Lupus, Seronegative Spondyloarthropathies, pedatric arthropathies Flashcards
what are the 2 most helpful clinicla clues for diagnosis
joint pattern
presence of absence of extraarticular manifestations
lupus is a ______________ disorder
inflammatory autoimmune
lupus mostly affects
women of colour in reproductive years
those with family hx
those with environmental RFs like smoking and IV light exposure
what are some environmental RFs that affect lupus
smoking= triggers
UV light = exacerbates
describe the pathophys of lupus
production of antibodies to nuclear, cytoplasmic, cell surface, and soluble antigens = systemic inflammation
lupus manifesting as skin nd joint sx is considered
cutaneous lupus erythematosus
lupus presenting in organs + as life threatening disease is considered
systemic lupus erythematosus
pattern of lupus presentation
usually relapsing- remitting
can be continuous
what are the 4 constitutional sx of lupus
fever, anorexia, malaise, weight loss
skin findings in lupus (4)
malar rash or discoid rash
photosensitivity
painless mucous membrane lesions (during exacerbation)
alopecia- patchy or diffuse
which is more common? a malar or discoid rash
discoid
erythematous raised patches with adherent keratotic scale that can cause scarring is
discoid rsah
sharply demarcated, fixed erythema over cheeks and nose, sparing the nasolabial folds is
mlar rash
what are some clinical joint findings in lupus
symmetrical, polyarticular, with or without active synovitis
less severe, less swelling, shorter morning stiffness than RA
reducible swan neck deformities (erosive chnges rare)
muscle sx in lupus
myalgia, myositis, tendonitis
renal rx of lupus
glomerulonephritis
interstitial nephritis
lupus is characterized by production of various autoantibodies, describe their spec + sens
ANA: v sensitive, not spec
anti-dsDNA: v spec, not sens
smith: v spec, not sens
APL: predicts thrombosis
what are some lab findings you may see i nlupus
ANA
anti-dsDNA
smith
APL
hypocomplementemia
hematologic: anemia, leukopenia, thrombocytopenia
hematuria, proteinuria (renal disease)
mildly elevated ESR, CRP
name 7 drugs/ classes associated with lupus
hydralazine, isoniazid, procaainamide, chlorpromazine, minocyclone
TNFi
PPIs
what are some features more common to drug induced lupus than SLE
sex ratio equal, tends to affect older people
renal, CNS features absent
ANA positive but no hypocomplementemia + dsDNA Ab negative
clinical features and lab abnormalities disappear when drug withdrawn
name 5 complications of lupus
accelerated atherosclerosis
ESRD
infections
osteoporosis and avasculaar necrosis
mlignncy
nonphram lupus tx
avoid prolonged sun exposure + use sunscreen
tobacco cessation
calcium + vit D
lupus pharm TX
NSAIDs PRN
antimalarials (hydroxychloroquine) for lupus rash and joint sx- is the core drug tx for lupus
steroids
immunomodulators
immunosuppressants for renal disease
what is the core drug tx for pts with lupus
antimalarials like hydroxychloroquine
max dose of hydroxychloroquine
5mg/kg/d
topical steroids in lupus are used for
cutaneous manifsetations
when are oral steroids used in lupus
systemic complications
what is an alternative to topical hydrocortisone in lupus
calcineurin inhibitors
5 immunomodulators used in lupus
MTX, ASA
belimumab
nifrlumab
deucravacitinib
when are immunosuppressants used in lupus
in renal disease
4 immunosuppressants used in lupus
cyclophosphamide, mycophenolate mofetil, cyclosporine, belimumab
lupus treatment with ntiphospholipid sx
anticoagulation
when might PJP prophylaxis be required in lupus
if prednisone >20mg/d for 2 weeks
if using cyclophosphamide + addition RF
what is seronegative spondyloarthropathy
inflammatory arthritis of the spine and sacroiliac joints
seronegative spondyloarthropathy is associated with ______ and sometimes ____ or _____
enthesopathy
sometimes asymmetric oligoarthritic of large peripheral joints
uveitis
what is uveitis
swelling and irritation of the uvea = intense pain, redness, photophobia
what is enthesopathy
inflammation where ligaments, tendons, and joint capsule insert into bone
waht is dactylitis
inflammation of an entire digit (toe >finger)
what is ankylosing spondylitis (AS)
chronic inflammatory disease of the axial skeleton
AS has a _____ onset of pain and _____ stiffening of the _____
gradual onset of pain + progressive stiffening of the spine
changes in ankylosing spondylitis are
symmetrical and bilateral
based on familial pattern
which joints/ bones are affected in AS
lumbar spine, sacroiliac joints
what happens to the SI joint in AS
syndesmophytes form bony ankylosis where cartilage is replaced by bone
what happens in the spine in AS
outer annular fibres replaced by bone
describe back stiffness and pain in AS
intermittent pain, that may radiate to butt/ side to side alternating
stiffness >30min + worse in morning and with rest
improves with activity
AS progression leads to
progression results in limited mobility, flattening of normal lumbar curve, exaggerated thoracic curve, cervical kyphosis, advanced disease = spinal fusion
describe effect of AS o nperipheral joints (hips, knees, shoulders)
transient inflammation more common than perm damage
what is enthesopathy
a disorder of the entheses, which are the connective tissues between bones and tendons or ligaments. Enthesopathy occurs when these tissues have been damaged, due to overuse, injury or infection.
