Clinical questions - Rheumatology Flashcards
Gout treatment
Acute gout:
-NSAIDs
2nd line colchicine
Glucocorticoids - intraarticular or PO
Chronic:
- Allopurinol or febuxostat to decrease uric acid production
- Probenecid inhibits uric acid reabsorption in proximal convoluted tubules
Systemic lupus erythematosus: Clinical presentation -Constitutional -Hematologic -Neuropsych -Mucocutaneous -Serosal -MSK -Renal Lab findings
Constitutional: Fever
Hematologic:
Leukopenia
Thrombocytopenia
Autoimmune hemolysis
Neuropsych:
Delirium
Psychosis
Seizure
Mucocutaneous:
Non-scarring alopecia
Oral ulcers
photosensitivity
Serosal:
Pleural or pericardial effusion
Acute pericarditis
MSK: joint involvement
Renal:
Proteinuria > 0.5g/24h
Renal bx with lupus nephritis
Best initial dx test: ANA if negative r/o SLE
Most specific tests:
Anti-dsDNA Ab
Anti-Smith Ab
Seronegative spondyloarthropathy (HLA-B27) associated with asymmetric arteritis preceded by GI or GU infection
Reactive arthritis - uveitis, urethritis, asymmetric arthritis
Seronegative spondyloarthropathy (HLA-B27) associated with inflammatory back pain + “bamboo spine” on XR
Ankylosing spondylitis
Seronegative spondyloarthropathy (HLA-B27) associated with skin plaques with silvery scaling + pitting of nails + arthritis
Psoriatic arthritis
- pencil in cup on XR
Temporal arteritis - presentation, dx, testing
Vasculitis of medium to large size vessels
Presents: headache, fever, vision disturbances, jaw claudication
Dx:
ESR - if normal rules it out
Confirm with temporal artery bx
Tx: high dose glucocorticoids as soon as suspected with risk of blindness
Rheumatoid arthritis - presentation, dx, treatment
Pain/stiffness worse in morning but improves after “loosening up”, stiff knees, generalized fatigue
PE: tenderness and swelling of multiple MCP and PIP joints and wrist
Most specific lab test: anti-citrullinated protein Ab (ACPA) 88-96% specificity
RF 85% specificity
Tx:
DMARDs - start early to prevent joint damage
-Hydroxychloroquin
-Sulfasalazine
-MTX
-TNF alpha inhibitors: entarecept, infliximab
-Anticytokine - anakinra, rituximab, evabrocept
Acute flairs, short term use
- NSAIDs
- Glucocorticoids
Dermatomyositis, presentation, PE, lab, tx
How does it differ from polymyositis?
Proximal muscle weakness progressively worsening without soreness or pain
-difficulty rising from chair or climbing stairs
PE:
- decreased motor strength - shoulder abduction, hip flexion/extension
- Normal handgrip and rest of euro exam
- symmetrical, pinkish-red papule on dorsal surfaces of MCP joints and IP joints of both hands
- Hyperpigmentation of shoulders and anterior upper chest - shall like distribution
Lab: Elevated CK, aldolase \+ ANA and anti-Jo1 Ab Normal ESR EMG: inflammatory myopathy Definitive test: muscle bx - inflammation
Tx: high dose steroids - slow taper over 6-12 months
15% associated with cancer
Difference from polymyositis:
Polymyositis does not have skin involvement and only 10% cancer association
Medications with the highest risk of causing drug-induced lupus
SHIPP Sulfonamides - sulfasalazine Hydralazine Isoniazid Phenytoin Procainamide
Disorder strongly associated with anti-dsDNA
SLP - especially in active lupus nephritis
Disorder strongly associated with Anti-histone
drug induced lupus
Disorder strongly associated with Anti-La/SSB
Sjogrens - also anti-Ro/SSA
Disorder strongly associated with Anti-Smith
SLE
Disorder strongly associated with Anti-topoisomerase 1
Diffuse cutaneous systemic sclerosis - anti Scl 70
Disorder strongly associated with anticetromere
limited cutaneous systemic sclerosis (CREST scleroderma)
CREST scleroderma
Calcinosis cutis Raynaud's Esophageal dysmotility Sclerodactyly Telangectasias
First line pharmacotherapy for Raynaud phenomenon
Dihydropyridine CCB - nifedipine, amlodipine to prevent vasospasm
