Browse topics
Rheumatology
36 notes, 109 questions and 301 flashcards.
Tier 1 is core knowledge expected of every trainee. Tier 2 is deeper or less common.
Presentations
- Acute lower back painFree sampleSort acute back pain into non-specific, radicular or serious pathology, image only when serious pathology is suspected, and treat with reassurance and activity rather than opioids, paracetamol or gabapentinoids.Tier 1, approach to a presentation, 3 questions, 9 flashcards
- Acute monoarthritisOne hot swollen joint is septic until the aspirate says otherwise. Aspirate first, read the fluid (cells, Gram stain, culture, crystals), then work through gout, CPPD, haemarthrosis, reactive and early inflammatory arthritis, with the traps in older people.Tier 1, approach to a presentation, 3 questions, 8 flashcards
- Approach to polyarthritisIs it inflammatory, how long has it lasted, and what pattern does it follow? Viral arthritis (parvovirus, Ross River) settles within weeks; persistent symmetric small-joint synovitis needs anti-CCP, RF and referral within 6 weeks so DMARDs start early.Tier 1, approach to a presentation, 3 questions, 8 flashcards
Key conditions
- FibromyalgiaChronic widespread pain with fatigue, unrefreshing sleep and cognitive symptoms, diagnosed positively with the 2016 ACR criteria after a few targeted tests. Exercise is the only strongly recommended treatment; low-dose amitriptyline or duloxetine help some, and opioids don't.Tier 1, condition, 3 questions, 8 flashcards
- Polymyalgia rheumatica and giant cell arteritisGirdle stiffness with raised inflammatory markers after 50, the GCA symptoms that make it an emergency, same-day steroids, ultrasound or biopsy, steroid tapers from the 2025 EULAR update, and tocilizumab or upadacitinib to spare steroids.Tier 1, condition, 3 questions, 10 flashcards
- Regional musculoskeletal conditions including rotator cuff diseaseRotator cuff tendinopathy and tears, frozen shoulder, tennis elbow, greater trochanteric pain syndrome, bursitis and heel pain. Most settle with education and progressive loading; injections give short relief, subacromial decompression doesn't beat placebo, and acute traumatic cuff tears need early referral.Tier 1, condition, 3 questions, 9 flashcards
- Sjögren syndromeSicca plus systemic disease, the 2016 ACR/EULAR classification score, the extraglandular features examiners like (renal tubular acidosis, neuropathy, ILD, cryoglobulins), lymphoma red flags, anti-Ro in pregnancy, and what the drugs can and can't fix.Tier 1, condition, 3 questions, 8 flashcards
- Systemic lupus erythematosusThe 2019 EULAR/ACR classification, which antibodies mean what, organ manifestations, hydroxychloroquine for all and prednisolone at 5 mg or less, early steroid-sparing therapy with belimumab or anifrolumab (PBS), LLDAS targets, pregnancy and the infection trap, updated to the 2025 ACR guideline.Tier 1, condition, 3 questions, 9 flashcards
- Systemic sclerosis (limited and diffuse scleroderma)Limited versus diffuse disease, the antibodies that predict ILD, PAH and renal crisis, the annual screening that catches them early, and organ-based treatment from the EULAR 2023 and BSR 2024 guidance.Tier 1, condition, 3 questions, 9 flashcards
Arthritis
- Gout and calcium pyrophosphate diseaseGout flares (NSAID, low-dose colchicine or prednisolone), treat-to-target allopurinol to a urate under 0.36 mmol/L (under 0.30 with tophi), febuxostat and the PBS, and calcium pyrophosphate disease from acute arthritis to crowned dens syndrome.Tier 1, condition, 4 questions, 10 flashcards
- OsteoarthritisA clinical diagnosis in people over 45 with activity-related pain and brief stiffness. Exercise and weight loss are the treatment; topical NSAIDs before oral; no opioids, no arthroscopy, and look for a secondary cause when the joint pattern is wrong.Tier 1, condition, 3 questions, 9 flashcards
- Rheumatoid arthritisTreat to target with methotrexate from diagnosis, short-term glucocorticoid bridging, then biologic or JAK inhibitor escalation under PBS rules. Screen before immunosuppression, watch for extra-articular disease (ILD, vasculitis, Felty syndrome) and manage cardiovascular risk and pregnancy.Tier 1, condition, 3 questions, 9 flashcards
