MSK Re-Up #2 Flashcards
Eosinophilic Granulomatosis with Polyangiitis (EGPA - Churg-Strauss) is systemic small and medium sized granulomatous necrotizing vasculitis.
What is this a rare side effect of?
Montelukast and Zafirlukast
What triad of symptoms is associated with EGPA?
What labs (there is a specific lab)
Asthma + Eosinophilia + Chronic Rhinosinusitis
Eosinophilia + P-ANCA HALLMARK
What diagnostic is most accurate for EGPA?
Treatment?
Biopsy
Glucocorticoids (may add Cyclophosphamide if severe)
On the other hand, granulomatosis with polyangiitis is inflammation and necrosis of what three things?
What are symptoms?
-Nose, lungs, kidneys
-Triad: upper respiratory tract involvement + lower respiratory tract involvement + glomerulonephritis
–Nasal congestion, saddle nose deformity, otitis media, stridor, refractory sinusitis
–cough, dyspnea, wheezing, hemoptysis, pulmonary infiltrates
–rapidly progressive glomerulonephritis (crescent on biopsy), hematuria, RBC casts, proteinuria
Best initial test for GPA - Wegener’s
C-ANCA
Treatment for GPA - Wegener’s
Glucocorticoids PLUS Cyclophosphamide
Microscopic Polyangiits (MPA) is small and medium vessel vasculitis that is NOT associated with _________.
It’s symptoms include…
Nasopharyngeal symptoms, necrosis, or granulomatous inflammation (like in GPA)
Palpable purpura, cough, dyspnea, hemoptysis, acute rapidly progressive glomerulonephritis (crescentic)
Lab and treatment for MPA
-P-ANCA
Glucocorticoids PLUS Cyclophosphamide
Immunoglobulin A Vasculitis (Henoch-Schoenlein-Purpura) MC occurs in ________.
It often occurs after __________
What are the four cardinal symptoms (HSPA)
-MC occurs in children (3-15 years old)
After infection (URI, GABHS, Parvovirus B19)
Hematuria
Synovial (arthritis or arthralgia)
Palpable Purpura (on LE)
Abdominal Pain (may present with GI bleeding)
Usually a clinical diagnosis, Henoch-Schonlein Purpura has what lab studies?
What is seen on kidney biopsy?
-Normal PT, PTT, and platelets
-Mesangial IgA deposits
What is the treatment for HSPA?
-Supportive: NSAIDs, hydration, bed rest
Anti-GBM Antibody (Goodpasture’s) Disease is a Type II hypersensitivity reaction where IgG antibodies are against…..
Symptoms are limited to which systems? What are the symptoms?
Against Type IV collagen of alveoli and glomerular basement membrane of the kidney
Limited to lungs and kidneys
-Hemoptysis, dyspnea, dry cough, hematuria, oliguria
What is the best initial test for Goodpasture’s?
Next diagnostic (specific antibody)
What is seen on biopsy of the kidney?
UA: Increased BUN/Cr, hematuria, proteinuria, dysmorphic RBC’s, RBC casts
-Anti-glomerular basement membrane antibodies
-Linear IgG deposits. Crescentic glomerulonephritis
Treatment for Goodpasture’s
-Glucocorticoids + Cyclophosphamide + Plasmapheresis
Psoriatic Arthritis is inflammatory arthritis in patients with psoriasis. What are risk factors associated with this, along with other seronegative spondyloarthropathies?
Young males, < 40 years old, HLA-B27 positivity
Symptoms of psoriatic arthritis
What is seen on radiographs (it has a unique description)
-Arthritis (may involve the DIP joint)
-Dactylitis, Sacroilitis, Uveitis
-Psoriasis (thick silvery white scales and nail pitting)
Pencil in a cup deformities: thin end of one bone is being inserted into a thicker bone
Treatment for Psoriatic Arthritis
-Mild
-Severe
Mild: NSAIDs
Severe: Methotrexate (> 5 joints, severe damage on XR, no response to NSAIDs)
Ankylosing Spondylitis, another seronegative condition, with chronic inflammatory arthropathy of the axial skeleton. What are some symptoms of this condition?
