Deja - Internal - Rheumatology Flashcards
7 diagnostic criteria for RA?
- Morning stiffness >1h.
- 3 or more joints with arthritis.
- One hand joint with arthritis.
- Symmetric arthritis.
- Rheumatoid nodules.
- Elevated RF.
- Radiographic evidence of erosive arthritis.
How many criteria must be positive for a diagnosis of RA?
4.
How long does each of the criteria need to be present to make a diagnosis?
At least 6 weeks.
What DMARDs are available for patients with RA?
- Methotrexate.
- Hydroxychloroquine.
- Gold compounds.
What are some newer biologic agents used to treat RA?
- Infliximab
- Etanercept
- Abatacept
- Rituxan
What is the MC type of arthritis?
Osteoarthritis.
What are the X-ray findings seen in OA?
- Narrowed joint spaces.
2. Osteophyte formation.
What is the treatment for OA?
- NSAIDs to relieve pain.
- Muscle-strengthening exercises.
- Steroid joint injection.
- Last resort is joint replacement.
Etiology of gout?
- Decr. urate excretion (high-protein diet, alcohol, diuretic use).
- Incr. urate production (genetic diseases, hemolysis, cancer).
What is the MC joint to be affected in gout?
1st MTP.
What is the classic radiographic finding in advanced gout?
“Rat-Bite” appearance.
How is gout diagnosed?
Fluid aspirated from the joint would reveal needle-shaped monosodium urate crystals with NEGATIVE birefringence under polarized light.
What is pseudogout?
Deposition of calcium pyrophosphate crystals in joints, causing inflammation.
Risk factors for pseudogout?
- Advanced age.
- Gout.
- Hemochromatosis.
- Extensive OA.
- Diabetes.
- Hyperparathyroidism.
- Hypothyroidism.
- Hypomagnesemia.
- Neuropathic joint.
Pseudogout - Signs and symptoms:
May present as an acute arthritis affecting one or multiple joints like gout, or it may present as a chronic polyarthritis similar to OA or RA.
What does joint fluid aspiration in pseudogout demonstrate?
POSITIVELY birefringent rhomboid crystals.
What joint is always affected in ankylosing spondylitis?
Sacroiliac joint.
How is SLE distributed based on race?
Black>White.
What is the mnemonic for diagnosing SLE?
DOPAMINE RASH
Discoid rash Oral ulcers Photosensitivity Arthritis >2 joints. Malar rash Immunologic criteria Neurologic symptoms ESR up (not part of the 11 criteria)
Renal disease
ANA
Serositis (pericarditis, pleurisy)
Hematologic
How many of the criteria must be present to make the diagnosis of SLE?
4 or more.
Pathognomonic heart disorder seen in SLE patients?
Libman-Sacks endocarditis.
What autoantibody is most SENSITIVE for SLE?
ANA (it is NOT specific).
What autoantibody is most SPECIFIC for SLE?
- Anti-ds DNA (very high titers are associated with renal involvement).
- Anti-SM antibody.
What are lupus anticoagulant and anticardiolipin associated with?
- Thrombosis
- CNS lupus
- Thrombocytopenia
- Valvular heart disease
- Fetal loss
Anticardiolipin can cause a falsely elevated result with which lab test?
Elevated PTT, but in reality SLE patients are more likely to develop blood clots.
What drugs are known to cause-drug induced SLE?
SIQ CHaMP
Sulfasalazine
INH
Quinidine
Chlorpromazine Hydralazine a Methyldopa, minocycline Procainamide, Penicillamine
What is the MC drug to cause lupus-like symptoms?
Procainamide.
What are the signs and symptoms of scleroderma?
- Tight, thick skin.
- Raynaud.
- Dysphagia.
- Renal artery fibrosis.
- PHTN.
- Telangiectasias.
What lab test is 80% sensitive for CREST syndrome?
Anti-centromere antibody.
What lab test is highly SPECIFIC to scleroderma?
Anti-Scl-70 antibody.
What is the treatment for scleroderma?
CAPS
CCBs
ACEIs
Penicillamine
Steroids
Some findings associated with sarco?
GRUELLING
Granulomas RA Uveitis Erythema nodosum Lymphadenopathy Interstitial fibrosis Negative TB test Gamma-globulinemia
What renal problem is associated with sarco?
Nephrolithiasis because of hypercalciuria.
Name the syndrome associated with the following: Conjunctivitis Uveitis Urethritis Asymmetric arthritis
Reiter
What is the mnemonic used to remember the associated findings of Reiter syndrome?
“Can’t see. Can’t pee. Can’t climb a tree”.
2 forms of Reiter:
- Sexually transmitted.
2. Postinfectious: Campylobacter, Yersinia, Salmonella, Shigella.
What is the autoimmune syndrome associated with: Apthous ulcers Genital ulcers Arthritis Uveitis Psychiatric symptoms
Behcet syndrome.
Polymyositis - Signs and symptoms:
- Symmetric PROXIMAL muscle weakness.
- Dysphonia, and dysphagia.
- Patients have difficulty standing up from a chair or brushing their hair.
Dermatomyositis - Classic signs:
- Symmetric PROXIMAL muscle weakness.
- Heliotropic periorbital rash.
- Shawl sign (erythematous macules on shoulder and upper back).
- Gottron papules (violacious papules on DIP joints).
What autoantibody is associated with polymyositis and dermatomyositis?
Anti-Jo-1.
What are the 4 criteria for polymyositis?
- UP CPK.
- PROXIMAL muscle weakness.
- Low amplitude potentials and fibrillations on EMG.
- Incr. muscle fiber size on muscle biopsy.
2 peak incidences of myasthenia gravis?
Women –> 2nd to 3rd decades.
Men –> 5th to 6th.
What can myasthenia gravis be associated with?
Thymomas or other autoimmune diseases.
What are the signs and symptoms of myasthenia gravis?
- Muscle weakness and increasing fatigue with use.
- Proximal muscle weakness.
- Ptosis.
- Diplopia.
- Dysphagia.
What is the classic test used to diagnose myasthenia gravis?
Edrophonium test (Tensilon test).
What are the newer diagnostic methods for myasthenia gravis?
- Single-fiber EMG.
2. Anti-acetylcholine receptor antibody test.
Myasthenia gravis is often associated with what other finding?
Thymoma.
What blood test in the presence of myasthenia gravis is highly associated with the presence of a thymoma?
Anti-striated muscle (SM) antibody - present in >80% of patients younger than 40 with thymoma.
What is the pathology in Lambert-Eaton syndrome?
There are autoantibodies to presynaptic calcium channels.
How does Lambert-Eaton syndrome differ from myasthenia gravias?
Increased muscle use improves symptoms making muscles stronger.
What classical physical findings can be found in RA?
- Boutonniere deformity.
- Swan neck deformity.
- Ulnar deviation.
- Pain in the PIP and MCP (NOT DIP!).
- Rheumatoid nodules.