Seronegative spondyloarthropathies
- Ankylosing spondylitis and axial spondyloarthritisFree sampleInflammatory back pain in young adults, ASAS classification, sacroiliac imaging, NSAIDs then TNF or IL-17 inhibitors under PBS rules, and choosing a drug around uveitis, IBD and psoriasis, updated to the 2026 ACR/SAA/SPARTAN guideline.Tier 1, condition, 3 questions, 9 flashcards
- Enteropathic arthritisPeripheral type 1 and type 2 arthritis and axial disease in IBD, which forms track bowel activity, the arthralgia and drug reactions that mimic it, and choosing one drug for gut and joints.Tier 1, condition, 3 questions, 7 flashcards
- Psoriatic arthritisThe five clinical patterns, CASPAR classification, imaging clues, treat-to-target with methotrexate then a biologic chosen by domain (skin, gut, eye, spine), PBS rules and the comorbidities that change drug choice.Tier 1, condition, 3 questions, 8 flashcards
- Reactive arthritisSterile asymmetric lower-limb arthritis 1 to 4 weeks after chlamydia or enteric infection, the extra-articular clues, excluding septic and gonococcal arthritis, and when antibiotics do and don't help.Tier 1, condition, 3 questions, 7 flashcards
Less common or complex conditions
- Adult-onset Still diseaseQuotidian fever, evanescent salmon-pink rash, arthralgia and a neutrophilia with a very high ferritin. A diagnosis of exclusion (Yamaguchi criteria), treated early with IL-1 or IL-6 blockade under the 2024 EULAR/PReS treat-to-target plan, with macrophage activation syndrome as the complication that kills.Tier 2, condition, 3 questions, 8 flashcards
- Antiphospholipid syndromeThrombosis or pregnancy morbidity with persistent antiphospholipid antibodies. Who to test, how anticoagulants wreck the lupus anticoagulant assay, why warfarin beats DOACs in high-risk APS, the obstetric regimen, catastrophic APS, and the non-criteria features (livedo, valve disease, thrombocytopenia) examiners use.Tier 2, condition, 3 questions, 8 flashcards
- IgG4-related diseaseA fibroinflammatory disease of older men that forms tumour-like swellings in the pancreas, bile ducts, salivary and lacrimal glands, retroperitoneum and aorta. Why serum IgG4 neither proves nor excludes it, the biopsy features, the 2019 ACR/EULAR criteria, steroid response, and B-cell depletion (rituximab, inebilizumab in MITIGATE) for relapse.Tier 2, condition, 3 questions, 8 flashcards
- Neuropathic joint disease (Charcot arthropathy)The hot, swollen, painless or mildly painful foot in someone with neuropathy. Which neuropathies hit which joints, the 2 °C temperature rule, X-ray then MRI, telling Charcot from cellulitis and osteomyelitis, and immediate offloading in a non-removable knee-high cast until remission (IWGDF 2023).Tier 2, condition, 3 questions, 7 flashcards
- Periodic fever and autoinflammatory syndromesRecurrent fevers with high CRP and no infection. How attack length, triggers, ancestry and inheritance separate FMF, TRAPS, MKD, CAPS and PFAPA; colchicine for life in FMF and the 2024 EULAR/PReS update; IL-1 blockade; AA amyloidosis; and the adult-onset mimics (Schnitzler, VEXAS).Tier 2, condition, 3 questions, 8 flashcards
- SarcoidosisNon-caseating granulomas in lungs, nodes, skin, eyes and heart. Löfgren syndrome, the baseline screen every patient needs (ECG, calcium, creatinine, eyes), when to biopsy by EBUS, who to treat, and the 2025 shift towards methotrexate and shorter steroid courses (PREDMETH).Tier 2, condition, 3 questions, 8 flashcards
- TendinopathyLoad-related tendon pain. The continuum model, systemic causes to look for (fluoroquinolones, familial hypercholesterolaemia, spondyloarthritis, gout), progressive loading as the treatment, why steroid injections and PRP disappoint, and when a tendon has ruptured.Tier 2, condition, 3 questions, 8 flashcards
- Viral arthritisAcute symmetric polyarthritis from parvovirus B19, Ross River and Barmah Forest viruses, chikungunya and viral hepatitis, how to read the serology without being fooled, supportive care, and when persistent synovitis needs a rheumatologist.Tier 2, condition, 3 questions, 8 flashcards
