Exam 1 -- Randomized List of All Exam 1 Flashcards -- part 2
What is the typical age of onset for ankylosing spondylitis?
Late teens to early 30s
True or false: all biologic drugs for RA are safe to use in pregnancy
False; none of them are safe to use during pregnancy
What is a normal value for an ESR?
For males: less than half their age in years; for females, less than half of (their age in years + 10)
What ocular effects can occur with RA?
Dry eye, episcleritis, scleritis, scleromalacia perforans, PUK (peripheral ulcerative keratitis; abnormal bacterial ulcers)
Which biologic drug can be used to treat Juvenile Idiopathic Arthritis?
Tocilizumab
Which vasculitis conditions are considered to be large vessel conditions?
Giant cell arteritis, polymyalgia rheumatica, Takayasu arteritis
How does cyclophosphamide work?
Suppresses B and T cell function by 30-40%
The spondyloarthropathy conditions typically present _____________ (bilaterally/unilaterally).
Unilaterally
Which gender has a higher prevalence for reactive arthritis?
Male
Up to ___________% of lupus patients will have ocular involvement
30
What joints are most commonly involved in lyme arthritis?
Knee, ankle, elbow, wrist
True or false: symptoms of lupus can be exacerbated by UV light and also by stress
True.
Interleukin-1 (IL-1) is produced by what type of cell?
Activated macrophages
What is the role of SAA?
Recruits immune cells to inflammatory sites; induces enzymes that degrade ECM; is also associated with cancer (especially breast) and RA
What are the main symptoms of polyarteritis nodosa?
Fever, malaise, weight loss, kidney failure, livedo reticularis*, abdominal pain, MI and heart failure, gangrene, neuropathy, purpura, ulcers, liver failure, large joint arthritis
Which gender has the higher prevalence of polyarteritis nodosa?
Male (2:1)
In addition to elevated uric acid levels, what else must occur to trigger gout?
Trauma or inflammation
The symptoms of RA can be similar to the symptoms of an infection. How long do the symptoms of RA last?
More than 6 weeks (longer than symptoms from an infection)
What effects can relapsing polychondritis have in the ears?
Cauliflower ear, floppy ear, hearing loss
What is another term for the bending of the spine that occurs in ankylosing spondylitis?
Kyphosis
How many patients with ankylosing spondylitis test HLA B27 (+)?
90-95%
What systemic effects may be present in the heart of a patient with RA?
Coronary artery disease (CAD), myocarditis (inflammation of muscles around the heart), atrial fibrillation (abnormal heartbeat)
How would you treat giant cell arteritis?
40-60mg oral prednisone (IV methylprednisolone if very severe), low dose aspirin as an anti-platelet, can add concurrent methotrexate or cyclophosphamide if patient isn’t responding to steroids or doesn’t tolerate high-dose steroids)
How would you treat Kawasaki disease?
Single, high-dose IV Ig, aspirin daily 200-300 mg
Up to ___________% of lupus patients will have lung involvement.
50
Which Ig is found in bodily fluids (tears, saliva, breast milk, etc.)?
IgA
What percentage of Sjogren’s patients are ANA (+)?
70-80%
What percentage of patients with Sjogren’s experience arthralgia?
50%
True or false: systemic sclerosis affects only the skin
False; it can affect the internal organs as well
Patients with untreated chlamydia infection have what percentage chance of developing reactive arthritis?
4-8%
True or false: patients with enthesis-related Juvnile Idiopathic Arthritis are usually RF (+)
False; they are usually RF (-)
Patients with what conditions have an increased risk of gout?
Psoriasis and psoriatic arthritis
What percentage of normal patients are ANA (+)?
15%
What is the upper limit of how long a corticosteroid should be used?
About 3 months
Polymyalgia rheumatica is characterized by sudden stiffness and severe pain in what parts of the body?
Neck, shoulders, and hips
What symptoms might accompany acute rheumatic fever?
