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OPT 537 > Exam 1 -- Rheumatology #6 > Flashcards

Exam 1 -- Rheumatology #6 Flashcards

1
Q

What are overall causes for vasculitis conditions?

A

Infection (hepatitis B and C; HIV), autoimmune diseases, medications (diabetic meds, diuretics, gout meds, antibiotics), smoking

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2
Q

What are some common symptoms of vasculitis conditions?

A

Peripheral neuropathy, fever, fatigue, malaise, palpable purpura, pulmonary and renal involvement

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3
Q

Which vasculitis conditions are considered to be large vessel conditions?

A

Giant cell arteritis, polymyalgia rheumatica, Takayasu arteritis

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4
Q

Which vasculitis conditions are considered to be medium vessel conditions?

A

Polyarteritis nodosa, Kawasaki disease

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5
Q

Which vasculitis conditions are considered to be small vessel conditions?

A

Granulomatosis with polyangitis, microscopic polyangitis, eosinophilic granulomatosis with polyangitis

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6
Q

Giant cell arteritis often occurs with what other large vessel vasculitis?

A

Polymyalgia rheumatica

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7
Q

What is the average age of onset for giant cell arteritis?

A

72 (onset is rare below age 50)*

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8
Q

Which gender has a higher prevalence for giant cell arteritis?

A

Female (2:1)

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9
Q

True or false: African Americans are affected more with giant cell arteritis than are Caucasians

A

False; Caucasians are more often affected

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10
Q

Giant cell arteritis increases risk of what type of aneurysm?

A

Aortic

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11
Q

Prevalence of giant cell arteritis is higher in patients with what other conditions?

A

RA, lupus, other vasculitis conditions

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12
Q

What is another name for giant cell arteritis?

A

Temporal arteritis; also anterior arteritic ischemic optic neuropathy (AAION )

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13
Q

True or false: the ophthalmic artery and the posterior ciliary arteries can be affected in giant cell arteritis

A

True.

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14
Q

What are the most common symptoms of giant cell arteritis?

A

Severe HA, scalp tenderness, jaw claudication, tenderness/swelling of temporal artery, sudden, transient painless vision loss in one eye*

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15
Q

What percentage of patients with giant cell arteritis experience severe HA?

A

70-90%

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16
Q

True or false: less common symptoms of giant cell arteritis include peripheral muscle weakness and respiratory difficulty

A

True.

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17
Q

What percentage of patients with giant cell arteritis experience blurred vision (20/200 or worse)?

A

30%

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18
Q

What ocular symptoms can occur in giant cell arteritis?

A

Blurred vision, monocular transient vision loss, APD, swollen or pale optic nerve, diplopia, CRAO, visual field loss

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19
Q

What tests can be performed for giant cell arteritis?

A

ESR (>50mm/hr) and CRP, temporal artery biopsy (gold standard), pulse

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20
Q

How would you treat giant cell arteritis?

A

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)

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21
Q

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?

A

Yes; there is risk of an aortic aneurysm, as well as vision loss in the other eye within a few hours or days

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22
Q

True or false: the tapering of corticoteroids in treating giant cell arteritis can take years

A

True.

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23
Q

True or false: almost all patients with giant cell arteritis have complete vision recovery eventually

A

False; many have permanent partial or complete vision loss

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24
Q

What percentage of giant cell arteritis patients eventually have some improved vision?

A

30%

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25
Q

Patients with giant cell arteritis have a higher risk of what conditions?

A

Stroke and coronary artery disease

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26
Q

Polymyalgia rheumatica is characterized by sudden stiffness and severe pain in what parts of the body?

A

Neck, shoulders, and hips

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27
Q

True or false: polymyalgia rheumatica is common under age 50

A

Flase; it is rare under age 50*

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28
Q

Which gender has a higher prevalence for polymyalgia rheumatica?

A

Female (2:1)

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29
Q

Is the pain from polymyalgia rheumatica worse in the morning or later in the day?

A

Morning

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30
Q

The pain from polymyalgia rheumatica is generally ____________ (bilateral/unilateral).

