Basic Sciences in Rheumatology

Initiation of inflammation in acute gout is critically dependent on which cytokine?

A 68-year-old man with rheumatoid arthritis for 15 years has DEXA results showing a lumbar spine T-score of +1.3 and femoral neck T-score of −2.4.

What is the most likely explanation for the discrepancy between the lumbar spine and femoral neck?

Rheumatoid factor antibodies are directed against which antigenic component?

A patient has strongly positive anti-double-stranded DNA antibodies (>100 IU/mL) with a negative extractable nuclear antigen screen.

What is the most likely pattern on antinuclear antibody testing

What is the most common pattern of interstitial lung disease in rheumatoid arthritis?

What is the most prevalent neuropsychiatric complication of systemic lupus erythematosus?

In the setting of chronic glucocorticoid use, what is the primary mechanism of glucocorticoid-induced osteoporosis?

Bisphosphonates primarily act on which cell?

Based on randomised controlled trial data in chronic gout, what is the main benefit of febuxostat 80 mg daily over allopurinol 300 mg daily?

A 72-year-old man presents with malaise, arthralgia, abdominal pain, left foot drop, hypertension and non-blanching livedo reticularis. ESR is 102 mm/h and CRP 68 mg/L.

CT angiography shows multiple small aneurysms in the renal and mesenteric arteries. His autoantibody screening is most likely to show which result?

A 40-year-old woman on high-dose pantoprazole for reflux presents with severe hypertension and acute kidney injury (creatinine 315 μmol/L [49-90]).

She has Raynaud phenomenon, peripheral telangiectasia and grade III hypertensive fundal changes.

Urinalysis is bland and she has normocytic anaemia with platelets 115 × 10⁹/L [150-400].

Renal ultrasound is normal.

What is the most likely cause of her hypertension and AKI?

In acute rheumatic fever, molecular mimicry between streptococcal M protein and N-acetyl-beta-D-glucosamine involves shared epitopes with which cardiac component?

Which one of the following is a minor criterion for acute rheumatic fever?

Patients are considered for investigation of secondary causes of osteoporosis if their Z-score is less than −2.0.

Assuming a normal distribution, what does a Z-score of −2.0 indicate?

A 28-year-old man presents with an itchy, symmetrical, erythematous vesicular rash clustered on his shoulders, knees, buttocks and elbows.

Which disease is associated with his presentation?

Which neurological autoantibody target is associated with myasthenia gravis?

Type 4 renal tubular acidosis is most commonly seen in which condition?

Which antibiotic is most associated with Achilles tendinitis and rupture?

A 53-year-old man presents with 2 days of a red, hot, swollen right knee that has not responded to an oral cephalosporin.

Temperature is 37.4°C and white cell count 11.3 × 10⁹/L [4.0-11.0].

Joint aspirate shows 130,000 cells/mm³ with 95% neutrophils.

Gram stain is negative and no crystals are seen.

What is the most appropriate initial management?

An 88-year-old housebound woman presents with generalised pain, proximal muscle weakness, a waddling gait and difficulty rising from a chair. Calcium is slightly low, alkaline phosphatase slightly elevated and albumin low.

What is the most likely cause of her symptoms?