Carditis, CNS involvement (psychosis), subcutaneous nodules, multiple skin rashes
Articular cartilage is made of what type of collagen?
Type 2
Patients with psoriatic Juvenile Idiopathic Arthritis are typically RF ______________(positive or negative)?
Negative
By what method do CD8+ cells cause damage?
They themselves release perforin and granzymes
True or false: smoking, obesity, and heavy coffee drinking are all considered risk factors for RA
True.
How many joints must be affected in order to diagnose a condition as RA?
More than 3
True or false: oligoarticular Juvenile Idiopathic Arthritis affects girls and boys equally
False; girls are more affected than boys
What type of modified macrophage is found in gramulomatous inflammation?
Epithelioid cells
Which proteins have elevated levels during acute phase reaction?
C-reactive protein (CRP), fibrinogen, serum amyloid A (SAA)
How long do patients take to respond to hydroxychloroquine treatment?
3-6 months
How long do patients take to respond to sulfasalazine treatment?
3-6 months
True or false: patients with Sjogren’s have less dental cavities than the rest of the population
False; they have more
Extracellular fluid is made of what components?
Collagens, elastins, glycoproteins, proteoglycans, and cells
The muscle weakness of polymyositis and dermatomyositis is usually in which areas of the body?
Hips and shoulders
Inflammation in ankylosing spondylitis generally occurs in which joints?
Sacroiliac joints
Which ethnicities have a higher prevalence of lupus?
African and Caribbean (1 in 250)
What is the average age of onset for giant cell arteritis?
72 (onset is rare below age 50)*
What percentage of patients with reactive arthritis experience complete recovery within 6 months?
70%
How does UV phototherapy work for patients with psoriatic arthritis?
An enhancing agent (Psoralen) is ingested. Upon exposure to UV light, this agent helps the body to absorb the UV-A or UV-B light, which is supposed to decrease the inflammatory response
True or false: Type IV reactions are a function of T cells, not antibodies
True.
What percentage of patients with microscopic polyangitis are ANCA (+)?
70%
What percentage of lupus patients experience myalgia?
About 50%
True or false: patients with systemic sclerosis can get nail pitting and dactylitis
True.
True or false: azathioprine and leflunomide (DMARDs) are safe to take during pregnancy
False.
How would you treat tenosynovitis?
Split, corticosteroid injection, surgery
How many patients with systemic sclerosis experience a renal crisis?
10%
What is another name for Type IV hypersensitivity?
Cell-mediated (or delayed)
True or false: less common symptoms of giant cell arteritis include peripheral muscle weakness and respiratory difficulty
True.
The lipoxygenase pathway results in the production of what products?
Leukotrienes (5-LO) and lipoxins (5-LO then 12-LO)
What symptoms may be indicative of Juvenile Idiopathic Arthritis?
Symmetric joint pain, fever, rash
In delayed-type hypersensitivity, which T cell is responsible for the reaction?
CD4+
What is a side effect of probenecid?
Kidney stones
How is microscopic polyangitis differentiated from granulomatosis with polyangitis?
Microscopic polyangitis has no inflammatory granulomas in the lung
What tests can be performed to screen for polymyositis and dermatomyositis?
Chest x-ray, muscle biopsy, MRI
What mnemonic can help you remember some of the common symptoms of reactive arthritis?
Can’t see, can’t pee, can’t dance with me. (Uveitis, urethritis, lower limb arthritis)
How does doxycycline work?
It inhibits MMPs, TNF, T cells, and cytokines
What are some of the side effects of sulfasalazine use?
Nausea, rash, reversible infertility in males
Microscopic polyangitis is associated with what specific form of ANCA?
P-ANCA*
Giant cell arteritis often occurs with what other large vessel vasculitis?
Polymyalgia rheumatica
What medications can be used for osteoporosis?
Bisphosphonates (ibandronate q1mo, aldendronate q1week), estrogen therapy (raloxifene)
Where can rheumatoid nodules be found?
