1
Q
What is rheumatoid arthritis?
A
Chronic autoimmune inflammation of synovial joints
It can affect individuals of any age, with a higher prevalence in middle-aged women.
2
Q
What are the risk factors for rheumatoid arthritis?
A
- Smoking
- Obesity
- Family history (HLA DR4)
These factors increase the likelihood of developing the condition.
3
Q
What is the pathophysiology of rheumatoid arthritis?
A
Inflammation of synovial lining of joints, tendon sheaths, and bursae leading to thickening and infiltration by inflammatory cells.
4
Q
What is the typical presentation of rheumatoid arthritis?
A
- Joint pain
- Stiffness worse in morning (>30 mins)
- Inflammation (red, hot, swollen)
- General fatigue, malaise, weight loss, myalgia
Symmetrical distal polyarthritis is common.
5
Q
What are some characteristic hand symptoms associated with rheumatoid arthritis?
A
- Swan neck deformity
- Boutonniere deformity
- Z thumb
- Ulnar deviation
- Subluxation
These deformities affect the fingers and wrists.
6
Q
What is palindromic rheumatism?
A
Self-limiting episodes of inflammatory arthritis that last a few days and may resolve.
7
Q
What are extra-articular symptoms of rheumatoid arthritis?
A
- Pulmonary fibrosis
- Felty’s syndrome
- Sjogren’s syndrome
- Anemia of chronic disease
- Cardiovascular disease
- Rheumatoid nodules
- Lymphadenopathy
- Carpal tunnel syndrome
- Amyloidosis
- Bronchiolitis obliterans
- Caplan syndrome
These symptoms can affect various organ systems beyond the joints.
8
Q
What are the key laboratory findings in rheumatoid arthritis?
A
- Anemia
- Thrombocytosis
- Raised CRP
- Raised ESR
- Positive rheumatoid factor
- Positive anti-CCP
These tests help in diagnosing the disease.
9
Q
What is the significance of the Health Assessment Questionnaire (HAQ)?
A
Measures functional ability in patients with rheumatoid arthritis.
10
Q
What is the first-line treatment for rheumatoid arthritis?
A
Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate.
11
Q
What are common side effects of methotrexate?
A
- Mouth ulcers
- Liver toxicity
- Bone marrow suppression
- Leukopenia
- Teratogenic effects
Regular monitoring of FBC and LFTs is crucial.
12
Q
What are biological therapies used for in rheumatoid arthritis?
A
To interact with the immune system and reduce inflammation when there is an inadequate response to DMARDs.
13
Q
What is the role of TNF inhibitors in rheumatoid arthritis treatment?
A
They are used when there is an inadequate response to two or more DMARDs.
14
Q
What is psoriatic arthritis?
A
Inflammatory arthritis associated with psoriasis.
15
Q
What are the five patterns of psoriatic arthritis?
A
- Asymmetrical oligoarthritis
- Symmetrical polyarthritis
- DIP predominant pattern
- Spondylitis
- Arthritis mutilans
These patterns describe the various ways the disease can manifest.
16
Q
What is the typical presentation of ankylosing spondylitis?
A
- Lower back pain
- Stiffness in buttocks
- Pain worse at night, improves with movement
May progress to a kyphotic posture.
17
Q
What are the extra-articular features of ankylosing spondylitis?
A
- Anterior uveitis
- Amyloidosis
- Aortic regurgitation
- AV node block
- Sausage digit (dactylitis)
- Inflammatory back pain
- Crohn’s disease
These features may accompany the joint symptoms.
18
Q
What is osteomalacia?
A
Soft bones due to decreased bone mineral content and low vitamin D.
19
Q
What are common causes of osteomalacia?
A
- Vitamin D deficiency
- Malabsorption
- Chronic kidney disease
These factors impair the body’s ability to properly mineralize bones.
20
Q
What is osteoporosis?
A
Low bone mass leading to fragile bones and increased fracture risk.
21
Q
What are the common risk factors for osteoporosis?
