MSK and CT dos Flashcards
*Define SLE
multisyst auto immune CT do characterized by numerous autoantibodies, circ immune complexes, with widespread immunologically determined tissue damage
______ decent is most common afflicted by LSE
african american descent
90% of SLE cases are ______gender of _____(age)
female; child bearing
age reange of SLE diagnosis?
15-45 (after menarche and before menopause)
what are enviro triggers for SLE (4)
UV light, smoking,microrganisms, and likely estrogen
what are the two ways SLE causes tissue damage?
1) formation/deposition of immune complexes at dermal/epidermal jxn and at renal tissue
2) damage of specific cells resulting inflammation activated PMNs, and release of lysozymes and ROS – t lymphocyte dominant
exacerbations of SLE are common with _____ or when taking _____; in addition there is an inc incidence in males with _________
pregnancy or taking OCP
inc incidence in males with kleinfelters
SLE can be induced by various _____; these pts still have positive _____ tests
drugs
pos ANAs
*Name the 3 primary clinical features of SLE
arthritis, arthralgia(polyarthralgia), and fever(fever and rash) (raynauds is also common)
*_______ is the most common constitutional sx in SLE
fatigue(>90%)
SLE arthritis is often _____ and _________
transitory and migratory
SLE pts present with vasculitis, purpura, malar butterfly rash and _____ lesions
discoid (and painful oral ulcers)
_______ involvement can affect up to 60% of SLE pts and can include: chorea, depression, epilepsy and peripheral neuropathy.
CNS
females with SLE often have a normal rate of conception but a 1.5-3x higher rate of ________
miscarriage
_______ is positive in 98% of SLE cases but low titer has a low predictive value… conversely high titer….
ANA
higher titer =SLE more liekly
Tx for SLE includes NSAIDs, sun protection, exercise and smoking cessation
________ is the mainstay drug treatment -moniter for retinal toxcicity
________ is prescribed if the above drug is inneffective
antimalarials
corticosteroids– very bad side effects
If SLE pt is pregnant perscribe _______/_______
prednisone/prednisolone
what are the 5 critical comorbidities for SLE
accel atherosclerosis Pul HTN antiphospholipid syndrome osteopenia/porosis non-hodgkins lymphoma
Name the 6 ways to prevent SLE
sun protection vaccination caution with live attenuated vaccine and immunosupp supress reccurent UTIs prevent osteoporosis prevent/control obesity and CVD risk
what’s the difference between SLE and sjogren’s dz?
SLE- widespread destruction
Sjo-focal/specific destruction
what is sjogren’s syndrome?
autoimm do where the salivary and lacrimal glands are destroyed(exocrine glands)
Sjogren’s is most common in _______(age) _______(gender)
middle-aged females(9-1)
related to other autoimmune dos, can be a 2ry complication
_______ cells infiltrate glands in sjogren’s
b lymphocytes — hyperreactive
exocrine malfxn(sjogrens’) can lead to _____, _________, and ________
dry mouth(xerostomia) dry eyes(xeropthalmia) enlargement of parotid gland
name the 4 constitutional sx of sjogren’s
fever, wt loss, fatigue, lymphadenopathy
name 2 critical diagnostic criteria for sjogrens
histopath of salivary glands(biopsy)
reactive autobodies for RO/SS-A or LA/SS-b
how do you treat sjogrens
treat sx, often with lubricants for eyes, mouth, vagina, etc also try to inc PO intake
2 drugs used to treat sjogrens
NSAIDS for arthralgia
antimalarials/methotrexate (also corticosteroids for sx relief)
what is scleroderma
multi-syst autoimmune do with vasculopathy and excess collagen deposits leading to fibrosis and degen skin changes and organ damage - presents with high circ autoantibodies
name 2 early manifestations of scleroderma
raynaud’s phenomenon and skin calcinosis
scleroderma is 4.6:1 ___ to___(gender) with onset b/w _____and _____yo
f:m
30-50
______ damage occurs in scleroderma as a result of _____ activation and vasoconstrictors such as_____ – this leads to ulcerations, ischemia, and gangrene of digits and skin
endothelial
platelet activation
endothelin
what are the 2 types of scleroderma
diffuse -affects the organs and skin (arthralgias more prononced(crepetis present)
limited cutaneous - CREST syndrome (skin of face neck and elbows; pulm htn, and raynaouds/gangrene of fingers)
name 4 cardinal features of scleroderma
skin involvement(95%)
Raynauds(85%)
arthralgias, and esoph dysfxn
tendon/bursal friction rubs often seen prior to thickening of skin
Systemic and bilat skin changes result in scleroderma, name 5
non-pitting edema sausage fingers shiny skin(atrophy) dec facial pigment, face becomes taut beaking of nose and tight mouth loss of adipose tissue
In limited cutaneous scleroderma, what does CREST stand for\?
calcinosis raynauds esophageal dysfxn sclerodactyly -tight skin over fingers telangiectasia
scleroderma can result in _____ and ______ failure
cardiac(restrictive pericarditis)
renal
sclerodermal dx is mainly ____; but labs reveal pos _____, and anti-______ antibody in limited type
ANA
anti-centromere
treatment for scleroderma?
no curative tx
treat organ-specific sx
what is kawasaki’s dz?
acute systemic do of childhood that resembles viral exanthem
who is more suceptible to kawasaki? name the 4 complications
boys 3x more likely
coronary anuerysms, MI, Pericarditis, and effusions
whta is polymyalgia rheumatica
PMR is an inflam rheumatic condition with aching and a.m. stiffness in shoulders, hip girdle, neck and torso.
_________ may be assoc with PMR in 15% of pts
temporal arteritis (aka giant cell arteritis) which presents with jaw pain anemia, elvated ESR, headache and visual sx
PMR is typically seen in those +_____yo; and is assoc with the HLA-_____ type
50
DR4
In PMR pain/stiffness is most common in the _______(time), and after ______. stiffness may last more than 30 minutes
morning
after rest
In PMR swelling and tendnosynovitis can be seen in apendages. Swelling is typically ____(UL or BL), ______(prox vs dist), and _____(symet vs asymmet)
BL
proximal
symmetrical
________ are usually used to treat PMR which is dosed for 2 yrs and must be tapered. _____not freq used as 1ry tx.
corticosteroids
NSAIDs not used typically
what is fibromyalgia
controvesial chronic pain syndrome with widespread pain and tenderness to palpation at defined soft tissue structures/points — can be associated with mood disorders
pain of fibromyalgia is…(3)
non-articular, diffuse, and poorly localized “pain all over”
with fibromyalgia you must r/o _________and _________
inflamm condition and articular pathology
where are the 7 trigger points for fibromyalgia? what constitutes a diagnosis(# and duration of pain)
the neck, along the lev scapulae, central ant chest, near lat epicondyle of arm, hips, lowerback/butt, medial knee
need at least 11 points of pian for >3months
tx for fibromyalgia(4)
NARCOTICS ARE NOT INDICATED
amytriptyline - sedating for sleep
SSRIs
and Exercise