Toes, elbows, knuckles, spine, lungs, heart, liver, skin
What are possible treatment options for a patient with RA?
Physical therapy, NSAIDs, corticosteroids, DMARDs
Raynaud’s phenomenon is most commonly associated with what condition? Which other conditions can it be associated with?
Systemic sclerosis; lupus and Sjogren;s
In granulomatosis with polyangitis, lesions occur in what parts of the body?
Lungs/respiratory tract, kidneys, skin (purpura, subcutaneous nodules)
How would you treat Takayasu arteritis?
45-60 mg oral prednisone, methotrexate, azathioprine, TNF agents, cyclophosphamide, bypass grafts, low dose aspirin
True or false: rheumatoid arthritis is the most common type of autoimmune arthritis
True.
What are some treatment options for Raynaud’s?
Decrease vasoconstrictors (smoking), take vasodilators, treat any underlying disease with DMARDs
What percentage of IBD patients have Type 2 enteropathic arthritis?
3%
The spondyloarthropathy conditions typically involve the _____________ (axial/peripheral) joints.
Axial
Which complement molecules act as chemoattractants?
C5a and C5-C7 complex
What is dysplasia?
Disorderly proliferation of cells (but not neoplastic); sometimes called precancer
What percentage of patients with granulomatosis with polyangitis test ANCA (+)?
95%
True or false: rheumatoid arthritis presents bilaterally and symmetrically
True.
What ocular symptoms can occur in giant cell arteritis?
Blurred vision, monocular transient vision loss, APD, swollen or pale optic nerve, diplopia, CRAO, visual field loss
How would you treat a mild case of granulomatosis with polyangitis?
Prednisone, methotrexate
The biologic drugs have what type of suffix?
“-mab”
Secondary osteoporosis can be caused by what conditions?
Corticosteroids, hyperthyroidism, hyperparathyroidism
What are two examples of Type II reactions involving opsonization and phagocytosis?
Hemolytic anemia; transfusion hemolysis
Up to ___________% of lupus patients will have heart issues.
25
How does the enthesis (end of a bone) differ from the shaft of the bone?
The enthesis is more porous and is vascularized; the shaft is denser and avascular
Polyarticular Juvenile Idiopathic Arthritis is more common in what gender and age groups?
Girls age 2-5 or 10-14
What actions are the end result of the kinin cascade?
Vasodilation, increased vascular permeability, bronchial constriction, PGI2 and NO release
Which populations have a higher incidence of RA? Which have a lower incidence?
White and hispanic; African American and Chinese
What is/are the actions of IL-1?
Activates vessel endothelium to increase WBC adhesion (activates selectins and integrins), enhances the production of AA and NO (?)
Which vasculitis conditions are considered to be medium vessel conditions?
Polyarteritis nodosa, Kawasaki disease
What percentage of patients with granulomatosis with polyangitis are ANCA (+)?
90%
What are the main symptoms of EGPA?
Rhinitis, asthma, peripheral neuropathy, skin lesions, GI bleeding
Which biologic drug for RA is approved for children?
Tocilizumab
Attacks of gout may be separated by what length of time?
2-3 years
True or false: African Americans are affected more with giant cell arteritis than are Caucasians
False; Caucasians are more often affected
What is another name for tenosynovitis?
Trigger finger
Which gender has a higher prevalence of psoriatic arthritis?
Neither; prevalence is equal between the genders
Mast cells release what types of molecules?
Histamine and AA metabolites
True or false: hydroxychloroquine is safe to take during pregnancy
True.
Treatment of conditions involving the joints can consist of different classes of drugs. What class is meant to treat the actual condition, not just relieve the pain?
DMARDs (including biologics and tetracyclines)
What is the typical age of onset for psoriatic arthritis?
30-50 years
What cell types are associated with chronic inflammation?
Lymphocytes and macrophages
Giant cell arteritis increases risk of what type of aneurysm?
