ICM - Rheum 4 Flashcards
what anatomic site does gout (microcrystalline arthritis) affect?
joint space
cardiovascular exercise is important treatment/therapy in this disease
fibromyalgia
muscle strengthening is important treatment for these conditions
OA and LBP
treatment option for underlying immune defect in many autoimmune diseases
disease modifying anti-rheumatic drugs (DMARDS)
this calcium pyrophosphate deposition diseases is associated with OA (either result or cause)
chondrocalcionsis
matrix degrading enzymes responsible for collagen network degradation (cannot be reversed)
aggrecanases and collagenases (metalloproteinases)
Wolff’s hypothesis (of bone remodeling)
distribution/material of bone determined by magnitude/direction of load
stain that has high affinity for proteoglycans (paler staining of cartilage)
safranan O
can last for 15-30 min in OA….stiffness when first using the joint after period of rest
gelling
how many joints affected in OA?
one or few
knee in this position if lateral compartment degrades
valgus
commonalities among classification criteria of OA
pain in joint, aging, no inflammation, osteophytes
DDX for OA
CPPD, RA, infectious monoarticular disease, psoriatic arthritis
topical options for hand OA
capsacin or NSAID
oral treatments for hand OA
NSAIDs, COX 2 selective NSAID, tramadol (weak SSRI)
recommended pharmacological treatments for Hip and Knee OA
acetaminophen, NSAID, intraarticular corticosteroid, tramadol
this is hallmark of systemic onset JRA
quotidian fever (spiking 1-2x per day)
diagnostic for systemic onset JRA
fever and rash
description of rash in JRA
macular, evanescent, migratory rash on trunk and proximal extremities
extra-articlar manifestations of JRA
pericarditis, myocarditis, chronic uveiitis, growth retardation
polyarthritis JRA clinical features
PIP, MCP wrist (hands like adult RA), cervical spine disease, micrognathia (temporal mandibular disease)
oligoarthritis JRA clinical features
primarily knees/ankles/feet, uveitis (young females with ANA)
systemic JRA clinical features
quotidian fever, evaescent rash with Koebner phenomenon, hepatosplenomegaly/lymphadenopathy/pericarditis
describes rash in systemic JRA –> can be induced by rubbing or scratching the skin
Koebner phenomenon
growth retardation of TMJ –> shortening of jaw/chin
micrognathia
diagnostic criteria for JRA
6 weeks
primary site of pathologic anatomy/inflammation in seronegative spondyloarthropathies
enthesis
basic pathogenesis of seronegative spondyloarthropathies
fibrosis/ossification of enthesis (reducing ROM)
seronegative spondyloarthropathy involving primarily axial spine, pain/stiffness –> leading to fusion
ankylosing spondylitis
epidemiology if ankylosing spondylitis
male, young adult (by 20s), caucasian
symptoms of ankylosing spondylitis…typically longer than 3 months
LBP (insidious onset, better with exercise, pain at night), morning stiffness, fatigue/weight loss/low fever
extra-articular manifestations of ankylosing spondylitis
prostatitis (80%), iritis/conjunctivitis (25%), upper lobe fibrosis, CV disease
DDX for ankylosing spondylitis
mechanical BP, OA, osteitis condensans IIii, Reiter’s syndrome, psoriatic arthritis
special studies for ankylosing spondylitis
pelvic Xray (look at SI joint), MRI (and possibly HLA B27)
treatment for ankylosing spondylitis
stretching/flexibility, NSAIDs, sulphasalazine (peripheral), TNF blockers
triad of Reiter’s syndrome
urethritis, conjunctivitis, arthritis (> 1mo)
time it takes for Reiter’s syndrome to develop after diarrheal illness or sexual exposure
2-4 weeks
this condition is usually pauciarticular, affecting large joints, and the lower extremity; also sausaging or dactylitis of toes (due to swelling)
Reiter’s
mucocutaneous manifestation of Reiters –>skin lesions on soles and palms, toes, glans penis
keratoderma blenorrhagica
UG manifetation of Reiter’s….painless and superficial erosions on glans penis
circinate balantis
venereal organisms that can cause Reiter’s
Chlamydia trachomatis and Mycoplasma
HLA associated with Reiter’s
HLA B27
late manifestations of Reiter’s
sacroiliitis, iridiocyclitis, CV (palpitations, murmurs, rub), peripheral neuropathy
special studies for Reiter’s
joint aspiration, STD exam, SI xray (also CBC, WSR, UA, ANA, RF)
mainstay of therapy for Reiter’s syndrome
NSAIDs
mechanisms that estrogen may aggravate SLE
prolong survival autoimmune cells, increase CD4 CK production, stimulate B cells (to make Ab)
ANA associated with limited scleroderma (CREST)
anti-centromere
these are present in 100% of cases of drug induced SLE
antihistones
lace-like, purple rash seen in SLE
livedo reticularis
serositis manifestations of SLE
pleurisy and pericarditis
hematologic manifestations of SLE
anemia, leukopenia, thrombocytopenia
GN seen in SLE where immune deposits only in mesangial area
mesangial
renal involvement in SLE….less that 50% glomerular tufts affected with segmental proliferation –> Ig in mesangium, subendothelial/subepithelial/intraBM areas
focal proliferative nephritis
renal involvement in SLE…>50% glomerular tufts affected by hypercellularity (mesangial, endothelial, monocytes, PMN)
diffuse proliferative GN
renal involvement in SLE…little cellular proliferation, uniform thickening of glomerular BM (Ig and complement along glomerular BM)
membranous GN
Ab seen in sjogrens syndrome –> associated with ANA neg lupus, congenital lupus
anti Ro (SSA) and La (SSB)
diagnostic criteria for SLE (Need 4/11)
renal, arthriris, serositis, hematologic, oral ulcers, neurlogical (seizures/psychosis), malar rash, ANA, immunologic disorder, discoid rash, sun sensitivity
treatment for mild manifestations of SLE
antimalarials (hydroxychloroquin)
cytotoxic medications for major organ involvement in SLE
azathioprine, cyclophosphamide