A

Bilateral

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31
Q

Apart from pain, what are some symptoms of polymyalgia rheumatica?

A

Fatigue, weight loss, malaise, night sweats, bursitis, pitting edema

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32
Q

What testing can be done for polymyalgia rheumatica?

A

ESR and CRP

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33
Q

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?

A

40-50%

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34
Q

How would you treat polymyalgia rheumatica?

A

10-15mg prednisone in the morning

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35
Q

Takayasu arteritis is rare, except in which country?

A

Japan

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36
Q

Takayasu arteritis is also known as?

A

Pulseless disease, or aortic arch syndrome

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37
Q

Which gender has a higher prevalence for Takayasu arteritis?

A

Female (90%)*

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38
Q

What is the age of onset for Takayasu arteritis?

A

10-40 years*

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39
Q

What are the main non-ocular symptoms that can occur in Takayasu arteritis?

A

Absent peripheral pulse (unilateral; could lead to gangrene or ulcerations), asymmetric BP, peripheral claudication*, chest pain, renal dysfunction, arthralgia, myalgia, syncope, dementia

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40
Q

What ocular symptoms can occur in Takayasu arteritis?

A

VF loss, HA, retinal hemorrhages, decreased vision

41
Q

What sort of testing can you do for Takayasu arteritis?

A

Bruit, angiography, imaging

42
Q

How would you treat Takayasu arteritis?

A

45-60 mg oral prednisone, methotrexate, azathioprine, TNF agents, cyclophosphamide, bypass grafts, low dose aspirin

43
Q

What is the 5-year survival rate for patients with Takayasu arteritis?

A

80-90%

44
Q

Which gender has the higher prevalence of polyarteritis nodosa?

A

Male (2:1)

45
Q

True or false: polyarteritis nodosa affects middle-aged men most commonly

A

True.

46
Q

One-third of patients with polyarteritis nodosa also have what viral infection?

A

Hepatitis B*

47
Q

True or false: although polyarteritis nodosa mainly affects arteries, it can affect veins too

A

False; it only affects arteries. If veins are involved, the condition is not PAN

48
Q

Most of the systemic organs are involved in polyarteritis nodosa. Which major organ is not invovled?

A

Lungs

49
Q

A patient is tested for ANCA. If the patient only has polyarteritis nodosa, are they likely to test ANCA (+) or ANCA (-)?

A

ANCA (-)

50
Q

Whatis the 5-year survival rate for untreated patients with polyarteritis nodosa?

A

13%

51
Q

Whatis the 5-year survival rate for treated patients with polyarteritis nodosa?

A

80%

52
Q

What are the main symptoms of polyarteritis nodosa?

A

Fever, malaise, weight loss, kidney failure, livedo reticularis*, abdominal pain, MI and heart failure, gangrene, neuropathy, purpura, ulcers, liver failure, large joint arthritis

53
Q

What tests can be performed for polyarteritis nodosa?

A

Skin biopsy, ESR, angiography

54
Q

How would you treat polyarteritis nodosa?

A

Prednisone and/or immunosuppressants, antivirals if patient has hepatitis

55
Q

True or false: Kawasaki disease is the most common vasculitis in children

A

True.*

56
Q

What is another name for Kawasaki disease?

A

Mucocutaneous lymph node syndrome

57
Q

What age group is most commonly affected by Kawasaki disease?

A

Under 5 years

58
Q

Kawasaki disease is common in what parts of the world?

A

Japan and East Asia

59
Q

Which gender has a higher prevalence for Kawasaki disease?

A

Male

60
Q

Acute inflammation in Kawasaki disease lasts for how long?

A

12 days

61
Q

What are the main symptoms of Kawasaki disease?

A

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

62
Q

What are complications that can arise from Kawasaki disease?

A

Cardiac aneurysms, heart failure

63
Q

What tests can be done for Kawasaki disease?

A

None, apart from an echocardiogram

64
Q

How would you treat Kawasaki disease?

A

Single, high-dose IV Ig, aspirin daily 200-300 mg

65
Q

What is another name for granulomatosis with polyangitis?

A

Wegener’s granulomatosis

66
Q

In granulomatosis with polyangitis, lesions occur in what parts of the body?

