Exam 1 -- Randomized List of All Exam 1 Flashcards -- part 1
What are some of the side effects of methotrexate use?
Nausea, liver damage, pulmonary toxicity, mouth ulcers, alopecia, infections
What is a common drug used to decrease MMP activity?
Doxycycline
What are common symptoms of enteropathic arthritis?
Spondylitis, sacroilitis, stomach pain
What percentage of patients with giant cell arteritis experience severe HA?
70-90%
The COX-2 pathway is active in the kidneys. What is its result in the kidney?
Regulation of BP
What is the full name of lupus?
Systemic Lupus Erythematosus (SLE)
What cell types are associated with acute inflammation?
Neutrophils
Prevalence of giant cell arteritis is higher in patients with what other conditions?
RA, lupus, other vasculitis conditions
What systemic effects may be present in the lungs of a patient with RA?
Difficulty breathing, fibrosis, cough, nodules
Raynaud’s phenomenon can occur in response to what factors?
Stress, cold temperature, smoking
Why must care be taken after the immediate anaphylactic crisis is resolved?
Arachidonic acid metabolites are being created and will cause further problems 2-10 hours later
What is a normal ESR result for a male?
Half of the age in years (in mm/hr)
Which gender has a higher prevalence of osteoarthritis?
Female
What sort of testing can you do for Takayasu arteritis?
Bruit, angiography, imaging
A DEXA scan is one way to measure bone density. A score of how many standard deviations below the norm indicates osteoporosis?
2.5
What testing can be done to test for pseudogout?
X-ray (to see calcium deposits), synovial fluid analysis (looking for calcium pyrophosphate)
All of the spondyloarthropathy conditions are RF ___________ (negative/positive).
Negative
Which gender has a higher prevalence for Raynaud’s phenomenon?
Female (4:1)
A patient has already been diagnosed with polymyalgia rheumatica and you are suspicious for giant cell arteritis. What percentage of patients like this have a temporal artery biopsy that shows giant cells?
40-50%
True or false: RA is genetically associated with HLA-B27
False; HLA-B27 is associated with the spondyloathrothopy conditions, not RA.
What is a normal value for Serum Amyloid A test?
0
Which DMARD might be used if previous DMARDs haven’t been working?
Cyclophosphamide
What are the most common symptoms of giant cell arteritis?
Severe HA, scalp tenderness, jaw claudication, tenderness/swelling of temporal artery, sudden, transient painless vision loss in one eye*
Erythrocyte sedimentation rate is used to measure levels of what protein?
Fibrinogen
True or false: hip replacement surgery is an option for patients with AS
True.
What part of the skeleton is most affected in ankylosing spondylitis?
Spine, especially lower back
What neurologic effects may be present in a patient with RA?
Peripheral neuropathy
The end products of the COX pathway depends on the enzymes present in a particular type of cell. What cell type results in thromboxane A2 (TXA2)?
Platelets
How many joints are involved in Type 1 enteropathic arthritis?
6 or less
Although histamine is predominantly found in mast cells, where else might it be found?
Basophils and platelets
What are some medical treatment options for osteoarthritis?
Acetominophen (drug of choice), low-dose NSAIDs, topical capsaicin (for pain relief), corticosteroid injections, surgery
What is another term for rheumatology?
Collagen vascular diseases
What can cause bursitis?
Repetitive motion, pressure, RA, gout, trauma
What testing can be done for eosinophilic granulomatosis with polyangitis?
Eosinophilia*, ANCA, lung or skin biopsy with granulomas
What are some risk factors for osteoporosis?
Low estrogen, female, light weight, smoking, age (over 80 years)
What classes of drugs can cause dry mouth or dry eye?
Antihistamines, antipsychotics, anticonvulsants
Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the foot?
Achilles tendonitis; also, skin lesions (red papules on soles)
True or false: ankylosing spondylitis is more common among Caucasians
True.
Which DMARDs act as folic acid inhibitors?
Methotrexate and sulfasalazine
What is a good way to treat buritis?
