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Rheumatology quiz
Indian Journal of Rheumatology 2011 December Volume 6, Number 4; p. 197
PG Forum
Rheumatology quiz Vivek Arya, Varun Dhir
1. The non-steroidal anti-inflammatory drugs (NSAIDs) which is most commonly associated with aseptic meningitis is (a) diclofenac sodium (b) ibuprofen (c) mefenamic acid (d) indomethacin
6. All the following are true for QT interval changes following anti-TNF therapy except (a) prolongation of QT interval is the commonest change (b) usually clinically silent (c) unrelated to underlying diagnosis (d) more often seen with infliximab than with etanercept
2. “Shoulder pad” sign is seen in (a) sarcoidosis (b) rotator cuff tear (c) polymyalgia rheumatica (d) amyloid arthropathy
7. Eotaxin-3 has recently been shown to be a marker for active disease in (a) granulomatosis with polyangiitis (formerly Wegener’s granulomatosis) (b) microscopic polyangiitis (c) Churg–Strauss syndrome (d) Takayasu’s arteritis
3. Bony enlargement of the second and third metacarpophalangeal (MCP) joints with decreased range of movement is characteristically seen in (a) acromegaly (b) hemochromatosis (c) glycogen storage disorders (d) diffuse idiopathic skeletal hyperostosis
8. Anti-Jo-1 antibodies correlate best with which of the following skin manifestations of dermatomyositis? (a) Gottron’s papules (b) shawl sign (c) heliotrope rash (d) mechanic’s hands
4. Carcinoma-associated fasciitis is most commonly seen with carcinoma of the (a) breast (b) endometrium (c) ovary (d) stomach
9. Which of the following human leucocyte antigen (HLA) loci is associated with a slower progression of Human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome (AIDS)? (a) B5 (b) B27 (c) B47 (d) DR4
5. All the following features predict a chronic course in adult-onset Still’s disease (AOSD) except (a) polyarthritis (b) root joint involvement (c) human leucocyte antigen Bw35 positivity (d) higher baseline aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels
10. Which of the following HLA-B27 loci are not associated with an increased risk for ankylosing spondylitis? (a) B27*02 (b) B27*04 (c) B27*05 (d) B27*06 For answers refer page 200
doi: 10.1016/S0973-3698(11)60207-0
200
Indian Journal of Rheumatology 2011 December; Vol. 6, No. 4
with etanercept for one and a half years, to which she responded. Eight years after stopping etanercept, she developed skin lesions consistent with lupus erythematosus tumidus. There was no evidence of systemic involvement. Serological evaluation revealed a homogenous positive ANA in a titre of 1:160. Anti-dsDNA antibodies, SSB-La, Sm, Jo1, Scl-70, U1, SnRNP, and antihistone antibodies were negative, while SSA-Ro antibodies were positive by enzyme immunoassay, and anti-cyclic citrullinated peptide (anti-CCP) antibody test was positive by chemiluminescence. HLA class II genotyping for DRB1*DQB1* was performed by polymerase chain reaction low and medium resolution sequence-specific oligonucleotide assay; the results were as follows: DRB1 generic typing, DRB1*03XX and 15X; allelic typing, DRB1*0315, DRB1*1510, DRB1*0105, DRB1*0111; DQB1 generic typing, DQB1*02XX and 06XX; and allelic typing, DQB1*0202, DQB1*0601, 06012. The erythematous plaques disappeared after 6 months of hydroxychloroquine along with measures for decreasing sun exposure, and her RA disease activity remained low on methotrexate. This report highlights the fact that lupus may develop several years following tumour necrosis factor-blocker therapy.
