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1B Musculoskeletal > Rheumatology Diagnostics > Flashcards

Rheumatology Diagnostics Flashcards

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1
Q

what are the major divisions of arthritis?

A

osteoarthritis

inflammatory arthritis

septic arthritis

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2
Q

what are the bloods for inflammatory arthritis?

A

Hb low (anaemia) or normal

MCV normal

WCC normal

PLT normal or increased

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3
Q

what are the bloods for oesteoarthrits?

A

Hb, MCV, MCC, PLT all normal

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4
Q

what are the blood for septic arthritis?

A

Hb usually normal

MCV normal

WCC increased (leucocytosis)

PLT normal or increased

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5
Q

what does U & E results measure?

A

urea

creatinine

sodium

potassium

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6
Q

what does creatinine show?

A

Higher Cr= worse renal clearance = kidney problems

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7
Q

what rheumatoid diseases can affect the kidneys?

A
  • Systemic lupus erythematous (SLE) -> lupus nephritis
  • Vasculitis -> nephritis
  • Chronic inflammation in poorly controlled inflammatory disease -> high levels of serum amyloid A (SAA) protein -> SAA deposits in organs (AA amyloidosis)
  • Non-steroidal anti-inflammatory drugs (NSAIDs) can cause kidney impairment
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8
Q

what do LFTs measure?

A
  • Bilirubin
  • Alanine aminotransferase (ALT)
  • Alkaline phosphatase (ALP)
  • Albumin
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9
Q

what needs to be done on patients on methotrexate?

A

regular blood tests (Every 8 weeks)

DMARDs (methotrexate) can cause liver damage

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10
Q

what can low albumin indicate?

A

problem of synthesis (in liver)

the problem of a leak from kidney (e.g lupus nephritis)

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11
Q

what does a bone profile indicate?

A
  • Calcium
  • Phosphate (PO4)
  • Alkaline phosphatase (ALP)
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12
Q

why is ALP measured in bone and liver

A

ALP can be found in bone or liver

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13
Q

what is Page’s disease?

A

disease caused by abnormality of high bone turnover

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14
Q

what are the clinical features of paget’s disease?

A

bone pain

excessive pain growth

fracture through area of abnormal bone

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15
Q

what are the bone profile results for osteomalacia?

A

ALP normal or increased

CA and PO4 normal or low

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16
Q

what is osteomalacia?

A

soft bones due to vitamin D deficiency

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17
Q

what is osteoporosis?

A

low bone density

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18
Q

what is the bone profile for osteoporosis?

A

calcium, PO4 and ALP normal?

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19
Q

how is osteoporosis diagnosed?

A

DEXTA scan

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20
Q

what is ESR & CRP?

A

marker of inflammation

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21
Q

why might ESR be raised other than inflammation?

A
  • Elevated immunoglobulin level
  • Paraprotein (myeloma)
  • Anaemia
  • Tends to rise with age
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22
Q

is ESR or CRP more specific for inflammation?

A

CRP

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23
Q

which is more useful ESR or CRP in SLE?

A
  • ESR usually high but CRP normal
  • Exceptions to the rule: CRP high in SLE if there is significant synovitis or there is an inflammatory pleural or pericardial effusion
  • If CRP in lupus, have a low index of suspicion for infection
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24
Q

what are the 2 types of autoantibodies in RA?