PRICE (Protect, Rest with a little activity, Ice, Compress, Elevate); NSAIDs (higher doses); massage; corticosteroid (only if not bacterial in nature); possibly antibiotics; surgery in extreme cases
Podagra affects what percentage of gout patients?
90%
True or false: relapsing polychondritis can feature non-erosive joint pain
True.
What is the main difference between polymyositis and dermatomyositis?
Dermatomyositis involves the skin as well
What symptoms may be indicative of RA?
Pain, stiffness, swelling, and limited movement of small joints. Less common: weight loss, fever, fatigue, malaise
True or false: tenosynovitis is more common in diabetics
True.
What tests can be done for Kawasaki disease?
None, apart from an echocardiogram
Articular cartilage is a specific type of what cartilage?
Hyaline
What supplements can be taken to help with osteoporosis?
Calcium (1,000-1,200 extra mg per day) and Vitamin D (800 IU per day)
True or false: reactive arthritis is usually accompanied by acute, asymmetric lower limb arthritis
True.
What is a typical age of onset for lupus?
20-40 years
Which gender has a higher prevalence for Sjogren’s?
Female (12:1)
80% of lyme disease patients get what sort of sign?
Bull’s eye rash at site of tick bite
Briefly describe the wall touch test for ankylosing spondylitis
Have patient stand with their back up against the wall and try to move their head back to touch the wall too
What effects can relapsing polychondritis have in the nose?
Saddle-nose
Systemic effects are present in what percentage of RA patients?
40%
True or false: polymyalgia rheumatica is common under age 50
Flase; it is rare under age 50*
Describe migratory arthritis
Affects several joints in quick succession for 1-3 days each
What is/are the actions of NO?
Vasodilation (most potent vasodilator), microbiocide, antagonizes platelet activation, decreases leukocyte adhesion
What are the medical treatment options available for relapsing polychondritis?
NSAIDs, oral steroids, DMARDs, TNF inhibitors (cyclophosphamide reserved for severe cases)
What is the 10-year survival rate for systemic sclerosis?
60-80%
What are two examples of Type II reactions involving Ab-mediated cellular dysfunction?
MG and Grave’s disease
The cyclooxygenase pathway results in the production of what products?
Prostaglandins, prostacyclins, and thromboxanes
True or false: carpal tunnel syndrome is the most common entrapment neuopathy
True.
Which DMARDs are tetracyclines?
Minocycline and doxycycline
HLA B27 is “poor at fighting” what diseases?
Chlamydia, gonorrhea, salmonella
Kidney involvement with lupus is sometimes called what?
Lupus nephritis
Which Ab is involved in Type I reaction?
IgE
Behcet’s disease can cause oral and genital ulcers like what spondyloarthropathy?
Reactive arthritis
What parts of the body experience pain in ankylosing spondylitis?
Buttocks, hips
Does psoriatic arthritis feature more or less joint pain than RA?
Less
What percentage of lupus patients experience arthralgia?
More than 90%
What percentage of systemic sclerosis patients are ANA (+)?
95%
True or false: RA is the #1 cause of secondary amyloidosis
True.
True or false: patients with lupus have an increased risk of developing lymphoma
True.
What testing can be performed to try and differentiate lupus?
CBC, ESR, CRP, urea/creatinine (from urinalysis, if renal involvement), ANA, anti-dsDNA Ig, anti-SM Ig
What is the 10-year survival rate for lupus?
80-90%
What is another name for pseudogout?
Calcium pyrophosphate deposition (CPPD)
Febuxostat plays the same type of role as allopurinol in treating gout. When would it be preferred to allopurinol?
If patient has kidney failure, since it is less toxic to the kidney
Which joint(s) of the fingers are affected by RA?
MCP and PIP, not DIP (the proximal two joints, but not the distal joint)
What percentage of Sjogren’s patients are RF (+)?
Up to 90%
Which Ig is the most common?
IgG (75% of all Ig)
What is the name for the mass of modified macrophages that accumulates during granulomatous inflammation?
Giant cell (made from epitheloid cells, which are modified macrophages)
What is the main difference between gout and pseudogout?