shown that levels of MMP-3 correlate well with disease activity in this disorder. 8. Habibi S, Aggarwal A, Ramanan AV. Paediatric rheumatology in India: challenges and opportunities. Rheumatology (Oxford) 2011 Aug 28. [Epub ahead of print] The authors have highlighted issues related to paediatric rheumatology in India—prevalence of various disorders, need for trained paediatric rheumatologists and for much needed curricular reforms. They also highlight the differences between paediatric rheumatological disorders in India and in the West—higher frequency of ERA type of JIA, greater renal and CNS involvement in paediatric lupus in India and a higher prevalence of infection associated disorders. 9. Chogle AR, Shah CV, Murthy AK. Role of anti-tumor necrosis factor-alpha blockers in inducing lupus erythematosus tumidus in “rhupus syndrome”. J Rheumatol 2011; 38: 1218–9. The authors describe a patient who developed a rare variant of cutaneous lupus erythematosus several years after anti-TNF therapy for rheumatoid arthritis (RA). A 58-year-old woman with a 12-year history of seropositive RA failed to respond to a triple disease modifying antirheumatic drugs (DMARD) combination. She was treated
ANSWERS TO THE RHEUMATOLOGY QUIZ (PAGE 197) 1b, 2d*, 3b**, 4c***, 5c†, 6d††, 7c§, 8d, 9b§§, 10d¶. *Marked enlargement of both shoulders due to amyloid deposition in periarticular tissue. N Engl J Med 351; 25: e23. **Clin Exp Rheumatol 2001; 19: 98–102. ***Painful swelling and contractures of the hands. Clin Exp Dermatol 2008; 33: 10–5. † This HLA locus is believed to be protective in AOSD and its presence is associated with self-limiting disease.
Arya
††
Seen equally often with both drugs, no difference in changes in RA versus AS. J Rheumatol First Release Nov 1 2011; doi: 10.3899/jrheum.110158. § Specificity and sensitivity 98.6% and 85.5%, respectively, for active CSS. Rheumatology 2011; 50: 1737–8. doi: 10.1093/rheumatology/ker007. §§ AIDS Rev 2004; 6: 89–96. ¶ HLA B27*06 and HLA B27*09 have been found not to be associated with ankylosing spondylitis. Rheumatology 2002; 41: 857–68 provides a good review of HLA-B27 and its association with ankylosing spondylitis.
PG Forum
Rheumatology quiz Vivek Arya, Varun Dhir
1. The non-steroidal anti-inflammatory drugs (NSAIDs) which is most commonly associated with aseptic meningitis is (a) diclofenac sodium (b) ibuprofen (c) mefenamic acid (d) indomethacin
6. All the following are true for QT interval changes following anti-TNF therapy except (a) prolongation of QT interval is the commonest change (b) usually clinically silent (c) unrelated to underlying diagnosis (d) more often seen with infliximab than with etanercept
2. “Shoulder pad” sign is seen in (a) sarcoidosis (b) rotator cuff tear (c) polymyalgia rheumatica (d) amyloid arthropathy
7. Eotaxin-3 has recently been shown to be a marker for active disease in (a) granulomatosis with polyangiitis (formerly Wegener’s granulomatosis) (b) microscopic polyangiitis (c) Churg–Strauss syndrome (d) Takayasu’s arteritis
3. Bony enlargement of the second and third metacarpophalangeal (MCP) joints with decreased range of movement is characteristically seen in (a) acromegaly (b) hemochromatosis (c) glycogen storage disorders (d) diffuse idiopathic skeletal hyperostosis
8. Anti-Jo-1 antibodies correlate best with which of the following skin manifestations of dermatomyositis? (a) Gottron’s papules (b) shawl sign (c) heliotrope rash (d) mechanic’s hands
4. Carcinoma-associated fasciitis is most commonly seen with carcinoma of the (a) breast (b) endometrium (c) ovary (d) stomach
9. Which of the following human leucocyte antigen (HLA) loci is associated with a slower progression of Human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome (AIDS)? (a) B5 (b) B27 (c) B47 (d) DR4