A
- Older age
- Female gender
- Post-menopausal status
- Reduced mobility
- Low BMI
- Low calcium/vitamin D intake
These factors contribute to the development of osteoporosis.
22
Q
What does a DEXA scan measure?
A
Bone mineral density at the femoral neck.
23
Q
What is the first-line treatment for osteoporosis?
A
Bisphosphonates, such as Alendronate or Risedronate.
24
Q
What are the side effects of bisphosphonate therapy?
A
Reflux, oesophageal erosions, atypical fractures, osteonecrosis of jaw, external auditory canal
These side effects necessitate reassessment of bisphosphonate treatment after 3-5 years.
25
What is Denosumab and how does it function?
Monoclonal antibody against osteoclasts, administered subcutaneously twice yearly, inhibits RANK ligand
## Footnote
This inhibition prevents the maturation of osteoclasts, which are responsible for bone resorption.
26
How does Teriparatide affect bone health?
Acts as parathyroid hormone, increases bone formation
## Footnote
Teriparatide is used in the treatment of osteoporosis.
27
What is Raloxifene and its mechanism of action?
Selective oestrogen receptor modulator that stimulates oestrogen receptors in bones
## Footnote
Raloxifene is used in the treatment of osteoporosis.
28
What is Strontium ranelate's effect on bone?
Stimulates osteoblasts and blocks osteoclasts
## Footnote
It is used to treat osteoporosis.
29
What characterizes Paget’s disease of bone?
Focal bone remodeling due to increased bone turnover
## Footnote
It has a prevalence of about 5%.
30
What is the primary pathophysiology of Paget’s disease?
Cause is unknown, involves increased osteoclast and osteoblast activity
## Footnote
New bone formed is weaker, leading to deformities and fractures.
31
What are common risk factors for Paget's disease?
Older age, male sex, Northern latitude, family history
## Footnote
These factors increase the likelihood of developing the disease.
32
What are typical symptoms of Paget’s disease?
Asymptomatic in 60-80%, bone pain, untreated can lead to bowing of tibia and bossing of skull
## Footnote
Symptoms may vary in severity.
33
What laboratory findings are associated with Paget's disease?
Raised alkaline phosphatase, normal calcium and phosphate, raised urinary hydroxyproline
## Footnote
Alkaline phosphatase is a marker of bone turnover.
34
What imaging findings are characteristic of Paget's disease?
Localized bony enlargement, sclerotic changes, osteolytic areas, thickened skull vault
## Footnote
X-rays may show a cotton wool appearance in the skull.
35
What is the primary treatment for Paget's disease?
Bisphosphonates, calcitonin if bisphosphonates are unsuitable, analgesia, calcium and vitamin D supplementation
## Footnote
Surgery may be needed for fractures or deformities.
36
What is gout?
Joint inflammation due to deposition of monosodium urate (MSU) crystals in joints
## Footnote
It is classified as a type of crystal arthritis.
37
What causes gout?
High serum uric acid levels, decreased excretion, increased production, dietary factors
## Footnote
Renal dysfunction and certain medications can also contribute.
38
What are the classic symptoms of gout?
Pain, swelling, erythema, typically affecting the 1st MTP joint
## Footnote
Gouty tophi may also develop in chronic cases.
39
What laboratory tests are used to diagnose gout?
Raised serum uric acid during acute flare, synovial fluid analysis, X-ray findings
## Footnote
Polarised light microscopy can identify needle-shaped negatively birefringent crystals.
40
What is the first-line treatment for acute gout flares?
NSAIDs and a PPI, colchicine as a second option, oral steroids as a third option
## Footnote
Treatment should be initiated promptly to relieve symptoms.
41
What is pseudogout?
Deposition of calcium pyrophosphate (CPP) crystals on joint surfaces, leading to inflammation
## Footnote
Also known as calcium pyrophosphate dihydrate crystal deposition disease (CPPD).
42
What are the common symptoms of pseudogout?
