Mixed Flashcards
MC abnormality of valves in RA?
Mitral regurgitation
MC part affected by OA
Base of the thumb
OA Joints affected by heritability
Hip and hand - 50%
Knee - 30%
Common RA diseases in men
AS, Spondylitis, Gout
3 Rheuma diseases more common in Men than women
Gout
Spondyloarthritis
AS
Expected synovial fluid for gouty arthritis
2000-60,000
Colchicine and NSAID may be poorly tolerated in what conditions?
Elderly
GI dse
Renal insufficiency
Involvement of what joint in RA will predispose to concomittant OA
DIP
Involved joints in RA
wrist, MCP, PIP
Most sensitive and specific marker for RA
Most specific - Anti CCP
Sensitivity Anti CCP = RF
Expected cell count for infectious arthtitis
25,000 - 250,000 (ave 100,000)
Gonorrhea is best cultured in what organ?
Mucosa sites aka cervix
Synovial- almost none
Blood - 45%
Protective factor against SLE
Alcohol drinking
Which class of nephritis requires aggressive immunosuppression to avoid ESRD
Class III, IV
Autoantibody associated with dry eyes and mouth
Anto Ro (SSA)
Benefit of anti malarials in SLE
FAD
Fatigue
Arthritis
Dermatitis
Distinguishing hallmark for systemic sclerosis
WOF
Widespread capillary loss
Obliterative microangiopathy
Fibrosis
Avoid in scleroderma renal crisis
Steroids
Treatment of choice in scleroderma crisis
Symptomatic - acei arbs ccb endothelim antagonists
Most frequent complication SSc
Raynaud’s Disease
Clinical presentation of inclusion body myositis
Early predilection of wrists and finger with atrophy at age 50 or older with slightly elevated CK leves
Myositis mechanic hands and fever and non erosive arthritis indicate what?
Anti synthetase syndrome
Characterized by acute symmetric proximal weakness with underlying CTD/ statin use
Immune mediated necrotizing myopathy
For inflammatory myopathies when is it indicated to start a second line agent aside from steroids?
Severe weakness
Increases steroid complications
Development of necrotizing myopathy
Failure to improve 2-4 weeks
Drug to start if refractory to steroids and other second line agent
Rituximab
Inflammatory myopathy (IM) where M=F and M > F
M=F: NM
M> F: IBM
Adult onset predilection for IM types
PM
IBM > 55 yo
Most IM are proximal muscle group involvement except for what which involves finger, wrist, knee extensors
IBM
Associated with HMGCR or anti SRP antibodies
NM
Associated with anti CN1A antibodies, granular lymphocytes and reduced CD4/CD8 ratio
IBM
Match muscle biopsy findings with IM type
Perimysial and perivascular
Endomysial and perivascular
Necrotic
Perimysial fragmentation with Alk phos staining
Endomysial and perivascular with MHC-1 expression
Perimysial and perivascular: DM
Endomysial and perivascular: PM
Necrotic: NM
Perimysial fragmentation with Alk phos staining: ASS
Endomysial and perivascular with MHC-1 expression:IBM
Cellular infiltrate to IM typing: CD 4 and CD8
CD4: DM, ASS
CD8: PM, IBM
Macrophage: NM
IM with no to minimal response to Tx
IBM
IM triggered by statin use
NM
Mechanic hands, ILD, non errosive arthritis, Raynaud phenomenon IM
ASS
IM type: Sarcoidosis, scleroderma
IBM
Drugs that need G6PD testing in RA
Sulfasalazine
ACR criteria for diagnosis
Fulfillment of 6 or more
Joints
1 large joint-0
2 -10 large joints -1
1-3 small joints -2
4-10 small joints -3
>10 joints- 5
Acute phase reactants
Normal 0
Abnormal ESR or CRP 1
Serology
Normal anti CCP or RF 0
<= 3x elevation 2
>3x elevation 3
Duration
< 6 weeks - 0
>= 6 weeks - 1
Environmental factors in RA
Smoking
Porphyromonas gingivalis
Xray findings in RA
- Peri-articular osteopenia → initial radiographic finding
- Soft tissue swelling, symmetric joint space loss, subchondral erosions (MCPs, PIPs, MTPs)
- Lateral aspect of 5th MTP is usually targeted first
- ADVANCED DISEASE → joint subluxation and collapse
Chronic inflammation leads to ____ in RA
Chronic inflammation leads to synovial lining hyperplasia and formation of pannus
RA is often considered to be a _-driven disease
Macrophage
MC cause of death in RA
CV disease
Best diagnostic imaging for AS?
Pelvic MRI
Risk Factors for Extra-Articular Disease in RA
- History of Smoking
- Early onset significant physical disability
- Positive serum RF or anti-CCP antibodies
Types of fractures MC caused in RA
Hip
MC type of lymphoma in RA
DLBCL
initial treatment of moderate-severe RA
MTX
Administered in low-to-moderate doses to achieve rapid disease control before onset of fully effective DMARD therapy
Steroids
Administered in low-to-moderate doses to achieve rapid disease control before onset of fully effective DMARD therapy
Steroids
Contraindication for Anti TNF
Chronic HBV; HF NYHA FC III-IV
Contraindication for Anti TNF
Chronic HBV; HF NYHA FC III-IV
Definition of remission in RA
<=1 Tender, swollen joints; CRP <=1
SDAI score <= 3.3
DOC RA in flare during pregnancy
Low dose prednisone
May use HCQ and Sulfasalazine
MC systemic manifestation in SSC
Raynaud’s phenomenon
More common manifestations in lssc?
Mucocutaneous telangiectasia
GERD
PAH
Barretts
Calcinosis cutis
Digital ischemic ulcers
More common manifestations in lssc?
Mucocutaneous telangiectasia
GERD
PAH
Barretts
Calcinosis cutis
Digital ischemic ulcers
LSSC VS DSSC
Raynauds antedates skin involvement
Frequent calcinosis cutis
Autoantibodies
Raynauds antedates skin involvement
Frequent calcinosis cutis
Autoantibodies
-lssc: Anti centromere
-dssc: Anti topoisomerase I anti RNA polymerase III
Pathophysiology of Scleroderma renal crisis
Obliterative vasculopathy
intravascular hemolysis,
- activation of the complement pathways
-
Pathophysiology of Scleroderma renal crisis
Obliterative vasculopathy
intravascular hemolysis,
- activation of the complement pathways
-
Most commonly implicated organism in infectious arthritis?
N. gonnorhea
If non gonorrhea –> S. aureus
Diagnosis of ARF
2 major or 1 major + 2 minor
Diagnosis of recurrent ARF
2 major
1 Major + 2 minor
3 minor
Major criteria for ARF
<3 PECS
Carditis
Polyarthritis/arthralgia
Erythema marginatum
Chorea
SC nodules
Difference in criteria between low/high risk population for ARF
MAJOR
Polyarthritis - Monoarthritis
MINOR
Polyarthralgia - Monoarthralgia
Fever >= 38.5C - > 38C
ESR >= 60 - ESR >= 30
Diagnosis of AS
< 45 y/o, chronic back pain > 3mos, IBP
Diagnostic of choice
Pelvic MRI
First-line of pharmacologic therapy for AS
NSAIDS
First-line of pharmacologic therapy for AS
NSAIDS
MOST COMMON INDICATION FOR SURGERY IN PATIENTS WITH AS
Severe hip joint arthriti