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Rheumatology > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

Characteristics of Spondyloarthropathies

A 
Inflammatory axial spine involvement
Asymmetrical peripheral arthritis
Enthesitis
Inflammatory eye disease
Mucocutaneous features
Negative RF
High frequency of HLA-B27 antibodies
Familial aggregation
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2
Q

Define Spondyloarthropathies

A

Group of inflammatory arthropathies that share distinctive clinical, radiographic, & genetic features

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3
Q

Types of Spondyloarthropathies

A

Ankylosing spondylitis
Reactive arthritis (Reiter’s syndrome)
Psoriatic arthritis
Enteropathic arthritis (Crohn’s & UC)

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4
Q

Define Ankylosing Spondylitis

A

Chronic inflammatory disease of the joints of the axial skeleton

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5
Q

Describe Ankylosing Spondylitis

A

Changes in SI joints & hips

Inflammation around enethesis

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6
Q

Extra-Articular Manifestations of Ankylosing Spondylitis

A

Anterior uveitis
Aortic valvular disease
Restricted chest expansion
Skin rashes

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7
Q

Diagnostic Features of Ankylosing Spondylitis

A

Insidious onset low back pain >3 months
Improves with exercise
Morning stiffness >30 minutes
Awakened by pain during 2nd half of the night
Alternating buttock or posterior thigh pain
Sites of enthesitis
Sacroiliitis on x-ray

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8
Q

Radiographic Changes in Ankylosing Spondylitis

A

Erosion & sclerosis of SI joints
Involvement of apophysial joints of the spine
Ossification of the annulus fibrosus
Calcification of the anterior & lateral spinal ligaments
Squaring & generalized demineralization of the vertebral bodies
“Bamboo spine”

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9
Q

Characteristics of Ankylosing Spondylitis

A

Male 20-40
Insidious onset
Chronic pain & stiffness of middle spine- referred to one buttock or back of thigh
Morning stiffness that improves with exercise

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10
Q

Criteria for Diagnosing Ankylosing Spondylitis

A

Limited lumbar motion
Low back pain >3 months
Reduced chest expansion
Bilateral grade 2-4 sacroillitis on x-ray
Unilateral grade 3-4 sacroiliitis on x-ray

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11
Q

Define Reactive Arthritis

A

Acute inflammation arthritis occurring 1-3 weeks after infectious event

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12
Q

Reactive Arthritis TRIAD

A

Arthritis
Urethritis (cervicitis)
Conjunctivitis

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13
Q

Complications of Reactive Arthritis

A

Acute anterior uveitis
Myocarditis
Fasciitis

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14
Q

Signs/Symptoms of Reiter’s Syndrome

A 
Arthritis
Enthesitis
Dactylitis
Dysuria
Pelvic pain
Conjunctivitis
Oral ulcers
Rashes
Nail changes
Genital lesions
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15
Q

Common Pathogens of Reactive Arthritis

A 
Shigella
Salmonella
Yersinia enterocololitica
Campylobacter
Chlamydia trachomatis
C. pneumoniae
Ureaplasma urealyticum
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16
Q

Define Psoriatic Arthritis (PsA)

A

Chronic inflammatory arthropathy in setting of psoriasis

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17
Q

Nail Changes in Psoriatic Arthritis (PsA)

A

Pitting
Dystrophy
Onycholysis

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18
Q

Clinical Manifestations of Psoriatic Arthritis (PsA)

A 
Inflammatory arthritis in DIPs
Asymmetric arthritis
Sausage digits
Onycholysis
No rheumatoid nodules
RF negative
Erosive arthritis without osteopenia
Sacroiliitis
Paravertebral ossification
Enthesopathy
Pencil & cup deformity
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19
Q

Treatment for Spondyloarthropathies

A 
NSAIDs
PT, stretching & exercise
Maintain good posture
Sulfasalazine
Methotrexate
TNF inhibitors: Remicade, Humira, Enbrel
Prevent eye complications
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20
Q

NSAIDs effective for

A

Inflammatory back pain
Spinal stiffness
Peripheral arthritis
Enthesopathy

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21
Q

NSAIDs more Effective in Spondyloarthropathies

A

Penylbutazone
Indomethacine
Diclofenac

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22
Q

Use DMARDs When?

A

Anti-inflammatory therapy insufficient
Progression of inflammatory axial disease noted
Active persistent polyarthritis
Uncontrolled extra-articular disease

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23
Q

Medications for Uncontrolled Extra-Articular Disease

A

TNF inhibitors
Sulfasalazine
Methotrexate

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24
Q

Polymyalgia Rheumatica Characterized by

A

Aching & stiffness in the neck, shoulder & pelvic girdles

25
Q

Epidemiology of Polymyalgia Rheumatica

A

Females > Males

Higher incidence at higher latitudes

26
Q

Etiology of Polymyalgia Rheumatica

A

Polygenic
Multiple environmental & genetic factors
Possible viruses: adenovirus, RSV, parvovirus, parainfluenza
Possible bacteria: mycoplasma, chlamydia pneumoniae

27
Q

Clinical Manifestations of Polymyalgia Rheumatica

A

Persistent pain >1 month
Aching & morning stiffness in neck, shoulders, & pelvis lasting 30 minutes
Bilateral discomfort: interferes with ADLs

28
Q

Systemic Signs of Polymyalgia Rheumatica

A

Fever
Malaise/fatigue
Anorexia, weight loss

29
Q

Distal Manifestations of Polymyalgia Rheumatica

A

Nonerosive, self-limiting, asymmetric arthritis
Carpal tunnel syndrome
Distal extremity swelling & pitting edema

30
Q

Labs for Polymyalgia Rheumatica

A 
ESR >40
CRP
Modest anemia
Mildly abnormal LFTs
RF & ANA negative
CK & CPK normal
31
Q