Aortic
True or false: oligoarticular Juvenile Idiopathic Arthritis usually doesn’t cause lasting harm.
True.
Rheumatoid factor is associated with what Ig? Which portion of which other Ig does it target?
IgM; Fc portion of IgG
What are some symptoms of polymyositis and dermatomyositis?
Muscle weakness, dysphagia, polyarthritis, Raynaud’s phenomenon, interstitial lung disease, myocarditis
True or false: uveitis is more common in Juvenile RA than in RA.
True.
What is the prevalence of gout in the U.S.?
2.70%
How many joints are affected in polyarticular Juvenile Idiopathic Arthritis?
More than four
What age group is most commonly affected by Kawasaki disease?
Under 5 years
What gender and demographic is common for patients with Behcet’s disease?
Young men of Middle or Far East descent
True or false: Pacific Islanders have a higher prevalence of gout
True.
How would you treat a mild case of microscopic polyangitis?
Prednisone, methotrexate
True or false: osteoarthritis is the most common type of arthritis
True.
True or false: patients with fibromyalgia have a higher than normal pain tolerance
False; their pain tolerance is less than normal
What sort of ocular findings might a patient with granulomatosis with polyangitis have?
Proptosis, uveitis, scleritis, episcleritis
What is the name for a spondyloarthropathy following an infection?
Reactive arthritis
Matrix Metalloproteinases (MMPs) 2 and 9 degrade CT. What specific portions of the ECM do they degrade?
Collagen, proteoglycans, and fibronectin
Renal failure is very common gout patients who also have what other conditions?
Diabetes, CKD, HTN, obesity
What is/are the actions of interferon-gamma (IFN)?
Limits spread of inflammatory process, activates macrophages and neutrophils, stimulates synthesis of NO, protects against viral infection (inhibits viral replication), induces production of IgG from plasma cells
HLA B27 is present in what percentage of anterior uveitis cases?
20-40%
What are the two types of Type IV reactions?
Delayed-type hypersensitivity (DHT); T-cell mediated cytotoxicity
What is the result of serotonin release during the inflammatory response?
Vasodilation and easier clot formation
True or false: using two biologic drugs is completely safe for treatment of RA
False; it decreases the immune response too much
Apart from pain, what are some symptoms of polymyalgia rheumatica?
Fatigue, weight loss, malaise, night sweats, bursitis, pitting edema
True or false: pregnancy can be protective against RA.
True.
True or false: migratory arthritis is the earliest manifestation of acute rheumatic fever
True.
True or false: methotrexate is safe to take during pregnancy
False.
What type of adhesion molecule causes slowing of WBC movement along the vessel wall?
Selectin
What is amyloidosis?
Incorrectly folding proteins that can cause nodules inside the body
What would you test for in a patient you suspect of having lyme disease?
B. burgdorferi, ESR, CRP
What is the action of lipoxin?
Vasodilation, inhibition of neutrophil chemotaxis, stimulation of monocyte adhesion (?)
What percentage of patients with Behcet’s disease experience ocular symptoms?
33%
Juvenile Idiopathic Arthritis presents with symmetric or asymmetric joint pain?
Symmetric
How long do DMARDs take for their full effect?
6 weeks to 6 months
True or false: the tapering of corticoteroids in treating giant cell arteritis can take years
True.
Which complement molecules form the MAC?
C5b, C6-C9
A patient is tested for ANCA. If the patient only has polyarteritis nodosa, are they likely to test ANCA (+) or ANCA (-)?
ANCA (-)
By what percentage can dietary restriction reduce serum uric acid?
15%
Which cytokines are the most important in acute phase reaction?
TNF, IL-1, IL-6
What systemic effects may be present in the kidneys of a patient with RA?
Chronic kidney disease (CKD)
What are treatment options for Juvenile Idiopathic Arthritis? Which one should be used with caution?