Gout has sodium urate crystals, pseudogout has calcium crystals
What is the age and gender of a typical patient with fibromyalgia?
Middle-aged woman
Part of testing for RA can involve testing for Anti-Citrullinated Protein Antibodies (ACPAs). What percentage of RA patients have ACPAs?
50-70%
Most of the systemic organs are involved in polyarteritis nodosa. Which major organ is not invovled?
Lungs
What percentage of IBD patients have Type 1 enteropathic arthritis?
5%
Tumor necrosis factor (TNF) is produced by what type of cell?
Activated macrophages
What is the term for the crackling of joints that can sometimes be heard in a patient with osteoarthritis?
Crepitus
Which gender has a higher prevalence for granulomatosis with polyangitis?
Neither; prevalence is equal between the genders
What percentage of patients with psoriatic arthritis also get uveitis?
7%
What is a normal ESR result for a female?
Half of (the age in years plus 10) (in mm/hr)
Methotrexate causes a decrease in what cellular substance?
Folic acid, decreasing the ability of the cell to contribute to the inflammatory response. This leads to apoptosis.
How would you treat a patient with lupus?
NSAIDs, topical and/or oral corticosteroids, hydroxychloroquine*, cyclophosphamide/cyclosporine in severe cases
What is a potential environmental risk factor for systemic sclerosis?
Silica dust
What causes carpal tunnel syndrome?
Prolonged pressure and/or use, arthritis, pregnancy
Patients with Juvenile Idiopathic Arthritis are at risk for what ocular conditions?
Chronic uveitis and band keratopathy
Which areas of the body are common sites of Type III reactions?
Blood vessels, kidneys, and joints
What types of granulomas are there?
Foreign body and immune
How would you treat carpal tunnel syndrome?
Splint at night, corticosteroid injection, surgery
Relapsing polychondritis is associated with what conditions?
Vasculitis and arthritis
What is the age of onset for Raynaud’s phenomenon?
15-25 years
What might a brain MRI show in a patient with lupus, if they have nervous system involvement?
Increased white matter
If you are suspicious of giant cell arteritis in a patient who has recently experienced monocular transient vision loss, would you consider it an emergency?
Yes; there is risk of an aortic aneurysm, as well as vision loss in the other eye within a few hours or days
True or false: there is a cure for systemic sclerosis
False; there is no cure. All you can do is treat the lung and heart issues and use creams for the skin
Which joints are affected in pseudogout
Knee*, elbow, ankle
How many joints are involved in Type 2 enteropathic arthritis?
More than 6
What sort of testing can be performed for granulomatosis with polyangitis?
ANCA*, chest x-ray and/or CT-scan (pulmonary nodules, infiltrates, nodules), renal biopsy, urinalysis (increased protein, abnormal creatinine)
An x-ray of the spine of a patient with ankylosing spondylitis may show what?
Fused vertebrae (bamboo spine)
True or false: RA leads to destruction of bone, cartilage, and tendons, but not of ligaments.
False; it leads to destruction of all of these.
What sort of dietary restriction can help with gout?
Reduce alcohol, reduce calories and cholesterol, reduce soft drinks, reduce offal/organ meats, increase water intake
Which Ig is the largest?
IgM
Corticosteroid use is contraindicated in what common condition?
Pregnancy
What percentage of patients with polymyositis or dermatomyositis are ANA (+)?
80%
Psoriatic arthritis is characterized by what type of lesion?
White, scaley skin rashes
True or false: the pain of podagra usually begins at night
True.
Is the pain from polymyalgia rheumatica worse in the morning or later in the day?
Morning
True or false: the arthralgia experienced in lupus is unilateral and deforming
False; it is bilateral and non-deforming
What is the 5-year survival rate for treated patients with polyarteritis nodosa?
80%
How would you treat the underlying infection in reactive arthritis?
Oral antibiotic (azithromycin or doxycycline)
True or false: the pain from RA is worse in the morning and gets better with activity.
True.
True or false: lyme arthritis typically presents bilaterally
False; it typically presents unilaterally
Which gender has a higher prevalence of ankylosing spondylitis?
