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OPT 537 > Exam 1 -- Rheumatology #3 > Flashcards

Exam 1 -- Rheumatology #3 Flashcards

1
Q

Of the spondyloarthropathy conditions, which is most common?

A

Ankylosing spondylitis

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2
Q

All of the spondyloarthropathy conditions are RF ___________ (negative/positive).

A

Negative

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3
Q

True or false: the spondyloarthropathy condtions are associated with HLA B27, just like RA.

A

Trick question: they ARE associated with HLA B27, but RA is not.

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4
Q

The spondyloarthropathy conditions typically present _____________ (bilaterally/unilaterally).

A

Unilaterally

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5
Q

The spondyloarthropathy conditions typically involve the _____________ (axial/peripheral) joints.

A

Axial

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6
Q

True or false: the spondyloarthropathy condtions involve inflammation of the synovial fluid

A

False; they involve inflammation of tendons and/or ligaments

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7
Q

How many patients with ankylosing spondylitis test HLA B27 (+)?

A

90-95%

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8
Q

How many patients with spondyloarthropathy conditions other than ankylosing spondylitis test HLA B27 (+)?

A

70%

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9
Q

How many patients without spondyloarthropathy conditions test HLA B27 (+)?

A

5-10%

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10
Q

HLA B27 is present in what percentage of anterior uveitis cases?

A

20-40%

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11
Q

True or false: about half of patients with recurrent uveitis have some spondyloarthropathy condition

A

True.

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12
Q

HLA B27 is most common in what demographic?

A

Northern/Western European

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13
Q

HLA B27 is “best at fighting” what diseases?

A

HIV, hepatitis C, influenza

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14
Q

HLA B27 is “poor at fighting” what diseases?

A

Chlamydia, gonorrhea, salmonella

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15
Q

What part of the skeleton is most affected in ankylosing spondylitis?

A

Spine, especially lower back

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16
Q

Inflammation in ankylosing spondylitis generally occurs in which joints?

A

Sacroiliac joints

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17
Q

What parts of the body experience pain in ankylosing spondylitis?

A

Buttocks, hips

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18
Q

Which gender has a higher prevalence of ankylosing spondylitis?

A

Males (3:1)

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19
Q

What is the typical age of onset for ankylosing spondylitis?

A

Late teens to early 30s

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20
Q

True or false: ankylosing spondylitis is more common among Caucasians

A

True.

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21
Q

Fill in the blank: pain in ankylosing spondylitis improves with ________(movement/rest) and is worse with (movement/rest).

A

Movement; rest

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22
Q

What is another term for the bending of the spine that occurs in ankylosing spondylitis?

A

Kyphosis

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23
Q

True or false: kyphosis can lead to heart and lung problems

A

True; kyphosis is a bending of the spine due to ankylosing spondylitis, which compresses the heart and lungs

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24
Q

Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the foot?

A

Achilles tendonitis; also, skin lesions (red papules on soles)

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25
Q

Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the hand?

A

Dactylitis in 6% of AS patients; also, skin lesions (red papules on palms)

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26
Q

Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the eyes?

A

Uveitis in 20-40% of AS patients

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27
Q

What percentage of ankylosing spondylitis patients have inflammatory bowel disease?

A

About 50%

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28
Q

What tests can be performed to screen for ankylosing spondylitis?

A

ESR, CRP, HLA B 27

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29
Q

An x-ray of the spine of a patient with ankylosing spondylitis may show what?

A

Fused vertebrae (bamboo spine)

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30
Q

The first signs of ankylosing spondylitis (as seen in an x-ray) are seen in the _______ joint of 95% of AS patients.

A

Iliosacral

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31
Q

Briefly describe the Schober test for ankylosing spondylitis

A

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

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32
Q

Briefly describe the chest expansion test for ankylosing spondylitis

A

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

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33
Q

Briefly describe the wall touch test for ankylosing spondylitis

A

Have patient stand with their back up against the wall and try to move their head back to touch the wall too

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34
Q

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?

A

NSAIDs (effective in 70%); indomethacin; TNF-alpha blockers

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35
Q

True or false: hip replacement surgery is an option for patients with AS

A

True.

36
Q

Psoriatic arthritis is characterized by what type of lesion?

A

White, scaley skin rashes

37
Q

True or false: pain in psoriatic arthritis is alleviated with activity

A

True.

38
Q

Does psoriatic arthritis feature more or less joint pain than RA?

A

Less

39
Q

What percentage of patients with psoriasis will develop psoriatic arthritis?

A

10-30%

40
Q

What is the typical age of onset for psoriatic arthritis?

A

30-50 years

41
Q

Which gender has a higher prevalence of psoriatic arthritis?

A

Neither; prevalence is equal between the genders

42
Q

Does the arthritic portion of psoriatic arthritis present unilaterally or bilaterally?

A

Unilaterally

43
Q

What two symptoms are the most prevalent in psoriatic arthritis? What percentage of patients with PA experience these symptoms?

A

Nail dystrophy (pitting, separation of nail from bed; 80-90%); dactylitis (50-60%)

44
Q

What percentage of patients with psoriatic arthritis also get uveitis?

A

7%

45
Q

Psoriatic arthritis typically affects which joints?

