis Osteophytes Subchondral cysts

Question 48

At what point do erosions occour in RA?

Answer 48

In established disease, the aim is to treat early before erosions occour

Question 49

What is ultrasound useful for in RA?

Answer 49

Detecting synovitis

Question 50

Do RA or osteoarthritis have joint space narrowing?

Answer 50

Yes they both do

Question 51

Do RA or osteoarthritis have subchondral sclerosis?

Answer 51

RA doesnt osteo does

Question 52

Do RA or osteoarthritis have osteophytes?

Answer 52

RA doesnt osteo does

Question 53

Do RA or osteoarthritis have osteopenia?

Answer 53

RA does psteo doesn't

Question 54

Do RA or osteoarthritis have bony erosions?

Answer 54

RA does, osteo doesn't