-Back pain, stiffness, and decreased ROM worse in the morning with rest and decreases with exercise and activity
-Sacroilitis, large joint arthritis
-Dactylitis, uveitis
-AV cardiac blocks
What labs would show for ALS?
-Increased ESR
-Negative RF and ANA
What is seen on radiographs for ALS?
Most accurate diagnostic?
-Sacroilitis (narrowing of the SI joint)
-Bamboo spine: straightening of the spine, loss of normal lumbar curvature and squaring and fusion of the vertebrae.
MRI
First-line treatment for ALS?
What if there is no response to the first option?
NSAIDs, exercise program, and PT
Anti-TNF drugs (Etanercept, Adalimumab, Infliximab)
Reactive Arthritis, with is inflammatory arthritis in response to an infection or inflammation in another part of the body. Formerly known as Reiter Syndrome, this may be seen 1-4 weeks after _________ or ____________. It is also associated with ________ positivity.
Chlamydia Trachomatis
GI infection (Salmonella, Shigella, Yersinia)
HLA-B27 positivity
Symptoms of Reactive Arthritis
-Arthritis + Ocular (Conjunctivitis, Uveitis) + Genital (Urethritis, Cervicitis, Balanitis)
–Can’t see, can’t pee, can’t climb a tree
-Keratoderma blennorrhagicum (hyperkeratotic lesions on palms and soles)
What diagnostic should you do first and why for reactive arthritis?
Arthrocentesis: to rule out septic arthritis
What is the first-line treatment for Reactive arthritis?
NSAIDs
What is gout?
Who is it MC in?
What cause triggers of gout?
Uric acid deposition in soft tissues, joints, bones
MC in men (90%)
Purine-rich foods (alcohol, liver, seafood, yeasts).
Meds: Thiazides and Loop Diuretics, ACEi, Pyrazinamide, Ethambutol, Aspirin, ARBs
What is the only ARB that decreases uric acid levels?
Losartan
Symptoms of gout
-First MTP joint of the great toe MC (podagra)
-Severe joint pain, erythema, warmth, swelling, and tenderness, and fever
What is the diagnostic of choice for gout?
What is seen on this?
-Athrocentesis: negatively birefringent, needle-shaped crystals
What is also seen on radiographs for gout?
Mouse or rat bite lesions (punched out erosions with sclerotic and overhanging margins)
Acute management (attacks) of gout
Chronic Management (Prophylaxis) of gout
-Acute Attacks: NSAIDs initially. Corticosteroids if refractory or if renal disease. Colchicine if unable to use NSAIDs or Corticosteroids.
-Chronic: Lifestyle (decrease alcohol, weight loss, high purine foods). Allopurinol first line. Colchicine.
Calcium pyrophosphate dehydrate deposition disease AKA ________, involves what joints most commonly?
What is the initial diagnostic of choice and what is seen?
Pseudogout
Arthrocentesis: positively birefringent, rhomboid-shaped calcium pyrophosphate crystals
What are symptoms of pseudo gout?
-Majority asymptomatic
-Acute CPP crystal arthritis: severe joint pain, erythema, warmth, swelling, tenderness (MUCH like gout)
Treatment for pseudogout
-Corticosteroids IJ: if 1 or 2 joints
-NSAIDs if > 2 joints
Colchicine as prophylaxis if 3 or more attacks annually
Juvenile Idiopathic (Rheumatoid) Arthritis is autoimmune arthritis in children <16 years for > 6 weeks. There are three types. Explain the following:
-Systemic (Still’s Disease)
-Oligoarticular
-Polyarticular
-Systemic: daily or diurnal high fever, daily arthritis. Salmon-colored pink migratory rash. NO iridocyclitis.
-Oligo: < 5 joints involved. Iridiocyclitis (anterior uveitis)
-Polyarticular: 5 or more small joints, morning stiffness (like adult RA), iridocyclitis.
JRA is primarily a clinical diagnosis. What is the treatment?
NSAIDs first line
-Glucocorticoids second line
-PT
-Routine eye exam every 3 months if ANA positivity
