Conditions Related to RA

Question 1

What is the typical onset to seronegative rheumatoid arthritis of the elderly?

Answer 1

> 60y/o

Question 2

What is the clinical presentation of seronegative rheumatoid arthritis of the elderly?

Answer 2

Sudden development of mild arthritis. If elderly male patients over 70 also show pitting in their hand and feet, it is called RS3PE (remitting symmetric seronegative synovitis with pitting edema).

Question 3

What is the Tx of seronegative rheumatoid arthritis of the elderly?

Answer 3

Best controlled with low doses of prednisone.

Question 4

What are the 3 components to the Still disease?

Answer 4

Fever
Rash
Arthritis

Question 5

When is the onset to Adult Still disease?

Answer 5

between 16 and 35 years old

Question 6

What is the clinical presentation of Adult Still disease?

Answer 6

Quotidian fever (fever spike w/ return to normal all in 1 day): 39* C
Arthralgia
Arthritis: 1/3 of patients have joint disease that is progressive and destructive.
Leukocytosis
Macular evanescent rash: appearance of a macular salmon-colored eruption on the trunk and extremities.
Serositis
Lymphadenopathy
Splenomegaly
Hepatomegaly

Question 7

What are the lab abnormalities in Adult Still disease?

Answer 7

Seronegativity (negative rheumatoid factor and antinuclear antibody)

Question 8

What is the Tx of Adult Still disease?

Answer 8

high doses of aspirin or indomethacin.

Question 9

What is the triad of Felty syndrome?

Answer 9

Rheumatoid arthritis
Leukopenia
Splenomegaly

Question 10

What is the onset to Felty syndrome?

Answer 10

occurs after 12 years or more of rheumatoid arthritis.

Question 11

What are teh clinical features of Felty syndrome?

Answer 11

recurrent fevers with or without infection, weight loss, lymphadenopathy, skin hyperpigmentation, lower extremity ulcers, vasculitis, neuropathy, keratoconjunctivitis sicca, xerostomia, cytopenias.

Question 12

What are the cause of mortality of Felty syndrome?

Answer 12

patients with Felty syndrome often have bacterial infections, especially of the skin and lungs but infection related to the cytopenia is the major cause of mortality. Hypocomplementemia (immune compromised) often occurs with active vasculitis and patients die of sepsis even with vigorous antibacterial treatment.

Question 13

What are the lab fidnings in Felty syndrome?

Answer 13

High titers of rheumatoid factorsa re the rule, and a positive antinuclear antibody occurs in 2/3 of patients.

Question 14

What is the Tx of Felty syndrome?

Answer 14

corticosteroids, methotrexate, granulocyte colony-stimulating factor, and splenectomy

Question 15

What is the triad of Sjoren syndrome?

Answer 15

Arthritis (typically episodic polyarthritis) – connective tissue disease
Dry eyes – keratoconjunctivitis sicca with or w/o lacrimal gland enlargement
Dry mouth and dry mucous membranes – xerostomia w/ or w/o salivary gland enlargement

Question 16

What are the histological findings of Sjoren syndrome?

Answer 16

CD4 lymphocytic infiltration and destruction of lacrimal salivary glands

Question 17

What is the clinical presentation of Sjoren syndrome?

Answer 17

dry eyes and mouth

Question 18

What is the predominant population of Sjoren syndrome?

Answer 18

middle-aged women

Question 19

What are the lab findings of Sjoren syndrome?

Answer 19

polyclonal hypergammaglobulinemia, autoantibodies such as rheumatoid factor, antinuclear antibodies, and antibodies to extractable nuclear antigens (SS-A and SS-B).

Question 20

What is the Tx of Sjoren syndrome?

Answer 20

only treats the symptoms. Pilocarpine, 5mb orally 4x daily to improve salivary and lacrimal gland function.

Question 21

What is the associated malignancy in patients with Sjoren syndrome?

Answer 21

non-Hodgkin lymphoma