1.8 Rheumatology Flashcards
heberden and bouchard nodes
englargement of the interphalangeal joints that appear on osteoarthritis
heberden: distal
bouchard: proximal
side effects of colchicine
diarrhea
bone marrow suppression (neutropenia)
what drugs should I remove from a patient’s prescription to manage chronic gout?
thiazides
aspirin
niacin
*give losartan for hypertension
what to substitute allopurinol with if it is contraindicated?
febuxostat
xanthine oxidase inhibidor
pegloticase
dissolves uric acid
probenecid and sulfinpyrazone
increase the excretion of uric acid in the kidney
treat gout (rarely used)
antigout drugs that should not be started during acute attacks of gout
urisouric (probenecid, sulfinpyrazone)
allopurinol
what are the most common risk factors for pseudogout?
hemochromatosis
hyperparathyroidism
Milnacipran
Inhibitor od the Reuptake of Serotonin & Norepinephrin
approves specifically for the management of fibromyalgia
what joint is always spared in rheumatoid arthritis?
DIP
distal interpahalangeal joint
sicca syndrome
dry eyes, mouth and mucous membranes
RA + splenomegally and neutropenia
Felty Syndrome
RA + pneumoconiosis and lung nodules
Caplan Syndrome
What does a patient with RA + erosive disease or X-ray abnormalities need? Why?
Methotrexate!!!
to stop the progression of the disease
erosive RA
- joint space narrowing
- physical deformity
- x-ray abnormalities
adverse effects of methotrexate
- liver toxicity
- lung toxicity
- bone marrow suppression
which DMARDs are safe in pregnancy?
TNF inhibitors
(infliximab, adalimumab, etanercepts, golimumab, certolizumab)
Hydroychloroquine
Sulfasalazine
what precautions do I need to take before giving a patient a TNF inhibitors?
screen for TB with PPD
adverse effects of TNF inhibitors
reactivation of TB
infections
adverse effect of hydroxychloroquine
toxicity to the retina
do a dilated eye exam
sulfazalazine adverse effects
bone marrow toxicity
hemolysis with G6PD deficiency
rash
adverse effect of rituximab
infection
adverse effect of gold salts
nepthrotic syndrom
🚩 rash, high spiking fever of unidentified etiology in a young person
JRA (juvenile rheumatoid arthritis)
STILLS
- Salmon colored rash
- Temperatur elevation
- Ill appearing patient
- Lymphadenopathy
- Leukocytosis
- Splenomegaly
what are the 11 diagnostic critera for SLE?
- macular Rash
- discoid Rash
- photosentivity
- oral ulcers
- arthritis (normal x-ray)
- chest pain (with preicardia/pleural effusion)
- renal involvement (mc: membranous glom.)
- neurologic symptoms (psychosis, seizures, stroke)
- hemolytic anemia (mc: anemia of chronic disease)
- positive ANA
- postive:
- Anti-double stranded DNA
- Anti-Sm
- False + for Syphilis
- LE cell preparation
🚩 thrombosis + recurrent spontaneous abortions
APL syndrome
🚩 clotting + elevaded aPTT + normal PT
APL syndrome
what is the treatment to preven spontaneous abortion recurrence?
heparin and aspirin
CREST syndrome
(limited scleroderma)
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia
💡 proximal weakness + dysphagia
inflammatory miositis
💡 unresolving pneumonia not better with antibiotics
Wegner Granulomatosis
🚩 leukocytoclastic vasculitis on biopsy
Henoch Scholein Purpura
sterile skin postules from minor trauma
pathergy
what is treatment for anti-TNF resistant psoriatic arthritis?
secu-kinu-mab
ixe-kizu-mab
antil IL17 medications
apremilast
oral phosphodiesterase inhibitor
psoriasis and psoriatic arthritis
when does densitometry screening start?
all women above the age of 65
denosumab
RANKL inhibitor
firt line with biphosphonates to treat osteoporosis
🚩 bowel or bladder incontinence, erectile dysfunction with saddle area anesthesia
cauda equina syndrome
3 main types of antiphospholipid syndrome
lupus anticoagulant
anticardiolipin antibodies
beta 2 glycoprotein