Males (3:1)
How old must a patient be in order for their condition to be considered Juvenile Idiopathic Arthritis, assuming all other symptoms match?
Under age 16 years
True or false: about half of patients with recurrent uveitis have some spondyloarthropathy condition
True.
Which gender has a higher prevalence for eosinophilic granulomatosis with polyangitis?
Male
Rheumatoid factor is found in what percentage of healthy patients over the age of 70?
25%
What percentage of the US population is affected with rheumatoid arthritis (RA)?
1%
What are the main non-ocular symptoms that can occur in Takayasu arteritis?
Absent peripheral pulse (unilateral; could lead to gangrene or ulcerations), asymmetric BP, peripheral claudication*, chest pain, renal dysfunction, arthralgia, myalgia, syncope, dementia
What percentage of RA patients have rheumatoid factor?
70%
True or false: reactive arthritis is most common over age 50
False; it is more common in younger patients
What are some risk factors for osteoarthritis?
Obesity, trauma, estrogen, smoking
What treatment strategies can be employed for not only bursitis, carpal tunnel syndrome, and tenosynovitis, but also for RA?
Rest and light exercise, physical therapy, smoking cessation, alcohol reduction, weight loss, Omega-3, fish oil supplements, medications
True or false: cyclosporine is safe to take during pregnancy
False.
True or false: osteoarthritis is the second most common cause of diability
False; it is the most common cause of diability
What are some of the side effects of doxycycline use?
Skin rash, GI upset, sensitivity to sun, dizziness, decreases effectiveness of birth control, increases potency of blood thinners, causes teeth and bone deformity in children (CI pregnancy and breast feeding)
Fact: Osteoarthritis is related to aging.
Free card!
What class of medication is effective in treating most patients with AS? Which drug in this class is usually used? What other class of drug could be used?
NSAIDs (effective in 70%); indomethacin; TNF-alpha blockers
Treatment of conditions involving the joints can consist of different classes of drugs. Which classes are meant to relieve the pain?
NSAIDs, corticosteroids, analgesics
True or false: polyarteritis nodosa affects middle-aged men most commonly
True.
What is another name for granulomatosis with polyangitis?
Wegener’s granulomatosis
True or false: patients with enthesis-related Juvnile Idiopathic Arthritis can be HLA B27 (+)
True.
Uric acid stones cause what percentage of kidney stones?
5-10%
What is most commonly the first sign of osteoporosis?
Fragility fracture (usually in the spine)
Which complement molecules increase vascular permeability by mast cell degranulation?
C3a, C5a
Briefly outline Ab-mediated cellular dysfunction during a Type II reaction.
Ab binds to or blocks a receptor, thus interfering with normal tissue function
What sort of heart issues can a person with lupus experience?
Heart attack, stroke, vasculitis, anemia
What is another name for Kawasaki disease?
Mucocutaneous lymph node syndrome
True or false: patients with oligoarticular Juvenile Idiopathic Arthritis are RF (-)
True.
How would you treat polymyalgia rheumatica?
10-15mg prednisone in the morning
What is the age of onset for Sjogren’s?
About 40 years
What sort of testing can be done for systemic sclerosis?
CBC, urea and creatinine (urinalysis), ANA, RF
What type of infection can be reactivated with DMARD use?
Usually TB
What are common features of the acute phase reaction (APR)?
Fever, fatigue, malaise, elevated WBC, elevated HR and BP, anorexia
True or false: kyphosis can lead to heart and lung problems
True; kyphosis is a bending of the spine due to ankylosing spondylitis, which compresses the heart and lungs
Takayasu arteritis is also known as?
Pulseless disease, or aortic arch syndrome
HLA B27 is “best at fighting” what diseases?
HIV, hepatitis C, influenza
Polymyositis and dermatomyositis are more common in what ethnicity?
African American
Which ethnicity has a higher prevalence of relapsing polychondritis?
Caucasian
True or false: rheumatoid nodules are tender to the touch
False; they are non-tender
What is another name for Type III hypersensitivity?
Immune complex mediated
The pain from polymyalgia rheumatica is generally ____________ (bilateral/unilateral).
