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44 Cards in this Set
- Front
- Back
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Arthritis in RA is
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Symmetrical and potentially deforming
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Susceptible gene for RA
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HLA-DR4/DR1
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Pathology of RA
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Synovium laden with macrophages and giant cells
Synovium expands and invades surrounding bone and cartilage |
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Finger joints involved in RA and OA
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RA - MCPs and PIPs
OA - PIPs and DIPs and 1st CMC |
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Antibodies in RA
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Anti CCP and rheumatoid factor
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Treatment in RA
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DMARDs with steroids to cover lag-phase
Frequent review until stable |
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SLE arthritis features
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No deforming, RA distribution but no radiological erosions
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Antibodies in SLE
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Anti-nuclear antibody (ANA) especially in the presence of anti-dsDNA, anti-Sm, anti Ro and La
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Monitoring SLE
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Anti dsDNA positively correlates with disease acitivity
Complement levels negatively correlate with disease activity Urine tests for renal function |
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Treatment of SLE
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Mild - NSAIDs, hydroxychloroquine, topical steroids
Moderate - Oral steroids, azathioprine, methotrexate Severe - IV steroids, Rituxamib |
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Features of limited and diffuse systemic sclerosis
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Limited - CREST (Calconosis, Raynaud’s, Esophageal dysmotilty, Sclerodactyly, Telangiectasia)
Diffuse - skin changes and early organ involvement |
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Sjogren's syndrome antibodies
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Anti-Ro and Anti-La
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Systemic sclerosis antibodies; limited and diffuse
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Limited - anti-centromere
Diffuse - anti-scl-70 |
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Mixed connective tissue antibody
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Anti-RNP
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Antiphospholipid syndrome antibodies
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Anti cardiolipin and lupus anti-coagulant
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Polymyositis =
Dermatomyositis = |
Inflammatory disease characterised by invasion of muscles
Demartomyositis = polymyositis + skin involvement |
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Poly/dermomyositis antibodies
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Anti-Jo-1
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Crystals in gout
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Urate crystals
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Crystals in pseudogout
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Calcium pyrophosphate crystals
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Under polarised light
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Urate (gout) = negatively birefringement and needle shaped
Calcium pyrophosphate (pseudogout) = positive and rhomboid shaped |
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Gout is more common in
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MEN (10:1)
High alcohol and meat intake People taking diuretics (thiazide) Diseases such as hypothyroid, psoriasis, renal or heart failure |
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Most commonly affected joint in gout
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1st MTP
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Gout can be associated with
(renal) |
Stone formation (urolithiasis)
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Most common site for pseudogout
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Knee
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X-ray sign in gout
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Punched out lesions
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Heberden's nodes are found on
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(Osteoarthritis)
Bouchard - PIP |
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Main side effects of sulfasalazine
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Nausea, skin rashes, mouth ulcers, neutropaenia (low level of white cells (neutrophils)) and/or thrombocytopenia (decreased platelets)
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Isolated raise in ALP
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Paget's disease
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Squaring of thumb occurs in
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Osteoarthritis
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Signs of OA of the knee
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Knee effusion, crepitations, osteophytes, decreased range of movement, genu varum and valgum
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Treatment of OA
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Lifestyle - not due to overuse, no bed rest, physio, weight loss
Pharma - paracetemol, NSAIDs (if appropriate) |
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How long should you wait to start allopurinol after an attacj
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2-4 weeks after attack
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Baker's cyst
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Fluctuant swelling on the back of the leg (in the popliteal space)
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Treatment for OA
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Lifestyle advice - not due to over-use, keep active, no bed rest, weight loss, physio
Pharmacological - paracetamol or NSAIDs (if appropriate) |
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How long does gout take to resolve?
Treated and not |
Treated - 3 days
Untreated - 10 days |
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What are tophi
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Chronic gout lesions, often secondary to long term diuretic use, may ulcerate and excrete uric acid
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Treatment for pseudogout
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NSAIDs, colchicine, steroids
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HLA associated diseases
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Ankylosing spondilitis
Goodpastures Rheumatoid SLE Grave'sT1DM |
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Gene in Ankylosing spondilitis
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HLA-B27
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What type of immune reaction is SLE?
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Type III - immune complex mediated
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Treatment for SLE
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Sun avoidance (if sun-sensitive), NSAIDs, hydroxychloroquine, DMARDs (methoxtrexate/azothioprine)
Rituximab if severe and unresponsive |
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What type of immune reaction is Rheumatoid Arthritis?
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Type IV - delayed hypersensitivity
Infiltration of synvoium by CD4+ T cells |
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What is rheumatoid factor?
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Antibody directed against the common (Fc) region of human IgG
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How many patients will have rheumatoid factor present at diagnosis?
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50%
(25% become +ve in next 2years) |