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A

rheumatoid factor

cyclin citrullinated peptides (CCP) antibodies

25
what is rheumatoid factor?
1. Antibodies that recognize the Fc portion of IgG as their target antigen typically IgM antibodies i.e. _IgM anti-IgG antibody_ ! 2. Positive in 70% at disease onset and further 10-15% become positive over the first 2 years of diagnosis
26
what does CCP antibodies show?
more specific than RF worse prognosis associated
27
what are anti-nuclear antibodies?
* Antibodies directed at nuclear component of the cell –
28
when is ANA test ordered?
* **only** order if suspect autoimmune CT diseases clinically
29
what are the non specific causes of altered ANA?
* Relatively common in general healthy population at low titre (level) * Prevalence of ANA increases with age in the general population * Sometimes transiently positive following infection
30
what are the rheumatological uses of ANA?
* High titre ANA in combination with the correct clinical features may indicate one of the autoimmune connective tissue diseases (eg SLE, Sjogren’s syndrome, scleroderma)
31
what are the signs of SLE?
1. Arthritis/ arthralgia 2. Skin rash (photosensitive) 3. Mouth ulcers 4. Kidney disease 5. Haematological abnormalities 6. Pleural effusion 7. Pericardial effusion
32
what are the signs of Sjogren's syndrome?
1. Dry eyes 2. Dry mouth 3. Extra-articular features
33
what are the signs of scleroderma
1. Vasculopathy (esp Raynaud’s phenomenon) 2. Skin thickening 3. Organ fibrosis
34
what are the signs of polymyositis?
1. Muscle inflammation 2. Weakness 3. High CK
35
how is ANA interpreted?
* Strength of ANA is reported as maximal dilution at which it is still detectable * eg 1:80 (weak), 1:320, 1:640, 1:1280 (strong) * Negative test rules out SLE
36
what does negative ANA rule out?
SLE
37
what does a positive test suggest?
* Positive test does not necessarily mean SLE, but suggestive IF there are other clinical and lab features to support the diagnosis. A stronger test is more likely to be clinically significant
38
what other tests should be done if ANA is positive?
ENA: panel of 5 autoantibodies dsDNA (double stranded DNA antibodies) complement C3 and C4
39
what are the ENA tests and what diseases do they suggest?
* Ro- Lupus or Sjogrens syndrome * La- lupus or Sjogren’s syndrome * RNP- lupus or mixed connective tissue disorder * Smith- lups * Jo-1- Polymyositis
40
what is dsDNA useful for?
* highly specific for lupus * associated with renal involvement * useful for tracking lupus activity over time
41
what is complement C4 and C3 useful for?
may be decreased in active lupus
42
how is synovial fluid obtained?
aspiration fluid from a joint
43
what are the indications for joint aspiration?
* diagnostic: to obtain synovial fluids for analysis * therapeutic: to relieve symptoms (+/- concurrent steroid injections)
44
what are the diagnostic uses of synovial fluid analysis?
suspected septic arthritis diagnosing crystal arthritis
45
how is synovial fluid used for septic arthritis?
* gold standard for diagnosis * send for MC&S * enables causative organism to be identified * sensitivities from culture guide antibiotic choice
46
how is synovial fluid used for crystal arthritis?
* Gout and pseudogout * Aspiration and examining under microscope using polarised light * Gout: needle shaped with negative birefringence * Pseudogout: rhomboid shaped with positive birefringence
47
what are the differences in septic arthritis and reactive arthritis?
* Synovial fluid * SA= positive * RA= sterile * Antibiotic therapy * SA= yes * RA= no * Joint lavage * SA= yes- for large joints * RA= no
48
what is the first line imaging in rheumatology?
X-rays: first-line, cheap, widely available
49
why are MRI useful in rheumatology?
* Best visualization of soft tissue structures like tendons and ligaments * Best for spinal imaging: can see spinal cord and exiting nerve roots * Expensive and time-consuming
50
when is ultrasound useful in rheumatology?
* Like MRI can visualize soft tissue structures. * Good for smaller joints, less good for deep/large joints like knee or hip
51
what are the x-ray findings for osteoarthritis?
* Plain X-rays remain the most useful test in the diagnosis of OA * Radiographic features of osteoarthritis: * Joint space narrowing (bone touching bone) * Subchondral bony sclerosis * Osteophytes * Subchondral cysts
52
what is the ray finding in Rheumatoid arthritis?
* Soft tissue swelling * Peri-articular osteopenia * Bony erosions- established disease occurance
53
what is the aim of treatment of RA?
treat early before erosions (permanent damage) occur
54
what are the US changes in RA?
* Synovial hypertrophy (thickening) * Increased blood flow (seen as doppler signal) * May detect erosions not seen on plain X-ray
55
what are the differences in radiographic changes between RA and osteoarthritis?
56
what does joint space narrowing indicate?
* articular cartilage loss * In RA is secondary damage due to synovitis * In OA is primary abnormality
57
what are osteophytes in different locations called?
* Osteophytes at the distal interphalangeal joints= Heberden’s nodules, * at proximal inter-phalangeal joints= Bouchard’s nodules
58
what is a common early radiographic sign of inflammatory arthritis in any cause?
juxta-articular osteopenia
59
where do bone erosions initially occur?
at the margins of the joint where the synovium is in direct contact with bone (the bare area)

1B Musculoskeletal (7 decks)

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