A

Lungs/respiratory tract, kidneys, skin (purpura, subcutaneous nodules)

67
Q

What percentage of patients with granulomatosis with polyangitis test ANCA (+)?

A

95%

68
Q

True or false: granulomatosis with polyangitis generally occurs in younger patients

A

False; it generally occurs in older patients

69
Q

Which gender has a higher prevalence for granulomatosis with polyangitis?

A

Neither; prevalence is equal between the genders

70
Q

True or false: granulomatosis with polyangitis is more common in Caucasians

A

True.

71
Q

What are the main symptoms of granulomatosis with polyangitis?

A

Rhinorrhea, sinusitis, hearing loss, oral ulcers, hemoptysis, saddle-nose, kidney disease*, painful breathing/cough, hematuria, joint pain

72
Q

What sort of ocular findings might a patient with granulomatosis with polyangitis have?

A

Proptosis, uveitis, scleritis, episcleritis

73
Q

What sort of testing can be performed for granulomatosis with polyangitis?

A

ANCA*, chest x-ray and/or CT-scan (pulmonary nodules, infiltrates, nodules), renal biopsy, urinalysis (increased protein, abnormal creatinine)

74
Q

What percentage of patients with granulomatosis with polyangitis are ANCA (+)?

A

90%

75
Q

How would you treat a mild case of granulomatosis with polyangitis?

A

Prenisone, methotrexate

76
Q

How would you treat a moderate to severe case of granulomatosis with polyangitis?

A

Prednisone with cyclophosphamide and rituximab

77
Q

Which medications can be used for maintenance of granulomatosis with polyangitis?

A

Methotrexate or azathioprine

78
Q

80% of patients with granulomatosis with polyangitis die within how many years, if untreated?

A

2 years

79
Q

What percentage of patients with microscopic polyangitis are ANCA (+)?

A

70%

80
Q

Microscopic polyangitis is associated with what specific form of ANCA?

A

P-ANCA*

81
Q

How is microscopic polyangitis differentiated from granulomatosis with polyangitis?

A

Microscopic polyangitis has no inflammatory granulomas in the lung

82
Q

What percentage of patients with microscopic polyangitis have glomerulonephritis?

A

60-90%

83
Q

How would you treat a mild case of microscopic polyangitis?

A

Prenisone, methotrexate

84
Q

How would you treat a moderate to severe case of microscopic polyangitis?

A

Prednisone with cyclophosphamide and rituximab

85
Q

Which medications can be used for maintenance of microscopic polyangitis?

A

Methotrexate or azathioprine

86
Q

What is another name for eosinophilic granulomatosis with polyangitis?

A

Churg-Strauss syndrome

87
Q

Which gender has a higher prevalence for EGPA?

A

Male

88
Q

What is the typical age of onset for EGPA?

A

30 years

89
Q

EGPA involves what parts of the body?

A

Skin, lungs, kidneys, heart

90
Q

What are the main symptoms of EGPA?

A

Rhinitis, asthma, peripheral neuropathy, skin lesions, GI bleeding

91
Q

What testing can be done for EGPA?

A

Eosinophilia*, ANCA, lung or skin biopsy with granulomas

92
Q

How would you treat EGPA?

A

Prenisone, can add cyclophosphamide; methotrexate or azathioprine for maintenance

93
Q

What is the main characteristic of fibromyalgia?

A

Diffuse musculoskeletal pain

94
Q

What is the age and gender of a typical patient with fibromyalgia?

A

Middle-aged woman

95
Q

True or false: patients with fibromyalgia have a higher than normal pain tolerance

A

False; their pain tolerance is less than normal

96
Q

What are the symptoms of fibromyalgia?

A

Fatigue, morning stiffness, aching, disturbed sleep, anxiety, depression, cognitive dysfunction (slow responses, difficulty concentrating, memory loss)

97
Q

How would you treat fibromyalgia?

A

Anti-depressants, anti-anxiety meds, anticonvulsants

98
Q

True or false: NSAIDs do not typically work for fibromyalgia

A

True.

OPT 537 (21 decks)

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