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)
