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443-SRH and MSK > Lupus, Seronegative Spondyloarthropathies, pedatric arthropathies > Flashcards

Lupus, Seronegative Spondyloarthropathies, pedatric arthropathies Flashcards

1
Q

what are the 2 most helpful clinicla clues for diagnosis

A

joint pattern
presence of absence of extraarticular manifestations

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2
Q

lupus is a ______________ disorder

A

inflammatory autoimmune

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3
Q

lupus mostly affects

A

women of colour in reproductive years
those with family hx
those with environmental RFs like smoking and IV light exposure

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4
Q

what are some environmental RFs that affect lupus

A

smoking= triggers
UV light = exacerbates

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5
Q

describe the pathophys of lupus

A

production of antibodies to nuclear, cytoplasmic, cell surface, and soluble antigens = systemic inflammation

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6
Q

lupus manifesting as skin nd joint sx is considered

A

cutaneous lupus erythematosus

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7
Q

lupus presenting in organs + as life threatening disease is considered

A

systemic lupus erythematosus

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8
Q

pattern of lupus presentation

A

usually relapsing- remitting
can be continuous

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9
Q

what are the 4 constitutional sx of lupus

A

fever, anorexia, malaise, weight loss

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10
Q

skin findings in lupus (4)

A

malar rash or discoid rash
photosensitivity
painless mucous membrane lesions (during exacerbation)
alopecia- patchy or diffuse

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11
Q

which is more common? a malar or discoid rash

A

discoid

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12
Q

erythematous raised patches with adherent keratotic scale that can cause scarring is

A

discoid rsah

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13
Q

sharply demarcated, fixed erythema over cheeks and nose, sparing the nasolabial folds is

A

mlar rash

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14
Q

what are some clinical joint findings in lupus

A

symmetrical, polyarticular, with or without active synovitis
less severe, less swelling, shorter morning stiffness than RA
reducible swan neck deformities (erosive chnges rare)

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15
Q

muscle sx in lupus

A

myalgia, myositis, tendonitis

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16
Q

renal rx of lupus

A

glomerulonephritis
interstitial nephritis

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17
Q

lupus is characterized by production of various autoantibodies, describe their spec + sens

A

ANA: v sensitive, not spec
anti-dsDNA: v spec, not sens
smith: v spec, not sens
APL: predicts thrombosis

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18
Q

what are some lab findings you may see i nlupus

A

ANA
anti-dsDNA
smith
APL
hypocomplementemia
hematologic: anemia, leukopenia, thrombocytopenia
hematuria, proteinuria (renal disease)
mildly elevated ESR, CRP

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19
Q

name 7 drugs/ classes associated with lupus

A

hydralazine, isoniazid, procaainamide, chlorpromazine, minocyclone
TNFi
PPIs

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20
Q

what are some features more common to drug induced lupus than SLE

A

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

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21
Q

name 5 complications of lupus

A

accelerated atherosclerosis
ESRD
infections
osteoporosis and avasculaar necrosis
mlignncy

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22
Q

nonphram lupus tx

A

avoid prolonged sun exposure + use sunscreen
tobacco cessation
calcium + vit D

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23
Q

lupus pharm TX

A

NSAIDs PRN
antimalarials (hydroxychloroquine) for lupus rash and joint sx- is the core drug tx for lupus
steroids
immunomodulators
immunosuppressants for renal disease

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24
Q

what is the core drug tx for pts with lupus

A

antimalarials like hydroxychloroquine

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25
Q

max dose of hydroxychloroquine

A

5mg/kg/d

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26
Q

topical steroids in lupus are used for

A

cutaneous manifsetations

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27
Q

when are oral steroids used in lupus

A

systemic complications

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28
Q

what is an alternative to topical hydrocortisone in lupus

A

calcineurin inhibitors

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29
Q

5 immunomodulators used in lupus

A

MTX, ASA
belimumab
nifrlumab
deucravacitinib

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30
Q

when are immunosuppressants used in lupus

A

in renal disease

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31
Q

4 immunosuppressants used in lupus

A

cyclophosphamide, mycophenolate mofetil, cyclosporine, belimumab

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32
Q

lupus treatment with ntiphospholipid sx

A

anticoagulation

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33
Q

when might PJP prophylaxis be required in lupus

A

if prednisone >20mg/d for 2 weeks
if using cyclophosphamide + addition RF

34
Q

what is seronegative spondyloarthropathy

A

inflammatory arthritis of the spine and sacroiliac joints

35
Q

seronegative spondyloarthropathy is associated with ______ and sometimes ____ or _____

A

enthesopathy
sometimes asymmetric oligoarthritic of large peripheral joints
uveitis

36
Q

what is uveitis

A

swelling and irritation of the uvea = intense pain, redness, photophobia

37
Q

what is enthesopathy

A

inflammation where ligaments, tendons, and joint capsule insert into bone

38
Q

waht is dactylitis

A

inflammation of an entire digit (toe >finger)

