alloimmunity/autoimmunity pt 1

Question 1

RA CM

Answer 1

joint inflammation - PIP, MCP, MTP

extraarticular rheumatoid nodules

systemic - ocular (Sjogrens), pulm (pleural disease, parenchymal disease), CV (pericarditis, myocarditis, HF, A fib, rheumatoid nodules, thromboembolic disease), heme (anemia, felty syndrome)

Question 2

felty syndrome

Answer 2

RA with splenomegaly & neutropenia

Question 3

RA diagnosis

Answer 3

ALL of the following:
- inflammatory arthritis involving 3 or more joints
- positive RF and/or ACPA
- elevated ESR or CRP
- disease w similar clinical features has been excluded
- duration of symptoms >6 weeks

Question 4

RA treatment

Answer 4

early initiation of DMARD by rheumatology

MTX weekly (CI in pregnancy, liver disease/ETOH, GFR <30) (monitoring w CBC, crt, LFTs, vaccinations, hep B/C, TB, CXR)

exercise, PT/OT

NSAIDs/glucocorticoids for pain (GI prophylaxis) - no opioids!

Question 5

SLE symptomatology

Answer 5

fatigue
fever
myalgias/arthralgias
cutaneous lesions - butterfly rash
weight loss
Raynaud’s phenomenon
discoid lesions - inflammatory, alopecia
antiphospholipid antibody syndrome (increase risk for VTE)
lupus nephritis (proteinuria w/wo RBC casts)

Question 6

SLE labs

Answer 6

-CBC - anemia, leukopenia, thrombocytopenia (not all)
-BUN/CRT - elevated
-UA - proteinurea, hematuria, casts
-serum protein electrophoresis - hypergammaglobulinemia
-ANA + in virtually all positive (anti-dsDNA and anti-smith confirmatory)
-CXR/EKG - cardiopulmonary manifestations?

Question 7

SLE meds

Answer 7

antimalarials - hydroxychloroquine, chloroquine

immunosuppression

glucocorticoids for flares 0.5-1g/day for 3 days

NSAIDs for pain

Question 8

SLE nonpharm mgmt

Answer 8

rheum referral
sun protection
exercise
smoking cessation
immunizations

Question 9

live vaccines

Answer 9

shingles
intranasal flu
yellow fever
MMR

Question 10

giant cell arteritis

Answer 10

=temporal arteritis

chronic inflammatory disease affecting medium-sized and large vessels in patients commonly over age 50

Question 11

GCA symptomatology

Answer 11

fever, fatigue, weight loss
HA & scalp tenderness
jaw claudication
visual symptoms
UR symptoms (nonproductive cough)
throat/tongue pain

Question 12

GCA diagnostics

Answer 12

CBC - normocytic, normochromic anemia, thrombocytosis

very high ESR

elevated transaminases

definitive diagnostic - temporal artery biopsy

can be diagnosed on clinical criteria

Question 13

GCA treatment

Answer 13

no visual impair - pred 1mg/kg/day

if visual impair - Methylpred - 500-1000 mg IV daily x3 day, then pred

2-4 weeks of therapy w taper

consider GI prophylaxis, antiemetics, osteoporosis infection, opportunistic infections, hyperglycemia

consider rheum referral