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Flashcards in Rheum Deck (96)
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1

What is monoarthritis

1 joint involved

2

What is oligoarthritis

<= 5 joints affected

3

What is polyarthritis

>5 joints affected

4

Give examples of monoarthritis

gout
septic
osteo

5

Give examples of oligoarthritis

reactive
psoriatic
gout
osteo
ankylosing spondylitis

6

Give examples of polyarthritis

symmetrical:
RA
osteo

asymmetrical
reactive
psoriatic

7

What conditions is Raynaud's present in

SLE
polumyositis
dermatomyositis

8

State some signs in the hands that are typical of RA

Z deformity of thumb
ulnar deviation
swan neck deformity
boutonniere deformity
nail pitting
nail fold vasculitis

9

What is Z deformity of the thumb

MCP flexion
IP hyperextension

10

What is swan neck deformity

PIP hyperextension
DIP flexion

11

What is Boutonniere deformity

PIP flexion
DIP extension

12

What are the key investigations in suspected RA?

Bloods: FBC, CRP, ESR, U+E, LFT, RF, ANA, anti-cyclic citrullinated peptide antibodies
Imaging: XR hands and feet, CXR, US/MRI joints

13

What can happen to CRP and ESR in RA?

inflammatory markers, so raised

14

Does a raised RF diagnose RA?

no!
can be raised in other infam diseases and in healthy!

15

What can a raised ANA (antinuclear antibodies) suggest?

SLE
RA
healthy!

16

What are the systemc problems causes in RA

lympadenopathy
pulmonary fibrosis
peripheral nerve entrapment

17

What vaccines need to be given to those taking DMARDs?

influenza - annual
pneumococcal - 10y
live vaccines contraindicated

18

Does RF or anti-CCP antibodies have a greater specificity for RA?

anti-CCP antibodies

19

What factors indicate a poor prognosis for RA?

rheumatoid factor positive
poor functional status at presentation
HLA DR4
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
insidious onset
anti-CCP antibodies

20

What complications can methotrexate cause?

liver cirrhosis
pneumonitis
myelosupression

21

What complications can prednisolone cause?

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

22

What monitoring needs to happen in methotrexate treatment

Monitoring of FBC & LFTs is essential due to the risk of myelosuppression and liver cirrhosis

23

How long does is take for DMARDs to produce a full response

2-6m

24

Why are DMARDs the best treatment for inflammatory arthritis

suppress disease progress
control the signs and symptoms
limit joint damage.

25

What treatment should be initiated in newly diagnosed active rheumatoid arthritis,

combination of DMARDs (including methotrexate and at least one other DMARD)
a short-term corticosteroid,
within 3 months of the onset of persistent symptoms.

26

When should you consider changing DMARD for a patient?

If a disease-modifying anti-rheumatic drug does not lead to an objective benefit within 6 months, it should be replaced by a different one.

27

When can a TNF inhibitor be prescribed in RA

an inadequate response to at least two DMARDs including methotrexate

28

What type of hypersensitivity reaction is SLE?

type III

29

What are someof the risk factors for SLE?

afro-caribbean
exposure to sunlight
drugs:
EBV

30

What are the key initial features of SLE?

fever
rash
mouth ulcers
joint pain
lympadenopathy