5. All the following features predict a chronic course in adult-onset Still’s disease (AOSD) except (a) polyarthritis (b) root joint involvement (c) human leucocyte antigen Bw35 positivity (d) higher baseline aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels
10. Which of the following HLA-B27 loci are not associated with an increased risk for ankylosing spondylitis? (a) B27*02 (b) B27*04 (c) B27*05 (d) B27*06 For answers refer page 200
doi: 10.1016/S0973-3698(11)60207-0
200
Indian Journal of Rheumatology 2011 December; Vol. 6, No. 4
with etanercept for one and a half years, to which she responded. Eight years after stopping etanercept, she developed skin lesions consistent with lupus erythematosus tumidus. There was no evidence of systemic involvement. Serological evaluation revealed a homogenous positive ANA in a titre of 1:160. Anti-dsDNA antibodies, SSB-La, Sm, Jo1, Scl-70, U1, SnRNP, and antihistone antibodies were negative, while SSA-Ro antibodies were positive by enzyme immunoassay, and anti-cyclic citrullinated peptide (anti-CCP) antibody test was positive by chemiluminescence. HLA class II genotyping for DRB1*DQB1* was performed by polymerase chain reaction low and medium resolution sequence-specific oligonucleotide assay; the results were as follows: DRB1 generic typing, DRB1*03XX and 15X; allelic typing, DRB1*0315, DRB1*1510, DRB1*0105, DRB1*0111; DQB1 generic typing, DQB1*02XX and 06XX; and allelic typing, DQB1*0202, DQB1*0601, 06012. The erythematous plaques disappeared after 6 months of hydroxychloroquine along with measures for decreasing sun exposure, and her RA disease activity remained low on methotrexate. This report highlights the fact that lupus may develop several years following tumour necrosis factor-blocker therapy.
shown that levels of MMP-3 correlate well with disease activity in this disorder. 8. Habibi S, Aggarwal A, Ramanan AV. Paediatric rheumatology in India: challenges and opportunities. Rheumatology (Oxford) 2011 Aug 28. [Epub ahead of print] The authors have highlighted issues related to paediatric rheumatology in India—prevalence of various disorders, need for trained paediatric rheumatologists and for much needed curricular reforms. They also highlight the differences between paediatric rheumatological disorders in India and in the West—higher frequency of ERA type of JIA, greater renal and CNS involvement in paediatric lupus in India and a higher prevalence of infection associated disorders. 9. Chogle AR, Shah CV, Murthy AK. Role of anti-tumor necrosis factor-alpha blockers in inducing lupus erythematosus tumidus in “rhupus syndrome”. J Rheumatol 2011; 38: 1218–9. The authors describe a patient who developed a rare variant of cutaneous lupus erythematosus several years after anti-TNF therapy for rheumatoid arthritis (RA). A 58-year-old woman with a 12-year history of seropositive RA failed to respond to a triple disease modifying antirheumatic drugs (DMARD) combination. She was treated
ANSWERS TO THE RHEUMATOLOGY QUIZ (PAGE 197) 1b, 2d*, 3b**, 4c***, 5c†, 6d††, 7c§, 8d, 9b§§, 10d¶. *Marked enlargement of both shoulders due to amyloid deposition in periarticular tissue. N Engl J Med 351; 25: e23. **Clin Exp Rheumatol 2001; 19: 98–102. ***Painful swelling and contractures of the hands. Clin Exp Dermatol 2008; 33: 10–5. † This HLA locus is believed to be protective in AOSD and its presence is associated with self-limiting disease.
Arya
††
Seen equally often with both drugs, no difference in changes in RA versus AS. J Rheumatol First Release Nov 1 2011; doi: 10.3899/jrheum.110158. § Specificity and sensitivity 98.6% and 85.5%, respectively, for active CSS. Rheumatology 2011; 50: 1737–8. doi: 10.1093/rheumatology/ker007. §§ AIDS Rev 2004; 6: 89–96. ¶ HLA B27*06 and HLA B27*09 have been found not to be associated with ankylosing spondylitis. Rheumatology 2002; 41: 857–68 provides a good review of HLA-B27 and its association with ankylosing spondylitis.