NSAIDs, DMARDs, TNF modulators, oral steroids with caution (interfere with bone growth)
How does cyclosporine work?
It inhibits IL-1 and IL-2 and T cells
What percentage of systemic sclerosis patients are RF (+)?
30%
What is the main characterizing symptom of gout?
Podagra (pain, redness, and swelling in big toe at MTP)
What sort of systemic findings might a patient with Sjogren’s have?
Arthralgia, RA, lupus*, thyroid disease, MG, hepatitis, pulmonary fibrosis, vasculitis, Raynaud’s phenomenon
Which gender has a higher prevalence of gout?
Male (10:1)
What can cause pseudogout?
Trauma or increased iron uptake
What causes tenosynovitis?
Repetitive use, RA, injury, genetics
After fibrin has formed a clot, which molecule has the potential to break it down?
Plasmin; its precursor, plasminogen, entered the area with the fibrinogen and is activated by the endothelium once this has healed
What are some side effects of febuxostat?
Cardiovascular risk factors
Briefly outline a Type III reaction.
Ag-Ab complex deposits in tissue and activates complement system; inflammation and tissue damage occur
Tophaceous gout is caused by what?
Inflammation adjacent to urate crystalsin synovium
What is the general age of onset for relapsing polychondritis?
Greater than 40 years
What is another term for “sausage digits?”
Dactylitis
Imbalances in which factors contribute to the degeneration of tissue in osteoarthritis?
MMPs, IL’s, TNF-alpha, and VEGF all increase, IGF decreases
What percentage of patients with microscopic polyangitis have glomerulonephritis?
60-90%
What are some side effects that can arise from corticosteroid use?
Osteoporosis, diabetes, HTN, weight gain, infections, Cushing’s syndrome (not disease), cataracts, glaucoma
What are some side effects of colchicine?
Kidney failure, liver failure, GI upset in 80%
What percentage of cases of type 1 enteropathic arthritis are self-limiting?
90%
What are some side effects that can arise from COX-1 inhibition?
GI upset, GI bleeding, nausea
What percentage of patients with Raynaud’s phenomenon have an underlying condition?
40-80%
Briefly describe the chest expansion test for ankylosing spondylitis
Measure the chest circumference of the patient when they breathe in and when they breathe out; abnormal measurement is less than 2.5 cm difference
What is tenosynovitis?
Inflammation of the synovium around a tendon (not inflammation of the tendon itself
What are some of the common symptoms of lupus?
Arthralgia, malar rash, fatigue, fever, weight loss, alopecia
EGPA involves what parts of the body?
Skin, lungs, kidneys, heart
Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the hand?
Dactylitis in 6% of AS patients; also, skin lesions (red papules on palms)
What percentage of ankylosing spondylitis patients have inflammatory bowel disease?
About 50%
True or false: cytokines stimulate fibronectin
False; they inhibit fibronectin, decreasing tissue rebuilding
In what way (relating to activity and rest) does bursitis differ from reheumatoid arthritis?
Bursitis is exacerbated by activity and improved by rest; RA is the opposite.
Whipple’s disease is a bacterial infection that might be mistaken for enteropathic arthritis. What part of the GI tract does Whipple’s effect?
Small intestine (enteropathic affects the large intestine)
True or false: mild anemia is present in nearly all rheumatoid conditions
True.
One-third of patients with polyarteritis nodosa also have what viral infection?
Hepatitis B*
What testing can be done for polymyalgia rheumatica?
ESR and CRP
What percentage of lupus patients have kidney involvement?
50%
Does RA present peripherally or axially?
Peripherally
What are some clinical features of systemic sclerosis?
Small mouth, beak-like nose, digital ulcers, arthralgia, fatigue*, telangiectasia, dry eyes, ED, vaginal dryness
There are five forms of Juvenile Idiopathic Arthritis. Which is most common?
Oligoarticular/pauciarticular (50-60%)
What tests can be performed for polyarteritis nodosa?