Differential Diagnosis for Polymyalgia Rheumatica

A 
SLE
RA
Polymyositis
Fibromyalgia
Late-onset spondyloarthropathy
Malignancy
Infection
32
Q

Things to Look for in SLE vs. PMR

A 
Pleuritis
Pericarditis
Leukopenia
Thrombocytopenia
Anti-dsDNA antibodies
Anti-ENA antibodies
33
Q

Things to Look for in RA vs. PMR

A

Small joints of hands/feet
Partially responsive to steroids
Considerable overlap with PMR & seronegative RA

34
Q

Things to Look for in Polymyositis vs. PMR

A 
Symmetric proximal muscle weakness
Pain not prominent
Elevated CK, Alk phos.
Abnormal EMG
Myositis on muscle biopsy
35
Q

Types of Malignancies That Would Present like EMR

A

Solid: kidney, ovary, stomach
Heme: myeloma, primary amyloidosis

36
Q

Infection to Rule out to Diagnose PMR

A

Bacterial endocarditis

37
Q

Treatment of Polymyositis Rheumatica

A

Steroids

Trial of NSAIDs

38
Q

Course of Polymyositis Rheumatica

A

Complete/nearly complete resolution of symptoms in a few days
Relapses do occur
Follow ESR or CRP
Treat for 1-2 years
Watch for steroid SE
Methotrexate in refractory cases
Methylprenisolone: similar efficacy, fewer SE

39
Q

Define Giant Cell Arteritis (GCA)

A

Chronic vasculitis of medium & large vessels

40
Q

Pathophysiology of Giant Cell Arteritis (GCA)

A

Vasculitis of extra-cranial branches of aorta, spares intracranial branches
Transmural inflammation -> intimal hyperplasia -> luminal occlusion

41
Q

Etiology of Giant Cell Arteritis (GCA)

A

Influenced by multiple genetic & environmental factors
No evidence of autoantibodies
Cellular immune response

42
Q

Presentation of Giant Cell Arteritis (GCA)

A 
Generally insidious onset
Headache
Fever
Malaise
Weight loss
Anorexia
43
Q

Symptoms of Giant Cell Arteritis (GCA)

A 
Headache
Jaw claudication
Transient visual symptoms
Fixed visual symptoms
CNS abnormalities
Dysphagia
Tongue claudication
Limb claudication
44
Q

Signs of Giant Cell Arteritis (GCA)

A 
Weight loss or anorexia
Decreased temporal artery pulsations
Fever
Artery tenderness
Erythematous or swollen scalp arteries
Large artery bruits
Fundoscopic abnormalities
45
Q

Complications of Giant Cell Arteritis (GCA)

A

Blindness
Aortic aneurysms
Stroke

46
Q

Lab Findings in Giant Cell Arteritis (GCA)

A

ESR >50
Mild-moderate anemia of chronic disease
Elevated LFTs

47
Q

Diagnosis of Giant Cell Arteritis (GCA)

A

Biopsy
MRI/MRA
Other options: arteriography, US, PET

48
Q

Treatment of Giant Cell Arteritis (GCA)

A

Glucocorticoids
Vision loss: IV pulse methylprednisolone
Low dose aspirin

49
Q

Define Fibromyalgia Syndrome (FMS)

A

Clinical syndrome characterized by widespread muscular pain, fatigue, & muscle tenderness

50
Q

Cause of Fibromyalgia Syndrome

A

Abnormal sensory processing in the CNS
Possible genetic role
Triggered by physical, emotional, or environmental stressors

51
Q

Symptoms of Fibromyalgia Syndrome

A 
Poor sleep
Headaches
IBS
Cognitive & memory problems
Numbness & tingling
Irritable bladder
TMJ disorder
Restless leg syndrome
Dry eyes & mouth
Morning stiffness
Anxiety & depression
52
Q

Who is more likely to develop fibromyalgia?

A 
RA patients
SLE patients
Ankylosing spondylitis
Family history
Associations: lyme disease, OSA, sleep deprivation
53
Q

Diagnosis of Fibromyalgia

A

4 symptoms
Generalized, chronic pain >3 months affecting the axial, upper & lower segments, & left & right sides of the body

54
Q

Shared Features of Fibromyalgia & Depression

A 
Strong genetic predisposition
Similar co-morbidity
Similar sleep disturbances
Similar cognitive disturbances
Orthostatic features
ANS dysfunction
Childhood abuse, stress
Can be debilitating
Imaging studies
Neuroendocrine studies
55
Q

Diagnosis of Fibromyalgia

A 
X-rays: normal
Labs: normal
Nuclear medicine & CT scans: normal
ESR, CRP: normal
Distinguish from RA, SLE, PMR & hypothyroidism
56
Q

Treatment of Fibromyalgia

A 
Medication trial
CBT, counseling
Physical rehab
TCAs: amitriptyline, cyclobenzaprine
Anticonvulsants: pregabalin, gabapentin
SNRIs: duloxetine, milnacipran
Diazepam & clonazepam 2nd line for restless leg syndrome & severe sleep disturbance
Therapeutic massage
Myofascial release therapy
Acupuncture
57
Q

Patient Self-Management of Fibromyalgia

A 
Schedule time to relax, meditate
Establish routine for going to bed and waking up
Aerobic exercise on daily basis
Self-education
Support group
CBT
58
Q

Physical Medicine or Rehabilitation for Fibromyalgia

A 
Avoid inactivity
Analgesic advice & non-pharmacologic treatment
CV fitness
Stretching, strengthening
OT
Work rehab
Ergonomics
59
Q

Mental Health for Fibromyalgia

A

Psychopharmacology
Counseling
CBT

Rheumatology (8 decks)

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