Rheumatology Revision

Question 1

What are the antibodies of SLE?

Answer 1

ANA, dsDNA, anti-Sm, anti-histone (drug-induced)

Question 2

What can be used as a marker of disesase activity in lupus?

Answer 2

dsDNA, C3/C4

Question 3

What is the most specific antibody for SLE?

Answer 3

anti-Sm

Question 4

What are the antibodies of sjogren’s

Answer 4

ANA, Ro, La

Question 5

What antibodies are in mixed connective tissues disease?

Answer 5

anti RNP

Question 6

What antibodies are in scleroderma?

Answer 6

ANA, anti Scl-70 (diffuse), anti centromere (limited), RNA polymerase III (renal crisis

Question 7

What antibodies are in myositis?

Answer 7

ANA, anti Jo1

Question 8

What test should be ordered in statin induced necrotising myopathy?

Answer 8

anti-HMG co-A reductase antibodies

Question 9

What antibodies are in RA?

Answer 9

RF, anti CCP

Question 10

Are RF and anti CCP markers of disease activity in RA?

Answer 10

No

Question 11

What antibodies are in ANCA associated vasculitis?

Answer 11

ANCA

Question 12

What are the three types of ANCA associated vasculitis?

Answer 12

granulomatosis with polyangitis, microscopic polyangits, eosinophilic granulomatosis with polyangitis

Question 13

Which ANCA subtype is associated with GPA?

Answer 13

PR3 antibodies

Question 14

Which ANCA subtype is associated with MPA?

Answer 14

MPO antibodies

Question 15

Which ANCA subtype is associated with EGPA?

Answer 15

MPO and PR3 antibodies

Question 16

Should ANA ever be repeated?

Answer 16

No

Question 17

What is a DMARD?

Answer 17

a disease modifying anti rheumatic drug

Question 18

What are the common conventional synthetic DMARDs?

Answer 18

methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, azathioprine

Question 19

What is the mechanism of action of methotrexate?

Answer 19

purine metabolism inhibitor

Question 20

What are the common side effects of methotrexate?

Answer 20

GI upset, fatigue, mental clouding, mouth ulcers, hair thinning, low blood counts, abnormal LFTs, pneumonitis

Question 21

Why do you need to check UECs in methotrexate?

Answer 21

because it is renally cleared, but it is not renal toxic

Question 22

What medication should be avoided when on methotrexate?

Answer 22

trimethoprim

Question 23

How do you minimise GI SEs of sulfasalazine?

Answer 23

start slow

Question 24

What are the SEs of sulsasalazine?

Answer 24

headaches, GI upset, orange discolourtation of urine/sweat, low blood counts, abnormal LFTs

Question 25

What are the SEs of hydroxychloroquine?

Answer 25

GI side effects, increased sensitibity to sun, blurred vision, worse psoriasis, retinal toxicity

Question 26

How often should patients on hydroxychloroquine get an opthalmology review?

Answer 26

every 12-18 months

Question 27

What are the SEs of leflunomide?

Answer 27

diarrhoea, dry mouth, mouth ulcers, hair thinning, HTN, dizziness, low blood count, abnormal LFTs, pneumonitis, peripheral neuropathy, shingles

Question 28

What test should be done in all patients before starting a DMARD?

Answer 28

quantiferon gold and CXR, Hep B, Hep C, HIV

Question 29

What vaccinations are recommended while on DMARDs?

Answer 29

pneumovax, fluvax and to have any live vaccines required before starting

Question 30

Which rheumatic medications can be used in pregnancy?

Answer 30

glucocorticoids, azathioprine, cyclosporine, tacrolimus, sulfasalazine, anti TNFs, IVIG

Question 31

Which rheumatic medications cant be used in pregnancy?

Answer 31

cyclophosphamide, methotrexate, mycophenolate, leflunomide, NSAIDs

Question 32

What should be done if someone accidentally conceives while on methotrexate?

Answer 32

cease and continue 5mg folate throughout pregnancy

Question 33

Can biologics be used in pregnancy?

Answer 33

TNF inhibitors are safe however others should be ceased

Question 34

What needs to be done about DMARDs in perioperative management?

Answer 34

csDMARDs can continue but biologics need to be stopped

Question 35

What should be done for SLE in perioperative management?

Answer 35

If not severe SLE stop 1/52 prior to surgery