Musculoskeletal Medicine & Rheumatology Flashcards

A 58-year-old woman presents with proximal limb weakness, difficulty rising from a chair, and a heliotrope (violaceous) rash around her eyelids. Serum CK is markedly elevated. What is the most likely diagnosis?

Answer: Dermatomyositis

Dermatomyositis presents with proximal inflammatory myopathy, markedly elevated CK, and pathognomonic skin findings including the heliotrope rash and Gottron's papules.

A 72-year-old woman presents with 3 months of bilateral shoulder and pelvic girdle aching and stiffness worse in the mornings, ESR 85 mm/hr, and CRP 45 mg/L. She responds dramatically to 15 mg prednisolone. What is the most likely diagnosis?

Answer: Polymyalgia rheumatica

Polymyalgia rheumatica presents in patients >50 years with bilateral girdle pain and stiffness, markedly elevated inflammatory markers, and a dramatic response to low-dose corticosteroids.

Which important complication must all patients with polymyalgia rheumatica be warned about and screened for?

Answer: Giant cell arteritis

Giant cell arteritis occurs in 15–20% of PMR patients and can cause irreversible ischaemic visual loss; patients must be warned to report new headache, jaw claudication, or visual symptoms urgently.

A 26-year-old man develops asymmetrical oligoarthritis, urethritis, and conjunctivitis 3 weeks after a confirmed Chlamydia trachomatis infection. What is this condition?

Answer: Reactive arthritis

Reactive arthritis (formerly Reiter's syndrome) is a sterile inflammatory arthritis triggered by genitourinary or gastrointestinal infection, classically causing the triad of arthritis, urethritis, and conjunctivitis.

A patient with rheumatoid arthritis on long-term methotrexate develops painful mouth ulcers and a macrocytic anaemia. Which supplement should be co-prescribed with methotrexate to prevent these side effects?

Answer: Folic acid

Folic acid is routinely co-prescribed with methotrexate to reduce folate-deficiency side effects such as mucositis and macrocytic anaemia caused by methotrexate's folate antagonism.

Which set of X-ray findings is characteristic of osteoarthritis, distinguishing it from inflammatory arthritis?

Answer: Joint space narrowing, osteophytes, subchondral sclerosis, and cysts

Osteoarthritis shows asymmetric joint space narrowing, osteophyte formation, subchondral sclerosis, and subchondral cysts — degenerative rather than erosive or inflammatory changes.

A 40-year-old woman with limited cutaneous systemic sclerosis develops severe Raynaud's phenomenon and is found to have pulmonary arterial hypertension on echocardiography. Which antibody is most associated with this presentation?

Answer: Anti-centromere antibody

Anti-centromere antibody is associated with limited cutaneous systemic sclerosis (CREST syndrome) and carries significantly increased risk of pulmonary arterial hypertension.