39
Q

what is ankylosing spondylitis (AS)

A

chronic inflammatory disease of the axial skeleton

40
Q

AS has a _____ onset of pain and _____ stiffening of the _____

A

gradual onset of pain + progressive stiffening of the spine

41
Q

changes in ankylosing spondylitis are

A

symmetrical and bilateral
based on familial pattern

42
Q

which joints/ bones are affected in AS

A

lumbar spine, sacroiliac joints

43
Q

what happens to the SI joint in AS

A

syndesmophytes form bony ankylosis where cartilage is replaced by bone

44
Q

what happens in the spine in AS

A

outer annular fibres replaced by bone

45
Q

describe back stiffness and pain in AS

A

intermittent pain, that may radiate to butt/ side to side alternating
stiffness >30min + worse in morning and with rest
improves with activity

46
Q

AS progression leads to

A

progression results in limited mobility, flattening of normal lumbar curve, exaggerated thoracic curve, cervical kyphosis, advanced disease = spinal fusion

47
Q

describe effect of AS o nperipheral joints (hips, knees, shoulders)

A

transient inflammation more common than perm damage

48
Q

what is enthesopathy

A

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.

49
Q

T or F: AS has no constitutional sx

A

T

50
Q

nondrug tx for AS

A

PT for postural exercise and Range of motion
tobacco cessation
total hip arthroplasty

51
Q

pharm tx for AS

A

NSAIDs
IA seroids
Sulfasalazine 1000mg BID
TNFi

52
Q

sulfasalazine in AS is only for

A

peripehral arthritis

53
Q

does MTX have to be used with TNFi in AS?

A

no- seronegative = no autoantibodies

54
Q

NSAIDs in AS may slow

A

radiographic progression

55
Q

IA steroid in AS is used for

A

symptomatic relief of individual joints, entheses

56
Q

TNFi in AS is traditionally used for

A

NSAID resistant axial disease ,NSAID/ csDMARD resistant peripheral disease, refractory enthesitis or dactylitis

57
Q

psoriatic arthritis is a

A

chronic inflammatory arthritis associated with skin and nail psoriasis, affecting SI joints, axial skeleton, and/or peripheral joints

58
Q

5 patterns of PsA

A
  1. symmetrical polyarticular
  2. asymmetric oligoarticular
  3. DIP involvement
  4. severe deforming arthritis with marked osteolysis
  5. spondylitic form
59
Q

T or F: dactylitis and enthesitis are common in psoriatic arthritis

A

T

60
Q

2 constitutional features of PsA

A

fatigue, sleep disturbance

61
Q

comorbidities for PsA

A

obesity, CV RF like HPTN, DM, dyslipidemia, depression, anxiety

62
Q

PsA treatment includes

A

bridging tx with NSAIDs/ steroids
MTX (+/- combo with other DMARDs like LEF, SSZ, HCQ, or a PDE4i like apremilast)
TNFis

63
Q

MTX in PsA can improve

A

cutaneous and joint manfestations

64
Q

TNFi in PsA result in

A

significant and early efficacy in decreasing cutaneous and arthritic sx, as well as axial disease and enthesitis and dactylitis

65
Q

juvenile idiopathic arthritis is

A

group of disorders that are a major cause of chronic arthritis in children

66
Q

diagnosis of JIA is made after ____ of sx

A

=>6wks

67
Q

subsets of JIA sx are classified based on

A

age at onset, number of joints involved initially
rheumatoid factor status
extraarticular sx

68
Q

JIA pharm tx includes

A

NSAIDs and glucocorticoids (IA or PO)
DMARDs

69
Q

early detection and tx is important to prevent complications like ________________ in JI

A

eyes, joint erosions or deformity, stunted growth

70
Q

__% of children with JIA will continue to hve active disease into adulthood

A

50

71
Q

what is the goal in JIA tx

A

remission of joint inflam, normal function, prevent complications

72
Q

what is first line tx in JIA

A

NSAIDs nd glucocorticoids (Ia or PO)

73
Q

NSAIDs nd glucocorticoids (Ia or PO) are first line in _______________________ JIA

A

oligoarticular, seronegative polyarticular JIA

74
Q

DMARDS are required for _________ JIA

A

seropositive polyarticular, systemic JIA

75
Q

T or F: growing pains are related to growth spurts

A

F

76
Q

growing pains often occur at

A

night after high activity levels

77
Q

growing pains are a _______ condition

A

benign, self limiting

78
Q

growing pains affect

A

lower limb, bilaterally

79
Q

growing pain episodes last

A

30-120min, intermittently may be 1-2x/wk

80
Q

treatment for growing pains include

A

heat, massage, APAP, ibuprofen

81
Q

what is hypermobility joint disorder

A

move beyond normal range expected = higher rsk of sprains/ dislocations/ subluxations = pain

82
Q

hypermobiltiy is likely due to

A

weaker collagen that forms ligaments

443-SRH and MSK (24 decks)

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