Pain, stiffness, swelling, typically in the knee, shoulder, hip, or wrist
## Footnote
Symptoms can be acute or chronic.
43
What findings support a diagnosis of fibromyalgia?
Widespread chronic pain, specific tenderness at 11 of 18 tender points
## Footnote
Associated symptoms include fatigue, cognitive impairment, and sleep disturbances.
44
What is systemic lupus erythematosus (SLE)?
Inflammatory autoimmune multi-system disorder, more common in females aged 20-40
## Footnote
Characterized by anti-nuclear antibodies and relapsing-remitting course.
45
What are common clinical features of SLE?
Fatigue, weight loss, fever, lymphadenopathy, malar rash, arthritis
## Footnote
Symptoms can involve multiple systems including skin, joints, and kidneys.
46
What laboratory tests are used to diagnose SLE?
85% ANA positive, anti-dsDNA specific for SLE, anti-Sm specific but not sensitive
## Footnote
Other auto-antibodies may indicate associated conditions.
47
What is the primary treatment for SLE?
Hydroxychloroquine, NSAIDs, steroids, DMARDs
## Footnote
Treatment is tailored based on the severity and organ involvement.
48
What is discoid lupus erythematosus?
Autoimmune chronic skin condition with follicular keratin plugs, characterized by raised erythematous rashes
## Footnote
Less than 5% progress to SLE.
49
What is systemic sclerosis?
Autoimmune disorder involving inflammation and fibrosis of connective tissues and skin
## Footnote
It can lead to significant complications including pulmonary hypertension.
50
What are the hallmark features of limited cutaneous systemic sclerosis?
CREST syndrome: Calcinosis, Raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia
## Footnote
This form is more common and has a better prognosis than diffuse systemic sclerosis.
51
What is Raynaud’s phenomenon?
Episodic vasospasm in fingers or toes in response to cold or stress
## Footnote
It can be primary (Raynaud's disease) or secondary to other conditions.
52
What are the primary symptoms of Sjogren’s syndrome?
Dry eyes, dry mouth, parotid swelling, systemic signs like fatigue and polyarthritis
## Footnote
It involves autoimmune destruction of exocrine glands.
53
What is the treatment for myositis?
Corticosteroids, immunosuppressants, physical therapy
## Footnote
Treatment aims to reduce inflammation and improve muscle strength.
54
What is polymyositis?
A condition characterized by symmetrical progressive proximal muscle weakness affecting shoulders and hips
## Footnote
Symptoms include difficulty squatting, climbing stairs, and raising hands, along with fatigue and muscle cramps.
55
What are common symptoms of dermatomyositis?
Heliotrope rash, Gottron's sign, photosensitive erythematous rash, and extra-muscular symptoms such as fever and arthralgia
## Footnote
Heliotrope rash is a purple discoloration of the eyelids, while Gottron's sign presents as scaly erythematous plaques over knuckles.
56
What laboratory findings are typically elevated in polymyositis and dermatomyositis?
CK, LDH, aldolase, AST, ALT
## Footnote
Autoantibodies such as anti-Jo-1 are also commonly present.
57
What is Behçet's disease?
A complex autoimmune inflammatory condition affecting blood vessels and tissues
## Footnote
It is characterized by a classic triad of oral ulcers, genital ulcers, and anterior uveitis.
58
What is the classic triad of Behçet's disease?
Oral ulcers, genital ulcers, anterior uveitis
## Footnote
The ulcers are painful and can heal in 2-4 weeks.
59
What are common symptoms of chronic fatigue syndrome (CFS)?
Disabling fatigue, sleep problems, muscle/joint pains, headaches, cognitive dysfunction
## Footnote
Symptoms worsen with physical or mental exertion.
60
What is the pathophysiology of vasculitis?
Inflammation and necrosis of blood vessel walls, leading to vessel wall destruction and potential complications like aneurysm and thrombosis
## Footnote
Conditions associated with vasculitis include rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and goodpasture syndrome.
