Poly/Monoarthritis

Question 1

What is the ANA blood test for?

Answer 1

AKA anti-nuclear antibodies (ANA)
- Raised in autoimmune disease

Done for arthritis, unexplained rashes, fevers, or chest pain to help diagnose

Question 2

What is Sjogren’s disease?

Answer 2

Autoimmune disease causing dry mouth and eyes

Question 3

What is mixed connective tissue disease (MCTD)?

Answer 3

An autoimmune disease

Diagnosis: presence of anti-U1-ribonuceloprotein in blood and features of more than 2 connective tissue diseases like lupus, systemic sclerosis, dermatomyositis

Question 4

What are the clinical manifestations of SLE?

Answer 4

Systemic:
- Fatigue, reduced exercise tolerance, episodic fever, weight loss

Musculoskeletal:
- Migratory arthralgia that is not erosive

Skin:
- Alopecia, photosensitivity, butterfly face rash, Raynaud’s, Urticaria, mouth ulcers

Question 5

What exacerbates SLE?

Answer 5

• Exposure to UV light exacerbates systemic disease and rash
• Infection
• Mental stress
• Not taking medication

Question 6

What is Raynaud’s phenomenon?

Answer 6

• Periodic, vasospastic disorder of
  extremities provoked by cold exposure
• Triphasic colour change of pallor,
  cyanosis and hyperaemia
  (peripheries white, blue, red)
• Attacks last minutes to hours
• Affects fingers, toes, tip of nose, ear
  lobes

Question 7

What is the difference between primary and secondary Raynaid’s?

Answer 7

Primary: often familial, onset in teens

Secondary: autoimmune, occupational (vibrating instruments), meds like beta-blockers, or chemicals like polyvinyl chloride

Question 8

Which other organs are Involved with SLE?

Answer 8

• Pulmonary (pneumonitis, fibrosis, hypertension)
• Cardiovascular (artery disease, hypertension, pericarditis, endocarditis)
• Renal (proliferative glomerulonephritis, nephritis)
• Neuropsychiatric (depression, headache, seizures, anxiety, psychosis, stroke)

Question 9

What is antiphospholipid syndrome?

Answer 9

• Causes venous, arterial thrombosis and recurrent miscarriage
• Can be primary or secondary to SLE

Question 10

How is SLE diagnosed?

Answer 10

Using the American College of Rheumatology classification of SLE (needs 4+ to diagnose)

1. Malar rash
2. Discoid rash
3. Photosensitivity
4. Oral ulcers
5. Non-erosive arthritis
6. Pleuritis or Pericarditis: chest pain/ rub/ effusion/ ECG evidence
7. Renal disorder: persistent proteinuria > 0.5g/ day or > 3+ protein on dip or
8. Neurologic disorder: seizures or psychosis
9. Haematological disorder
10. Immunological disorder’
11. Positive antinuclear antibody

Question 11

What are the different therapies available for autoimmune rheumatic diseases?

Answer 11

• Corticosteroids (prednisolone)
• Steroid sparing drugs (chloroquine, azathioprine, mycophenolate, mycophenolate, methotrexate)
• Biologics (Rituximab, immunoglobulins)
• Cyclophosphamide

Question 12

How is ankylosing spondylitis scored?

Answer 12

Using Basdai scoring
- Patient scores their symptoms from 1-10 to work out severity of disease

Question 13

What is the DAS score?

Answer 13

The disease activity score to measure rheumatoid arthritis

1-29: low
30-44: moderate
45-100: high

Question 14

How is psoriasis scored?

Answer 14

Using PASI (psoriasis area and severity index) scoring

Investigates body percentage affected, erythema, thickness, and scaling

Question 15

What does ANCA show?

Answer 15

For diagnosis of autoimmune diseases especially vasculitis

Question 16

What blood tests are requested to screen for rheumatic disease?

Answer 16

Anti-CCP
Rheumatoid factor
CRP
ESR
+ FBC, LFT, U&E

Question 17

What diseases is anti-CCP important for?

Answer 17

Rheumatoid arthritis
- It’s a very sensitive test

Question 18

How is rheumatoid arthritis managed?

Answer 18

• Take bloods, especially anti-CCP
• Prescribe prednisolone and 2 DMARDS (1st line methotrexate and hydroxychloroquine)

Question 19

How are GCA and polymyalgia rheumatica linked?

Answer 19

People with PMR (harmless) often have GCA that needs to be screened for and treated because that can cause death