Skin biopsy, ESR, angiography
What term is used to indicate a lack of rheumatoid factor?
Seronegative
What symptoms accompany systemic Juvenile Idiopathic Arthritis?
Fever and a rash that doesn’t itch
What manifestation can osteoarthritis have in the feet?
Hallux valgus (big toe points toward second toe)
10-40% of patients with ulcerative colitis or Crohn’s disease develop what kind of arthritis?
Enteropathic arthritis
Rheumatoid factor can be associated with viral infections. Can ACPA also be associated with viral infections?
No
What tests can be performed to screen for ankylosing spondylitis?
ESR, CRP, HLA B 27
What are the main symptoms of granulomatosis with polyangitis?
Rhinorrhea, sinusitis, hearing loss, oral ulcers, hemoptysis, saddle-nose, kidney disease*, painful breathing/cough, hematuria, joint pain
Tophaceous gout is associated with what conditions or medications?
Renal impairment and long-term diuretic use
What role do omega-3 and fish oil supplements play in treating RA or other conditions that involve the joints?
They inhibit MMPs
True or false: granulomatosis with polyangitis is more common in Caucasians
True.
Relapsing polychondritis is an autoimmune mediated inflammation of what type of tissue?
Cartilage
Which medications can be used for maintenance of microscopic polyangitis?
Methotrexate or azathioprine
True or false: Kawasaki disease is the most common vasculitis in children
True.*
Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the eyes?
Uveitis in 20-40% of AS patients
How would you treat polyarteritis nodosa?
Prednisone and/or immunosuppressants, antivirals if patient has hepatitis
75% of untreated gout patients develop tophi after how many years?
20 years
What are the three basic mechanisms of Type II reactions?
Opsonization and phagocytosis; inflammation; Ab-mediated cellular dysfunction
True or false: bursitis normally presents bilaterally and symmetrically
False; it presents unilaterally and asymmetrically
Serum uric acid raised to what level is indicative of gout?
Higher than 6.8 mg/dL
What are some common causes of gout?
Purine foods*, high saturated fats, fructose in drinks, alcohol, obesity, trauma
True or false: serotonin is found in mast cells
False; it is found primarily in platelets
What is the action of prostacyclin?
Vasodilation and inhibition of platelet aggregation
Hydroxycloroquine binds to melanin, making it especially toxic for what part of the eye?
The macula
What are some side effects of allopurinol?
Skin rash, GI upset, can induce acute gout
What lifestyle changes can be made to help with osteoporosis?
Exercise, smoking cessation, fall prevention, alcohol avoidance
How many patients with oligoarticular Juvenile Idiopathic Arthritis also suffer from uveitis?
25%
Of the spondyloarthropathy conditions, which is most common?
Ankylosing spondylitis
What are two examples of Type IV delayed-type reactions?
Tuberculin reaction, contact dermatitis
True or false: pain in psoriatic arthritis is alleviated with activity
True.
Which gender has a higher prevalence for lupus?
Female (9:1)
What enzyme do corticosteroids target?
Phospholipase A2 (releases arachidonic acid from the cell membrane–AA is the precursor molecule for thromboxanes, prostacyclins, and prostaglandins
What are two of the most common causes of secondary Sjogren’s?
RA and lupus; 7% of RA patients and 17% of lupus patients have Sjogren’s
80% of patients with granulomatosis with polyangitis die within how many years, if untreated?
2 years
What are the main symptoms of Kawasaki disease?
Fever for more than 5 days, conjunctival injection, dry red lips and tongue, redness and edema of the palms and soles, lymphadenopathy*, rash/skin peeling, arthritis
Patients with what type of allergy should not be given celecoxib?
Sulfa
True or false: the spondyloarthropathy condtions are associated with HLA B27, just like RA.
Trick question: they ARE associated with HLA B27, but RA is not.
Raynaud’s phenomenon can cause ___________, which may result in having to remove the affected digits.