A

Distal interphalangeal joints in hand

46
Q

What medications can be used to treat psoriatic arthritis?

A

Topical corticosteroids or tacrolimus (for skin lesions), NSAIDs, DMARDs (except methotrexate, hydroxychloroquine, and sulfasalazine), anti TNF agents, and biologics

47
Q

How does UV phototherapy work for patients with psoriatic arthritis?

A

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

48
Q

What class of medication should a patient with psoriatic arthritis NOT be prescribed?

A

Oral steroids (they decrease the response of the skin in healing itself; lesions last longer)

49
Q

What is the name for a spondyloarthropathy following an infection?

A

Reactive arthritis

50
Q

What percentage of all spondyloarthropathies is reactive arthritis?

A

1%

51
Q

Which gender has a higher prevalence for reactive arthritis?

A

Male

52
Q

Patients with untreated chlamydia infection have what percentage chance of developing reactive arthritis?

A

4-8%

53
Q

Besides chlamydia, what other types of infections are common in patients who then develop reactive arthritis?

A

Salmonella, Yersinia, Shigella, campylobacter, E. coli

54
Q

What percentage of patients with reactive arthritis experience complete recovery within 6 months?

A

70%

55
Q

True or false: reactive arthritis is most common over age 50

A

False; it is more common in younger patients

56
Q

How long after infection can symptoms of reactive arthritis occur?

A

1-4 weeks

57
Q

True or false: reactive arthritis is usually accompanied by acute, asymmetric lower limb arthritis

A

True.

58
Q

What mnemonic can help you remember some of the common symptoms of reactive arthritis?

A

Can’t see, can’t pee, can’t dance with me. (Uveitis, urethritis, lower limb arthritis)

59
Q

How many patients with reactive arthritis are HLA B 27 (+)? What other tests can be done to test for reactive arthritis?

A

40-75%; stool sample and testing for chlamydia

60
Q

How would you treat the underlying infection in reactive arthritis?

A

Oral antibiotic (azithromycin or doxycycline)

61
Q

How would you treat the non-infection-related symptoms of reactive arthritis?

A

Start with NSAIDs, move on to corticosteroids, then to sulfasalazine and methotrexate, then finish with the TNF inhibitors

62
Q

10-40% of patients with ulcerative colitis or Crohn’s disease develop what kind of arthritis?

A

Enteropathic arthritis

63
Q

Which gender has a higher prevalence of enteropathic arthritis?

A

Neither; prevalence is equal between the genders

64
Q

What are common symptoms of enteropathic arthritis?

A

Spondylitis, sacroilitis, stomach pain

65
Q

What percentage of IBD patients have Type 1 enteropathic arthritis?

A

5%

66
Q

How many joints are involved in Type 1 enteropathic arthritis?

A

6 or less

67
Q

What percentage of cases of type 1 enteropathic arthritis are self-limiting?

A

90%

68
Q

What percentage of IBD patients have Type 2 enteropathic arthritis?

A

3%

69
Q

How many joints are involved in Type 2 enteropathic arthritis?

A

More than 6

70
Q

True or false: Type 2 enteropathic arthritis is chronic.

A

True.

71
Q

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.

A

Type 1: arthritis then IBD; Type 2: IBD then arthritis

72
Q

How would you treat enteropathic arthritis?

A

Treat the underlying disease; NSAIDs (though can worsen diarrhea); corticosteroids, sulfasalazine, methotrexate, infliximab is preferred

73
Q

Whipple’s disease is a bacterial infection that might be mistaken for enteropathic arthritis. What part of the GI tract does Whipple’s effect?

A

Small intestine (enteropathic affects the large intestine)

74
Q

Behcet’s disease can cause oral and genital ulcers like what spondyloarthropathy?

A

Reactive arthritis

75
Q

What gender and demographic is common for patients with Behcet’s disease?

A

Young men of Middle or Far East descent

76
Q

What percentage of patients with Behcet’s disease experience ocular symptoms?

A

33%

77
Q

Polymyositis and dermatomyositis affect which gender more?

A

Female (2:1)

78
Q

What is the main difference between polymyositis and dermatomyositis?

A

Dermatomyositis involves the skin as well

79
Q

What is the typical age of onset for polymyositis and dermatomyositis?

A

40-50 years

80
Q

What percentage of patients with polymyositis or dermatomyositis are ANA (+)?

A

80%

81
Q

The muscle weakness of polymyositis and dermatomyositis is usually in which areas of the body?

A

Hips and shoulders

82
Q

What are some symptoms of polymyositis and dermatomyositis?

A

Muscle weakness, dysphagia, polyarthritis, Raynaud’s phenomenon, interstitial lung disease, myocarditis

83
Q

Polymyositis and dermatomyositis are more common in what ethnicity?

A

African American

84
Q

What tests can be performed to screen for polymyositis and dermatomyositis?

A

Chest x-ray, muscle biopsy, MRI

85
Q

How would you treat polymyositis or dermatomyositis?

A

Physical therapy, corticosteroids, DMARDs, biologics, methotrexate

86
Q

What are some symptoms of unique to dermatomyositis?

A

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

OPT 537 (21 decks)

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