61
What are the classifications of vasculitis based on vessel size?
Large vessel, medium vessel, small vessel
## Footnote
Examples include giant cell arteritis for large vessel and microscopic polyangiitis for small vessel.
62
What is the hallmark symptom of polymyalgia rheumatica (PMR)?
Pain and stiffness in the shoulders, pelvic girdle, and neck
## Footnote
Symptoms typically worsen in the morning and improve with activity.
63
What is the first-line treatment for polymyalgia rheumatica?
Oral prednisolone
## Footnote
A dramatic improvement in symptoms is expected within days.
64
What is the primary symptom of temporal arteritis (giant cell arteritis)?
Unilateral headache
## Footnote
Other symptoms include jaw claudication and potential vision loss.
65
What is the treatment for Takayasu's arteritis?
Steroids
## Footnote
This condition affects large vessels, particularly the aorta and its branches.
66
What are the key features of polyarteritis nodosa (PAN)?
Medium-vessel vasculitis leading to necrotizing inflammation and aneurysms
## Footnote
Symptoms include fever, malaise, and mononeuritis multiplex.
67
What characterizes ANCA-associated vasculitis?
Presence of anti-neutrophil cytoplasmic antibodies (ANCA)
## Footnote
Includes microscopic polyangiitis and granulomatosis with polyangiitis (Wegener's granulomatosis).
68
What are the types of hypersensitivity reactions?
Type 1: anaphylactic, Type 2: cell-bound, Type 3: immune complex, Type 4: delayed hypersensitivity
## Footnote
Type 5 involves antibodies binding to cell receptors.
69
What is McArdle's disease?
An autosomal recessive glycogen storage disease caused by myophosphorylase deficiency
## Footnote
Symptoms include muscle pain and stiffness after exercise.
70
What is the role of methotrexate in treatment?
It inhibits the synthesis of purines and pyrimidines to diminish immune response
## Footnote
Indicated for inflammatory arthritis.
71
What is McArdle’s disease?
Autosomal recessive type V glycogen storage disease caused by myophosphorylase deficiency
72
What are the common symptoms of McArdle's disease?
Muscle pain, stiffness after exercise, muscle cramps, myoglobinuria, low lactate during exercise
73
What is the mechanism of action of Methotrexate?
Inhibits enzyme in synthesis of purines/pyrimidines, diminishing immune response
74
List three indications for Methotrexate.
* Inflammatory arthritis, especially RA
* Psoriasis
* Some chemotherapy for ALL
75
What are the side effects of Methotrexate?
* Mucositis
* Myelosuppression
* Pneumonitis
* Pulmonary fibrosis
* Liver fibrosis
76
How long should pregnancy be avoided after stopping Methotrexate?
More than 6 months
77
What is the recommended starting dose of Methotrexate?
7.5 mg
78
True or False: Methotrexate toxicity can be treated with folinic acid.
True
79
What is Azathioprine metabolized to?
Mercaptopurine, a purine analogue that inhibits purine synthesis
80
List two side effects of Azathioprine.
* Bone marrow depression
* Nausea and vomiting
81
What is Hydroxychloroquine used for?
Management of SLE and RA
82
What is a serious side effect of Hydroxychloroquine?
Bull’s eye retinopathy leading to permanent visual loss
83
What is Sulfasalazine used for?
A DMARD used in RA and IBD
84
What is a prodrug for 5-ASA?
Sulfasalazine
85
List two side effects of Sulfasalazine.
* Oligospermia
* Stevens-Johnson syndrome (SJS)
86
What is Still's disease characterized by?
Bimodal age distribution and salmon-pink maculopapular rash
87
What are the symptoms of Still's disease?
* Arthralgia
* Fever that rises in late afternoon/evening
* Lymphadenopathy
88
What laboratory finding is elevated in Still's disease?
Elevated serum ferritin
89
What criteria are used to diagnose Still's disease?
Yamaguchi criteria
90
List two treatments for Still's disease.
* NSAIDs
* Steroids
finals
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