Gangrene
Which gender has a higher incidence of RA?
Women (3:1)
What substances contribute to the chemotaxis that pulls WBCs toward the damaged area?
Bacterial products, C5a, LTB4, IL-8
What purpose do proteoglycans have in the extracellular fluid?
They are GAG chains that bind the fluid together and retain nutrients
How would you treat enteropathic arthritis?
Treat the underlying disease; NSAIDs (though can worsen diarrhea); corticosteroids, sulfasalazine, methotrexate, infliximab is preferred
Rheumatic heart disease involves calcification of what structure in the heart?
The mitral valve (and the aortic valve, to a lesser degree)
What medical options are available in chronic gout?
Allopurinol (blocks synthesis of uric acid, decreases purine synthesis), febuxostat, probenecid (increases excretion and stop resorption of uric acid)
What is the usual age of onset for gout?
30-50 years
True or false: bursitis is more common than RA and lupus
True.
Joint aspiration shows what shape of cystals in gout?
Rod-shaped
What is the 5-year survival rate for relapsing polychondritis?
65-75% (45% if systemic vasculitis involved)
What is the typical age of onset for pseudogout?
Above 65 years
What is another name for osteoarthritis?
Degenerative Joint Disease (DJD)
Fill in the blank: pain in ankylosing spondylitis improves with ________(movement/rest) and is worse with (movement/rest).
Movement; rest
Acute inflammation in Kawasaki disease lasts for how long?
12 days
True or false: systemic sclerosis has the highest mortality of any autoimmune rheumatic disease
True.
Which cytokine activates immature macrophages?
Interferon gamma
What is/are the actions of platelet activating factor?
Platelet aggregation/adhesion, vasodilation, increased permeability, stimulates synthesis of AA metabolites, chemotaxis
What percentage of lupus patients experience malar rash?
More than 75%
Which NSAIDs are very COX-1 selective? Which are COX-2 selective?
Aspirin and piroxicam are very COX-1 selective; celecoxib and meloxicam are COX-2 selective
How does hydroxychloroquine work?
It impairs the cytokine response
What percentage of lupus patients have nervous system involvement?
20-80%
Which gender has a higher prevalence of enteropathic arthritis?
Neither; prevalence is equal between the genders
Takayasu arteritis is rare, except in which country?
Japan
Which NSAIDs are used as topical agents to reduce macular swelling after cataract surgery (and prophylactically, too)?
Ketorolac, diclofenac
What types of agents may cause a granulomatous inflammation?
Bacteria, fungi, inorganic materials
True or false: patients with gout have a lower risk of CVD
False; they have a higher risk of CVD
What medical options are available in acute gout?
High dose NSAIDs (naproxen, diclofenac, indomethacin, but not aspirin; aspirin can induce gout); low-dose colchicine, oral or injected corticosteroids
What is metaplasia?
A cell type changing to another cell type to cope with the environmental factors
What percentage of all spondyloarthropathies is reactive arthritis?
1%
What percentage of patients with psoriasis will develop psoriatic arthritis?
10-30%
What substance does the WBC release in order to pass through the basement membrane?
Collegenase
Psoriatic arthritis typically affects which joints?
Distal interphalangeal joints in hand
What are some common symptoms of vasculitis conditions?
Peripheral neuropathy, fever, fatigue, malaise, palpable purpura, pulmonary and renal involvement
What is/are the major actions of cytokines?
They cause WBC adherence to the vessel endothelium (activate, aggregate, and aggravate)
Which gender has a higher prevalence for Takayasu arteritis?
Female (90%)*
Acute rheumatic fever occurs most commonly in what age group?
5-15 years
What is the name for the bony spurs that can occur in the DIP joint?
Heberden’s nodes
True or false: doxycycline has both antibiotic and anti-inflammatory effects
True.
Which Ig can cross the placenta?
IgG
If a patient tests positive for both RF and ACPA, what is the likelihood that they have RA?