Bilateral
What is the name for the bony spurs that can occur in the PIP joint?
Bouchard’s nodes
Pseudogout crystals have what shape?
Triangular or rhomboid
How long after infection can symptoms of reactive arthritis occur?
1-4 weeks
What is the age of onset for systemic sclerosis?
30-50 years
True or false: almost all patients with giant cell arteritis have complete vision recovery eventually
False; many have permanent partial or complete vision loss
HLA B27 is most common in what demographic?
Northern/Western European
What is another name for eosinophilic granulomatosis with polyangitis?
Churg-Strauss syndrome
What medications can cause an attack of gout?
Cyclosporine, aspirin, diuretics
Cytokines are produced mostly by what types of cells?
Lymphocytes and macrophages
Focal erosion of cartilage occurs in osteoarthritis, leading to bone rubbing on bone. What is the name for the bone overgrowth that occurs as the bone attempts to repair itself?
Osteophyte
Patients with giant cell arteritis have a higher risk of what conditions?
Stroke and coronary artery disease
True or false: although polyarteritis nodosa mainly affects arteries, it can affect veins too
False; it only affects arteries. If veins are involved, the condition is not PAN
Which leukotriene(s) is/are responsible for neutrophil chemotaxis?
LTB4
What are some of the side effects of cyclosporine use?
HTN, kidney problems (in 50%), infection
What tests can be performed for giant cell arteritis?
ESR (>50mm/hr) and CRP, temporal artery biopsy (gold standard), pulse
True or false: virtually all of patients with systemic sclerosis experience Raynaud’s phenomenon
True.
The first signs of ankylosing spondylitis (as seen in an x-ray) are seen in the _______ joint of 95% of AS patients.
Iliosacral
Collagens make up how much of the synovial fluid?
90%
Type 1 and Type 2 enteropathic arthritis can be distinguished based on which came first, the arthritis symptoms or the IBD symptoms. List the order for each type.
Type 1: arthritis then IBD; Type 2: IBD then arthritis
How would you treat polymyositis or dermatomyositis?
Physical therapy, corticosteroids, DMARDs, biologics, methotrexate
Which Ig is involved in allergic responses?
IgE
True or false: all biologic drugs for RA are injections
True.
What is another name for Type I hypersensitivity?
Anaphylactic (also, atopic)
How many patients without spondyloarthropathy conditions test HLA B27 (+)?
5-10%
What is a normal dose of hydroxychloroquine for RA?
200-400mg (usually 200mg) bid
Does a tendon connect bone to bone or muscle to bone?
TMB (Tendon connects muscle to bone)
Briefly outline inflammation during a Type II reaction.
Ab binds to cellular or tissue “Ag;” complement is activated and neutrophils and monocytes are recruited; these release inflammatory mediators which cause tissue damage due to frutrated phagocytosis
What sort of CNS symptoms could a patient with lupus experience?
Migraines, epilepsy, cerebellar ataxia, cognitive and mood disorders, memory loss
What type of adhesion molecule causes the WBC to stop along the vessel wall?
Integrin
If a biologic drug is used to treat RA, it is usually given with what other DMARD?
Methotrexate
What are some of the side effects of cyclophosphamide use?
Herpes zoster, alopecia, nausea/vomiting, infertility in males and females
Lyme arthritis is accompanied by what symptoms?
Joint swelling, bursitis, tendonitis, fatigue, fever, HA, weight loss
How would you treat pseudogout?
Steroid injections, NSAIDs, colchicine, methotrexate, hydroxychloroquine
What are some symptoms caused by expression of IL-1?
Fever, lethargy, and decreased appetite
Polymyositis and dermatomyositis affect which gender more?
Female (2:1)
What are some symptoms caused by expression of TNF?
Fever, lethargy, and decreased appetite
What are complications that can arise from Kawasaki disease?
Cardiac aneurysms, heart failure
What are two examples of Type II reactions involving inflammation?
Acute rheumatic fever, Mooren ulcer
How would you treat the non-infection-related symptoms of reactive arthritis?
