ICM - Rheum 3 Flashcards
most common drugs that cause SLE
procainamide, hydralazine
possible environmental factors that can trigger SLE
molecular mimicry, drugs, hair dye, tobacco smoke, UV light
possibly occurs in SLE due to Ab to cell membrane
hemolytic anemia, thrombocytopenia, leukopenia
these are damaged in SLE due to immune complex deposition
blood vessels and kidneys
Ab to this in SLE will cause prolonged PTT, venous/arterial thrombosis, fetal distress, livedo reticularis, and thrombocytopenia
phospholipid
this occurs from SLE Ab to brain constituents
lupus cerebritis
most common cause of death in lupus patient
infection
systemic manifestation of SLE
fever, weight loss, morning stiffness
skin manifestations of SLE
sun sensitive/butterfly rash, maculopapular rash, vasculitis, alopecia, oral ulcers, discoid, subacute cutaneous
skin condition in 19% SLE….sharply defined papule and plaques (raised border) –> central area become atrophic/central clearing (*scars*)
discoid lupus
hardening of skin by abnormalities of microvasculature and large vessels and fibrotic changes in muscles, joints, viscera
scerloderma
potent vasoconstrictors that are important in pathogenesis of scleroderma
endothelins, NO, EDCF
what are targeted in scleroderma?
endothelial cells (vascular endothelium)
early phase of scerloderma
edematous
classic phase of scleroderma
indurative/sclerotic
pulmonary manifestations of scleroderma
interstitial fibrosis, dyspnea, pulmonary HTN
GI manifestations of scleroderma
esophageal dysmotility, malabsorption (duodenum and jejunum), colonic wide sacculations, biliary cirrhosis
possible cardiac manifestation of scleroderma….secondary R heart failure due to pulmonary HTN
cor pulmonale
cardiac manifestations of scleroderma
pericardial effusion and cor pulmonale
renal manifestations of scleroderma
progressive arterial lesions (intimal proliferation, medial thinning, fibrosis) that decrease GFR, sudden collapse GFR
markers that may signify renal problems (arterial lesions causing decreased blood flow, sudden collapse GFR) related to scleroderma
proteinuria, HTN, azotemia, microangiopathic hemolytic anemia
spots on skin that may appear in scleroderma
telangiectasia
band of sclerotic induration and hyperpigmentation occuring on single extremity or face
linear scleroderma
DDX for scleroderma
scleredema, scleromyxedema, eosinophilic fasciitis, toxic syndromes
classic triad of fibromyalgia
widespread pain (achy/burning in muscle), fatigue, sleep disorder
9 trigger points of pain in fibromyalgia (all bilateral)
occipital, low cervical, trapezius (midpoint upper border), supraspinatus, 2nd costochondral junction, lateral epicondyle, upper/lateral gluteus, greater trochanter, medial fat pad knee
how many pain/trigger points are necessary for diagnosis of fibromyalgia?
11/18/2015
lab tests that may help look for uderlying causes of fatigue/achiness in fibromyalgia patients
CBC (anemia, leukemia), CMP (diabetes, liver, kidney), CPK (muscle breakdown), ESR (inflammation), TSH (Hypo)
possible treatments of peripheral pain generators
CV exercise, heat/ROM, rubs, manipulative therapies (chiropractic, massage), analgesics/injections
meds usually used to treat fibromyalgia
tricyclic antidepressants (NE and serotonin reputake inhibitor)
responsible for problems associated with scleroderma
large amounts of collagen
arthritis that affects men and women at same rate
psoriatic
look for skin changes in these areas for psoriasis
periumbilical area, elbow, intragluteal fold, nail pitting
these cause symmetric polyarthritis
RA and SLE
this arthritis involves DIPs
OA
commonly to see this on hand Xray in psoriatic arthritis
pencil in cup deformity
enteropathic causes of arthritis
ulcerative colitis, Chron’s disease, reactive arthritis, bowel bypass disease, whipple’s disease
ulcerative colitis and Chron’s disease have been associated with this kind of arthritis
ankylosing spondylitits
relapsing syndrome of oral ulceration, genital ulceration, and uveitis –> could cause arthritis
Bechet’s disease
common finding on Xray in enteropathic arthritis
sacroiliitis
5 different types of psoriatic arthritis
DIP involvement, peripheral asymmetric oligoarthritis, rheumatoid like, arthritis mutilans, sacroiliitis
account for 10-30% of nongonoccal bacterial arthritis (usually from skin or soft-tissue infection)
B-hemolytic strep
gram negative bacteria that most commonly cause septic arthritis in IV drug users
S marcescens and P aeurgionsa
common gram negative bacteria that cause septic arthritis in elderly (from skin or UTI)
E coli
aka vertebral body TB
Pott’s disease
may need this to diagnose TB related septic arthritis
synovial biopsy
where are organisms located in joint in septic arthritis?
subsynovial space
clinical features of septic arthritis
warm, swollen painful joint with constitutional symptoms
arthritis that most resembles septic arthritis (monoarticular)
gout and pseudogout
treatment for G+ coccal septic arthritis (after aspiration)
naficillin or first gen cephalosporin
antbiotic for G- cocci (gonnorhea) septic arthritis after aspiration
ceftriaxone
antibiotic for G- rod septic arthritis
aminoglycoside
clinical presentation of gonoccal arthritis
migratory polyarthralgia (3-5 joints), tenosynovitis, dermatitis, fever
DDX for septic arthritis (rash and arthritis)
SLE, lyme disease, bacterial endocarditis, N meningitidis
typical antibiotic used in disseminated gonococcal infection
penicillin
these 2 synovial fluid classifications are friable
inflammatory and septic