80-97%
True or false: cyclophosphamide is safe to take during pregnancy
False.
Which Ig is the fastest responder?
IgM
True or false: polyarticular Juvenile Idiopathic Arthritis usually shows up RF (+)
False; it can show up RF (+) or RF(-) depending on the age of diagnosis
List the stages of gout:
Hyperuricemia, urate deposition, trauma/inflammation, podagra, chronic tophaceous gout
What are three examples of Type III reactions?
Reaction arthritis (ReA), Systemic lupus erythematosus (SLE), Sjogren’s syndrome
What medication can cause rheumatoid nodules?
Methotrexate
Kawasaki disease is common in what parts of the world?
Japan and East Asia
Lupus can be caused by some medications. Which medication most commonly causes lupus?
Procainamide (anti-arrhythmia drug; sodium channel blocker)
Granulomatous inflammation is characteristic of what type of hypersensitivity?
Type IV hypersensitivity
The COX-2 pathway leads to what kind of prostaglandins?
Inflammatory–recruitment of inflammatory cells, sensitization of skin pain receptors.
True or false: Raynaud’s phenomenon presents symmetrically and bilaterally
True.
How quickly can arthritis manifest from the onset of RA (not diagnosis, but onset)?
Within 3-6 months
Enthesis-related Juvnile Idiopathic Arthritis is most common in what gender and age group?
Boys age 8-12 years
True or false: the ophthalmic artery and the posterior ciliary arteries can be affected in giant cell arteritis
True.
What percentage of relapsing polychondritis patients get valvular disease?
10%
Is articular cartilage vascular or avascular?
Avascular
Are bursitis, carpal tunnel syndrome, and tenosynovitis rheumatologic in nature?
No, but they are dealt with by rheumatologists often
What is the typical age of onset for EGPA?
30 years
How would you treat rheumatic heart disease?
Antibiotics* (penicillin, amoxicillin, azithromycin), aspirin*, anti-inflammatories
True or false: pseudogout is more painful than gout
False; it is less painful
In T-cell mediated cytotoxicity, which T cell is responsible for the reaction?
CD8+
What are overall causes for vasculitis conditions?
Infection (hepatitis B and C; HIV), autoimmune diseases, medications (diabetic meds, diuretics, gout meds, antibiotics), smoking
What effects can relapsing polychondritis have in the eyes?
Episcleritis, scleritis, proptosis
True or false: Juvenile Idiopathic Arthritis (JIA) is the exact same condition as RA, just in younger patients
False.
Which gender has a higher prevalence of pseudogout?
Female
What is the age of onset for Takayasu arteritis?
10-40 years*
True or false: symptoms of osteoporosis improve with use and are worse with rest
False; symptoms are exacerbated by use and reduced by rest
How long can cyclophosphamide be used for?
3-6 months
True or false: polyarticular Juvenile Idiopathic Arthritis usually doesn’t cause lasting harm.
False; it is progressive and destructive
What sort of testing might help distinguish osteoarthritis?
X-rays (for osteophytes), MRIs (for cartilage injury)
What percentage of Sjogren’s patients have xerostomia?
90%
Which gender has a higher prevalence for giant cell arteritis?
Female (2:1)
What is another term for acute phase reaction?
Systemic inflammatory response syndrome
What sort of testing can be done for Sjogren’s?
Salivary gland or lip biopsy, anti-Ro or anti-La, RF, ANA, ESR, CRP
Which joints in the hand can become affected in osteoarthritis?
CMC (proximal joint of thumb) and DIP and PIP (two most distal joints of the other fingers)
What percentage of giant cell arteritis patients eventually have some improved vision?
30%
Osteoarthritis is uncommon below what age?
50
Tophaceous gout is characterized by very high levels of uric acid, as well as tophi. What are tophi and where can they be found?
They are white deposits which can ulcerate. They form on the ears, fingers, and ankles.