Start with NSAIDs, move on to corticosteroids, then to sulfasalazine and methotrexate, then finish with the TNF inhibitors
What is another term for Type II hypersensitivities?
Antibody-mediated
What are some symptoms of unique to dermatomyositis?
Gottron’s papules (raised skin lesions); heliotrope rash (looks like purple eye makeup); facial erythema; shawl sign, V sign, Hoster sign (look like sunburn); nail changes, scalp changes, calcinosis cutis
The symptoms of enthesis-related Juvnile Idiopathic Arthritis are usually seen in which portion of the skeleton?
Axial
Besides chlamydia, what other types of infections are common in patients who then develop reactive arthritis?
Salmonella, Yersinia, Shigella, campylobacter, E. coli
What is the action of thromboxane?
Vasoconstriction and platelet aggregation
How much of the primary care workload is rheumatology?
20-30%
What are some examples of Type IV T-cell mediated cytotoxicity reactions?
T1DM, MS, Hashimoto thyroiditis
Which medications can be used for maintenance of granulomatosis with polyangitis?
Methotrexate or azathioprine
What effects can relapsing polychondritis have in the lungs?
COPD, apnea
How many joints are affected in oligoarticular Juvenile Idiopathic Arthritis?
Four or fewer
True or false: NSAIDs can damage the liver
True.
What is the role of CRP?
Binds to cell wall of bacteria and fungi as opsonin and activates complement
What medications can be used to treat psoriatic arthritis?
Topical corticosteroids or tacrolimus (for skin lesions), NSAIDs, DMARDs (except methotrexate, hydroxychloroquine, and sulfasalazine), anti TNF agents, and biologics
The COX-1 pathway leads to what kind of prostaglandins?
Cytoprotective–protection of gastric mucosa; also aid in platelet aggregation
Briefly outline opsonization and phagocytosis during a Type II reaction.
Drug on cell surface makes cell look foreign; Ab (IgG or IgM) attaches to cell and activates complement; cell is either destroyed by MAC, or C3a attracts neutrophils and macrophages while C3b serves as opsonin.
What substances act as opsonins during an inflammatory response?
IgG and C3b (among others)
How many patients with reactive arthritis are HLA B 27 (+)? What other tests can be done to test for reactive arthritis?
40-75%; stool sample and testing for chlamydia
Describe transudate in terms of protein and cellular content.
Low protein content and few cells
How would you treat a patient with lyme arthritis?
Oral doxycycline or amoxicillin for a month, followed by another month if needed. If those fail, treat with IV ceftriaxone
What is/are the actions of IL-8?
Chemo-attractant; activates PMNs (polymorphonuclear leukocytes), setting the stage for phagocytosis
What are the side effects of biologic drugs?
Infection risk, TB activation, increased risk of malignancy, demyelination
Does the arthritic portion of psoriatic arthritis present unilaterally or bilaterally?
Unilaterally
What is another name for giant cell arteritis?
Temporal arteritis; also anterior arteritic ischemic optic neuropathy (AAION )
Enthesis-related Juvnile Idiopathic Arthritis is sometimes referred to by what other name?
Pediatric spondyloarthropathy
True or false: diabetes and renal failure can induce attacks of gout
True.
What is the name for nutrient rich fluid that is secreted by cells in the ECM?
Hyaluronan
Which leukotriene(s) is/are responsible for vasoconstriction?
LTC4, D4, and E4
Use of biologic drugs for a patient with RA is contraindicated if the patient has what other condition?
MS
Which complement molecules are important in opsonization?
C3b
What is citrullination? What effect does it have in terms of inflammation?
The conversion of an arginine to a citrulline. In the synovial fluid, the citrullinated site fits into the antigen binding site of HLA. This starts an inflammatory response.
Describe exudate in terms of protein and cellular content.
High protein content and some WBC and RBC
For how long must a patient have symptoms in order to be diagnosed with Juvenile Idiopathic Arthritis?
More than 3-6 weeks
What two symptoms are the most prevalent in psoriatic arthritis? What percentage of patients with PA experience these symptoms?
