JH IM Board Review - SOS IV Flashcards
6+6 processes that mimic arthritis:
Bursitis Tendonitis Fasciitis Enthesitis Periostitis Fibromyalgia
+
Myositis Vasculitis Neuropathy Thyroid disease Parathyroid disease Cellulitis
What is the Gel phenomenon?
Stiffness after prolonged inactivity.
Assessment of WBC count of synovial fluid:
<200
200-2000
>2000
>100.000
<200 ==> Normal.
200-2000 ==> Abnormal, but NOT inflammatory.
> 2000 ==> Inflammatory.
> 100000 ==> Septic.
U/S and Baker cyst?
Useful in differentiating thrombophlebitis from PSEUDOthrombophlebitis.
…% of >65y will have radiographic evidence of OA.
33%.
What is the diffuse idiopathic skeletal hyperostosis (DISH)?
Variant of OA w/ axial + peripheral skeletal manifestations.
MC in elderly men.
DISH — Radiographic diagnosis characterized by:
- Flowing calcification or ossification along the ANTEROLATERAL aspect of at least 4 CONTIGUOUS VERTEBRAE.
- Relative preservation of the intervertebral disk space at the involved levels (in contrast to classic OA).
- Absence of apophyseal and sacroiliac joint involvement (in contrast to AS !).
Is there a role for SYSTEMIC CS in OA?
None.
Which part of the spine is spared in RA?
LUMBAR SPINE.
MC extra-articular manifestations in RA include?
Rheumatoid nodules.
Are rheumatoid nodules specific for RA?
No — they can occur in other rheumatic diseases.
Rheumatoid nodules (nodulosis) may worsen by administering which drug?
MTX!
Even as inflammatory disease improves.
4 ocular manifestations of RA:
- Episcleritis.
- Scleritis.
- Scleromalacia perforans (emergency!).
- Keratoconjunctivitis sicca (2o Sjogren).
How can RA lead to bronchopleural fistulae?
Pleural nodules may CAVITATE.
Keep in mind RA’s Caplan disease (and Felty):
RA + Nodules + Pneumoconiosis.
RA hematologic manifestations:
- Anemia — Mixed ==> Chronic Fe loss (NSAIDs) + Chronic disease.
- Felty.
- Thrombocytosis — Thrombocytopenia.
- 2x increased in NHLs.
Rheumatoid factor is a misnomer — It is also seen in:
- Other rheumatic diseases — Sjogren, juvenile arthritis, SLE, cryoglobulinemia.
- NON rheumatic diseases — ILD, endocarditis, TB, hepatitis, malignancy.
Do anti-CCP abs have a prognostic significance?
Yes — They are predictive of more aggressive, erosive disease.
Limit of solubility of urate is approx. … mg/dL.
7mg/dL.
Leflunomide (DMARD) main side effects:
- Stomatitis — nausea/diarrhea.
- Hepatitis.
- Myelosuppression.
- Teratogenic.
Abatacept characteristically worsens respiratory function in which pts?
COPD pts.
Tocilizumab particular toxicity involves …
- Lipid problems.
- Transaminitis.
- Neutropenia.
- Gastric/diverticular perforation (!).
Tofacitinib is a …
ORAL Janus kinase inhibitor.
Gout tophi may be confused w/ …
Rheumatoid nodules.
Xanthine oxidase inhibitors important drug interaction to keep in mind?
With aza + 6-MP — Should lower dose of these drugs by 75% (!).
Before initiation of allopurinol, consider HLA-… testing in selected patients (eg Koreans with stage 3 or worse chronic kidney disease, and Han chinese and Thai):
HLA—B*5801
This makes them high-risk for developing ALLOPURINOL HYPERSENSITIVITY SYNDROME.
Mention 9 conditions that are a/w pseudogout:
- OA.
- Gout.
- Hemochromatosis.
- Hypothyroidism.
- Hyperparathyroidism.
- Wilson.
- Amyloidosis.
- Hypomagnesemia.
- Hypophosphatemia.
Prophylaxis regimen for pseudogout:
- Chronic admin of low-dose colchicine or NSAIDs may be effective.
- No CPPD-lowering agents are currently available.
AS thoracic spine disease may present as …
CHEST PAIN.
Extra-articular disease in AS pts:
- Anterior uveitis.
- Aortitis + AV insufficiency.
- Pulmonary fibrosis of the apical lung fields.
- Subclinical colitis (!).
Schober test:
Measures lumbar spine distraction w/ flexion (<5cm is abnl).
In enteropathic arthritis, peripheral or axial joint disease activity correlates w/ GI activity?
PERIPHERAL.
==> Axial disease is independent.
The dactylitis seen in psoriatic arthritis is a form of …
ENTHESITIS.
What is involved in the Tx of psoriatic arthritis?
- MTX — both skin and joint disease.
- Leflunomide ==> joint disease.
- TNF inhibitors.
- Ustekinumab ==> Both skin and joint disease.
- APREMILAST ==> PDE-4 inhibitor — recently approved for arthritis.
+ NSAIDs, CS.
Reactive arthritis has epidemiological association with …
HIV/AIDS.
Extra-articular disease in reactive arthritis:
- Uveitis — conjunctivitis.
- Mucocutaneous manifestations.
- Oral aphthous ulcers.
- CIRCINATE BALANITIS.
- Keratoderma blenorrhagicum — Clinically + Histologically indistinguishable from psoriasis.
Prognosis of reactive arthritis:
Up to …% of pts may experience relapse.
…% may experience chronic, destructive, and disabling disease.
Disease is usually self-limited — lasting 3-12mo.
Up to 50% of pts may experience relapse.
15% may experience chronic, destructive, and disabling disease.
In septic arthritis, IVDU may present with what types of infections?
Sternoclavicular — Sacroiliac — Disk space infections.
Sensitivity of Gram stain in septic arthritis synovial fluid?
60-80%.
In young pts with disseminated gonococcal infection, you must think about …
Complement deficiencies.
Tx of lyme disease (3 regimens):
- Doxy PO x14-21 days.
- Amoxicillin PO x21-30 days.
- Ceftriaxone IV x14-28 days.
What is the Poncet disease?
TB arthritis — Symmetrical polyarthritis — Seen in conjunction with active disseminated infection.
Which vasculitis has the widest range of blood vessel involvement?
Behcet.
Small — medium — large in both the venous and the arterial circulations.
Behcet is a/w HLA-…
B-51.
What is the pathergy phenomenon?
Development of sterile pustules at sites of needle stick.
A minority of Behcet pts — HIGHLY specific when present.
Behcet can be confused with which neurologic disease?
MS.
Behcet has a tendency to involve white matter (brainstem involvement).
Tx of Behcet — For mucocutaneous disease, give … (2):
- Colchicine — 1st line therapy for oral ulcers.
2. Topical glucocorticoids — limited efficacy for oral + genital ulcers.