Myopathies
- Drug-induced and metabolic myopathyThe drugs that damage muscle (statins, steroids, colchicine, hydroxychloroquine, checkpoint inhibitors), the CK thresholds that change management, statin rechallenge and anti-HMGCR disease, and how exercise history separates glycogen, lipid and mitochondrial myopathies from endocrine causes.Tier 2, condition, 3 questions, 8 flashcards
- Inflammatory myopathiesDermatomyositis, antisynthetase syndrome, immune-mediated necrotising myopathy and inclusion body myositis. The antibody that predicts each phenotype, the 2017 EULAR/ACR score, ILD and cancer screening, troponin I versus T, and steroids plus an early steroid-sparing drug, IVIg and the anti-MDA5 emergency.Tier 2, condition, 3 questions, 8 flashcards
Vasculitis
- ANCA-associated vasculitisGPA, MPA and EGPA. Telling them apart, PR3 and MPO by immunoassay, the biopsy, rituximab or cyclophosphamide with reduced-dose steroids, the avacopan withdrawal, rituximab maintenance, anti-IL-5 drugs in EGPA (MANDARA), and the 2025 BSR update.Tier 2, condition, 3 questions, 9 flashcards
- Immune complex vasculitis and polyarteritis nodosaThe Chapel Hill 2012 map of vasculitis by vessel size. Immune complex small-vessel vasculitis (IgA vasculitis, cryoglobulinaemic, hypocomplementaemic urticarial, anti-GBM) and polyarteritis nodosa, with its microaneurysms, mononeuritis, hepatitis B link, DADA2 and treatment by Five-Factor Score.Tier 2, condition, 3 questions, 8 flashcards
- Takayasu arteritisLarge-vessel vasculitis of young women, the pulse and blood pressure clues, MR angiography as the key test, prednisolone plus a steroid-sparing drug for everyone, and revascularisation only once the disease is quiet.Tier 2, condition, 3 questions, 9 flashcards
Investigations and procedures
- Inflammatory markers, urate and baseline investigations in rheumatic diseaseFree sampleHow to use ESR and CRP, serum urate, FBC, renal and liver tests, urinalysis, ACE and viral serology in a patient with joint or systemic symptoms, what to check before starting a DMARD or biologic, and where the autoantibody tests are covered.Tier 1, medical sciences concept, 3 questions, 8 flashcards
- Musculoskeletal CT, MRI, ultrasound, DXA and nuclear imagingWhich advanced test answers which rheumatology question. MRI sequences and sacroiliitis, ultrasound for synovitis, crystals and the GCA halo, dual-energy CT for urate, CT for bone detail, bone scan and FDG-PET, DXA in glucocorticoid users, with sample reports read step by step.Tier 1, medical sciences concept, 3 questions, 9 flashcards
- Musculoskeletal X-ray interpretationA systematic ABCDS read of joint X-rays, the patterns that separate RA, psoriatic arthritis, gout, CPPD, OA, haemochromatosis and axial spondyloarthritis, region-by-region views and findings for hands, knees, hips, shoulders, spine and sacroiliac joints, and when an X-ray won't help.Tier 1, medical sciences concept, 3 questions, 9 flashcards
- Synovial fluid analysis and knee aspirationWhen and how to aspirate a knee, which tubes to send, how to read the fluid step by step (appearance, cell count, Gram stain and culture, polarised microscopy), the likelihood ratios for sepsis, the crystals and their mimics, prosthetic joint thresholds, and when the result changes management.Tier 1, medical sciences concept, 3 questions, 9 flashcards
Specific issues
- Cardiovascular morbidity in inflammatory rheumatic diseasesHow much RA, SLE, spondyloarthritis, gout and vasculitis raise cardiovascular risk, why risk calculators underestimate it, the lipid paradox, EULAR advice (1.5 multiplier in RA, BP under 130/80 in SLE, drug choices) applied to the 2023 Australian calculator, and drug effects from glucocorticoids to JAK inhibitors.Tier 1, medical sciences concept, 3 questions, 8 flashcards
- Rheumatology: specific issuesThe size and cost of musculoskeletal disease in Australia (AIHW 2026 figures), its effect on work, mobility and independence, how to measure function, and the Medicare, NDIS, aged care and First Nations pathways that keep people moving and at home.Tier 1, topic overview, 3 questions, 8 flashcards