Nail dystrophy (pitting, separation of nail from bed; 80-90%); dactylitis (50-60%)
Does a ligament connect bone to bone or muscle to bone?
LBB (Ligament connects bone to bone)
True or false: about 25% of patients in the advanced stages of RA have rheumatoid nodules.
True.
How would you treat a moderate to severe case of microscopic polyangitis?
Prednisone with cyclophosphamide and rituximab
Which leukotriene(s) is/are responsible for bronchospasm?
LTC4, D4, and E4
What are some of the common skin-related symptoms of lupus (apart from the malar rash)?
Lesions on nails, urticaria (hives) and purpura, livedo reticularis (net-like appearance of BVs), palmar and plantar erythema, mouth ulcers, Raynaud’s phenomenon
Which gender has a higher prevalence for Kawasaki disease?
Male
What is the peak onset age for oligoarticular Juvenile Idiopathic Arthritis?
3 years
What is the most common ocular effect of RA?
Dry eye (occurs in 15-25% of RA pts)
What is the 5-year survival rate for patients with Takayasu arteritis?
80-90%
How many patients with spondyloarthropathy conditions other than ankylosing spondylitis test HLA B27 (+)?
70%
True or false: granulomatosis with polyangitis generally occurs in younger patients
False; it generally occurs in older patients
Systemic sclerosis is characterized by ____________.
Thickened, hardened skin
What is the name for the pockets of synovial fluid that can occur in the back of the knee in osteoarthritis?
Baker’s cysts
What are some of the common symptoms of Sjogren’s?
Dry mouth, dry eyes, dry skin and/or vaginal dryness*, dyspnea, COPD, pulmonary fibrosis, Raynaud’s phenomenon, liver and kidney damage, hearing loss, dental cavities
Fill in the blank: patients with systemic Juvenile Idiopathic Arthritis usually have ______ (high/low) CRP, _____ (high/low) ESR, and are RF ______ (positive/negative)
High, high, negative
True or false: the spondyloarthropathy condtions involve inflammation of the synovial fluid
False; they involve inflammation of tendons and/or ligaments
The COX-2 pathway results in prostacyclins. What is the role of prostacyclins?
They cause vasodilation and keep thromboxanes in check. Hence, inhibition of COX-2 results in vasoconstriction (an increase in BP) and an increase in clot formation due to the thromboxanes.
True or false: sulfasalazine is safe to take during pregnancy
True.
What are some treatment options for Sjogren’s?
Artificial tears, Restasis, punctal plugs, ointment, saliva replacement, pilocarpine (NSAIDs, DMARDs, corticosteroids for arthralgia)
What is a normal value for a CRP?
Less than 1.0 mg/dL (less than 10 mg/L)
Osteoarthritis normally affects which joints?
Knees, hips, fingers, spine
What is a mnemonic for the symptoms of systemic sclerosis?
CREST: Calcinosis, Raynaud’s*, Esophageal dysfunction, Sclerodactyly, Telangiectasia
How would you treat a moderate to severe case of granulomatosis with polyangitis?
Prednisone with cyclophosphamide and rituximab
What are the 4 benefits of NSAIDs?
Anti-pyresis (fever-reducing); anti-platelet (clot reduction); analgesic (pain-reducing); anti-inflammatory (in higher doses)
What class of medication should a patient with psoriatic arthritis NOT be prescribed?
Oral steroids (they decrease the response of the skin in healing itself; lesions last longer)
Which gender has a higher prevalence of relapsing polychondritis?
Neither; prevalence is equal between the genders
Prostaglandins and leukotrienes are metabolites of what molecule?
Arachidonic acid
True or false: Type 2 enteropathic arthritis is chronic.
True.
Briefly describe the Schober test for ankylosing spondylitis
Draw a line 10 cm above the iliac crest and one 5 cm below; have patient bend over, and distance between these two lines should be greater than 21 cm in a normal person
How would you treat eosinophilic granulomatosis with polyangitis?
Prednisone, can add cyclophosphamide; methotrexate or azathioprine for maintenance
What percentage of lupus patients are ANA (+)?