T or F: AS has no constitutional sx
T
nondrug tx for AS
PT for postural exercise and Range of motion
tobacco cessation
total hip arthroplasty
pharm tx for AS
NSAIDs
IA seroids
Sulfasalazine 1000mg BID
TNFi
sulfasalazine in AS is only for
peripehral arthritis
does MTX have to be used with TNFi in AS?
no- seronegative = no autoantibodies
NSAIDs in AS may slow
radiographic progression
IA steroid in AS is used for
symptomatic relief of individual joints, entheses
TNFi in AS is traditionally used for
NSAID resistant axial disease ,NSAID/ csDMARD resistant peripheral disease, refractory enthesitis or dactylitis
psoriatic arthritis is a
chronic inflammatory arthritis associated with skin and nail psoriasis, affecting SI joints, axial skeleton, and/or peripheral joints
5 patterns of PsA
- symmetrical polyarticular
- asymmetric oligoarticular
- DIP involvement
- severe deforming arthritis with marked osteolysis
- spondylitic form
T or F: dactylitis and enthesitis are common in psoriatic arthritis
T
2 constitutional features of PsA
fatigue, sleep disturbance
comorbidities for PsA
obesity, CV RF like HPTN, DM, dyslipidemia, depression, anxiety
PsA treatment includes
bridging tx with NSAIDs/ steroids
MTX (+/- combo with other DMARDs like LEF, SSZ, HCQ, or a PDE4i like apremilast)
TNFis
MTX in PsA can improve
cutaneous and joint manfestations
TNFi in PsA result in
significant and early efficacy in decreasing cutaneous and arthritic sx, as well as axial disease and enthesitis and dactylitis
juvenile idiopathic arthritis is
group of disorders that are a major cause of chronic arthritis in children
diagnosis of JIA is made after ____ of sx
=>6wks
subsets of JIA sx are classified based on
age at onset, number of joints involved initially
rheumatoid factor status
extraarticular sx
JIA pharm tx includes
NSAIDs and glucocorticoids (IA or PO)
DMARDs
early detection and tx is important to prevent complications like ________________ in JI
eyes, joint erosions or deformity, stunted growth
__% of children with JIA will continue to hve active disease into adulthood
50
what is the goal in JIA tx
remission of joint inflam, normal function, prevent complications
what is first line tx in JIA
NSAIDs nd glucocorticoids (Ia or PO)
NSAIDs nd glucocorticoids (Ia or PO) are first line in _______________________ JIA
oligoarticular, seronegative polyarticular JIA
DMARDS are required for _________ JIA
seropositive polyarticular, systemic JIA
T or F: growing pains are related to growth spurts
F
growing pains often occur at
night after high activity levels
growing pains are a _______ condition
benign, self limiting
growing pains affect
lower limb, bilaterally
growing pain episodes last
30-120min, intermittently may be 1-2x/wk
treatment for growing pains include
heat, massage, APAP, ibuprofen
what is hypermobility joint disorder
move beyond normal range expected = higher rsk of sprains/ dislocations/ subluxations = pain
hypermobiltiy is likely due to
weaker collagen that forms ligaments
