MKSAP 19 Rheumatology Flashcards
For mucocutaneous ulcerations of Berchet’s, what is first line? Second line?
Colchichine, if doesn’t work, then apremilast, and if that doesn’t work, tapering doses of systemic steroids.
If tapering doses of systemic steroids doesn’t work for mucocutaneous ulcerations of Berchets, what are other options?
azathioprine, thalidomide, or tumor necrosis factor inhibitors
systemic inflammatory syndrome characterized by fever, abdominal pain, rash, and arthritis, each lasting only several days.
familial Mediterranean fever
lifelong daily prophylaxis with _________ for Familial Mediterranean Fever, which in most cases prevents ______, ______, and can inhibit ________ and suppress _______. If prophylaxis first line doesn’t work, second line is:
colchicine; attacks, prevents renal amyloidosis, and can inhibit neutrophils and suppress interleukin-1β generation.Canakinumab
Five clinical subtypes of psoriatic arthritis, which may overlap, are recognized: ____ (5)
Five clinical subtypes of psoriatic arthritis, which may overlap, are recognized: symmetric polyarthritis, asymmetric oligoarthritis, distal interphalangeal–predominant disease, spondyloarthritis, and arthritis mutilans.
The Classification Criteria for Psoriatic Arthritis (CASPAR) include (5)
evidence of psoriasis (current, past, and family history in first- or second-degree relatives), nail dystrophy, dactylitis (current or past), radiographic findings showing new bone formation, and a negative rheumatoid factor result. Each of these is assigned 1 point except for current psoriasis, which is assigned 2 points. These criteria are 91% sensitive and 98% specific for the diagnosis of PsA if 3 or more points are present. This patient’s score is greater than 3.
malaise, fatigue, arthralgia, and rash of 8 weeks’ duration; dry cough and sinus congestion of 6 weeks’ duration; and painless eye redness and dyspnea that began several days ago. Bilateral, localized ocular injection is seen. Scattered rhonchi are heard on lung auscultation, and petechiae and purpura are visible on the legs.
Erythrocyte sedimentation rate -87 mm/h
Creatinine -2.1 mg/dL (185.6 µmol/L)
ANCA- Pending
Urinalysis: 3+ blood; 2+ protein; 20-30 dysmorphic erythrocytes/hpf; 5-10 leukocytes/hpf; erythrocyte casts
What are you suspicious for? How to diagnose? First line treatment for severe active disease?
Granulomyatosis with polyangitis , kidney biopsy, intravenous pulse glucocorticoids or high-dose oral glucocorticoids plus rituximab (preferred) or cyclophosphamide.
low back pain of 6 months’ duration. He experiences back pain at night and back pain and stiffness in the morning for more than 30 minutes. He feels less back pain when he exercises. He had an episode of left Achilles tendinitis 4 months ago and continues to have some pain and swelling at the Achilles insertion.
On physical examination, vital signs are normal. Peripheral joints are normal. Lumbar spine flexion is limited, and hip flexion, abduction, and external rotation cause discomfort in the buttocks bilaterally.
Laboratory evaluation reveals normal erythrocyte sedimentation rate and blood C-reactive protein level.
Anteroposterior pelvic radiograph shows no evidence of sacroiliitis.
What is the next step?
A positive HLA-B27 antigen test result in the setting of a compelling clinical picture confirms the diagnosis of axial spondyloarthritis. If the HLA-B27 antigen result is negative, MRI of the pelvis to evaluate for sacroiliac joint inflammation is warranted. In a patient with inflammatory low back pain and a positive HLA-B27 antigen result but no other features of spondyloarthritis, MRI is also indicated. In general, HLA-B27 antigen testing adds probabilistic certainty to the evaluation of low back pain. If diagnostic certainty is already high (i.e., the patient has many features of spondyloarthritis), then a positive test result adds little to the posttest probability; if there are few features of spondyloarthritis, then a positive HLA-B27 antigen result is helpful.
he is an older man, he has typical symptoms and findings of_______ consisting of back pain and stiffness without sacroiliac pain, and his radiograph shows the distinctive finding of flowing linear calcification and ossification along the anterolateral aspects of the vertebral bodies
idiopathic skeletal hyperostosis