95%
Fibrosis of which internal organs is most worrisome in a patient with systemic sclerosis?
Lungs, heart, GI tract
How are lupus patients with kidney involvement monitored?
Urinalysis
What sort of lung involvement can a person with lupus experience?
Pleural effusion, chest pain, dyspnea
What is a key difference between hyperplasia and neoplasia?
Hyperplasms continues to respond to regulatory systems; neoplasms do not.
What are some of the side effects of hydroxychloroquine use?
Irreversible retinopathy (bull’s eye retinopathy) 1 in 2000; GI upset, nightmares, psychosis
Which gender has a higher prevalence for polymyalgia rheumatica?
Female (2:1)
What role do glycoproteins have in joints?
Tissue remodeling (they are also known as fibronectin)
What is the main characteristic of fibromyalgia?
Diffuse musculoskeletal pain
What percentage of patients with giant cell arteritis experience blurred vision (20/200 or worse)?
30%
What is the most common age of onset for RA?
45-75 years
What is lyme arthritis?
Arthralgia (joint pain) secondary to late stage lyme disease
What four classes of drugs are important for ODs in terms of inflammation?
Antihistamines, mast cell stabilizers, NSAIDs, corticosteroids
Which gender has the highest prevalence for systemic sclerosis?
Female (3-:1)
What is the 5-year survival rate for untreated patients with polyarteritis nodosa?
13%
What is the typical age of onset for polymyositis and dermatomyositis?
40-50 years
True or false: MMPs are upregulated during inflamation
True.
Systemic sclerosis is also known as?
Scleroderma
What sort of ocular issues can a person with lupus experience?
Dry eye, optic neuritis, cranial neuropathies, episcleritis, scleritis, conjunctivitis, retinopathy
Use of doxycycline is contraindicated in what populations?
Pregnant, breast-feeding, or kids (causes bone and teeth deformity)
True or false: NSAIDs do not typically work for fibromyalgia
True.
What is a normal value for CRP?
0-0.5 mg/dL
True or false: spinal stenosis (narrowing of spinal column) can occur in osteoarthritis
True.
True or false: some DMARDs can cause lupus
True.
What is/are the actions of TNF?
Causes aggregation and activation of neutrophils, activates vessel endothelium to increase WBC adhesion (activates selectins and integrins), increases thrombogenicity of endothelium (activates fibroblasts and increases collagen synthesis)
How would you treat fibromyalgia?
Anti-depressants, anti-anxiety meds, anticonvulsants
True or false: systemic Juvenile Idiopathic Arthritis affects girls and boys equally
True, up to age 5, then girls are more affected than boys
What ocular symptoms can occur in Takayasu arteritis?
VF loss, HA, retinal hemorrhages, decreased vision
What are symptoms of psoriatic Juvenile Idiopathic Arthritis?
Multiple rashes, sausage digits, nail pitting
Which vasculitis conditions are considered to be small vessel conditions?
Granulomatosis with polyangitis, microscopic polyangitis, eosinophilic granulomatosis with polyangitis
What ophthalmic solution contains cyclosporine?
Restasis (for dry eye)
What causes acute rhematic fever?
Streptococcal pharyngitis infection followed 2-4 weeks later by migratory arthritis
What are the symptoms of fibromyalgia?
Fatigue, morning stiffness, aching, disturbed sleep, anxiety, depression, cognitive dysfunction (slow responses, difficulty concentrating, memory loss)
Where can type 2 collagen be found?
Articular cartilage and the vitreous humor of the eye
Which leukocytes are involved in Type I reactions?
Mast cells and basophils
The end products of the COX pathway depends on the enzymes present in a particular type of cell. What cell type results in prostacyclin (PGI2)?
Endothelial cells
What type of inflammation is associated with new vessel growth and fibrosis?
Chronic
If acute rheumatic fever is left untreated, it can lead to rheumatic heart disease. How much time can pass before the onset of the rheumatic heart disease?
10-20 years
What are some non-medical treatment options for osteoarthritis?
Weight loss, light exercise, alternating heat and ice packs, massages
