Musculoskeletal and Skin Conditions

Question 1

What is systemic juvenile idiopathic arthritis and how does it present

Answer 1

Systemic arthritis seen in < 16 year olds
Usually presents with daily spiking fevers, salmon pink macular rash, arthritis (commonly 2+ joints)

Question 2

What commonly occurs w systemic JIA

Answer 2

Anterior uveitis

Question 3

Lab findings of systemic JIA

Answer 3

Leukocytosis, thrombocytosis, anemia, increased ESR & CRP

Question 4

Tx of systemic JIA

Answer 4

NSAIDs, steroids, methotrexate, TNF inhibitors

Question 5

What is Sjogren syndrome and seen in whom

Answer 5

Autoimmune disorder characterized by destruction of exocrine glands (especially lacrimal and salivary) by lymphocytic infiltrates
In females 20-40 years

Question 6

Findings in Sjogren syndrome

Answer 6

Inflammatory joint pain
Keratoconjunctivitis sicca (decreased tear production and subsequent corneal damage) = grainy feeling in eyes
Xerostomia = mucosal atrophy, tongue fissures
Presence of antinuclear antibodies, rheumatoid factor (can be positive in the absence of rheumatoid arthritis), antiribonucleoprotein antibodies: SS-A (anti- Ro) and/or SS-B (anti-La)
Bilateral parotid enlargement
Anti-SSA and anti-SSB may also be seen in SLE

Question 7

How does Sjogren’s occur

Answer 7

Its commonly primary but can be secondary to other autoimmune disorders (e.g RA, SLE, systemic sclerosis)

Question 8

Complications of Sjogren

Answer 8

Dental caries, MALT lymphoma (shows as parotid enlargement), higher risk of giving birth to baby with neonatal lupus

Question 9

Dx of Sjogren

Answer 9

Focal lymphocytic sialadenitis on labial salivary gland biopsy can confirm

Question 10

Common causes of septic arthritis

Answer 10

S aureus, Streptococcus, and Neisseria gonorrhoeae
Usually unilateral

Question 11

Presentation of septic arthritis

Answer 11

Affected joint is swollen, red, and painful
Synovial fluid purulent (WBC > 50,000/mm3)

Question 12

Tx of septic arthritis

Answer 12

Antibiotics, aspiration, and drainage (+/– debridement) to prevent irreversible joint damage

Question 13

Define disseminated gonococcal infection

Answer 13

STI that presents as either purulent arthritis (eg, knee) or triad of polyarthralgia, tenosynovitis (eg, hand), dermatitis (eg, pustules)

Question 14

What is seronegative spondyloarthritis

Answer 14

Arthritis without rheumatoid factor (no anti-IgG antibody)
Subtypes: Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis (PAIR)

Question 15

Gene in seronegative spondyloarthritis

Answer 15

Strong association with HLA-B27 (MHC class I serotype)

Question 16

Presentation in seronegative spondyloarthritis

Answer 16

Subtypes share variable occurrence of inflammatory back pain (associated with morning stiffness, improves with exercise), peripheral arthritis, enthesitis (inflamed insertion sites of tendons, eg, Achilles), dactylitis (“sausage fingers”), uveitis

Question 17

What does psoriatic arthritis present with + x-ray

Answer 17

Skin psoriasis and nail lesions
Asymmetric and patchy involvement
Dactylitis and “pencil-in-cup” deformity of DIP on x-ray
Seen in fewer than 1/3 of patients with psoriasis

Question 18

What is ankylosing spondylitis

Answer 18

Symmetric involvement of spine and sacroiliac joints = ankylosis (joint fusion), uveitis, aortic regurgitation
More common in males, with age of onset usually 20–40 years

Question 19

X-ray findings in ankylosing spondylitis

Answer 19

Bamboo spine (vertebral fusion)

Question 19

Complications of ankylosing spondylitis

Answer 19

Costovertebral and costosternal ankylosis may cause restrictive lung disease
Monitor degree of reduced chest wall expansion to assess disease severity

Question 20

What enteropathic disease is often associated with spondyloarthritis

Answer 20

Inflammatory bowel disease (Crohn’s, UC)

Question 21

Classic triad of reactive arthritis

Answer 21

Conjunctivitis, urethritis, arthritis
“Can’t see, can’t pee, can’t bend my knee.”

Question 22

Microorganisms associated w reactive arthritis

Answer 22

Infections by Shigella, Campylobacter, E coli, Salmonella, Chlamydia, Yersinia
“She Caught Every Student Cheating Yesterday and overREACTed.”

Question 23

What is SLE

Answer 23

Systemic, remitting, and relapsing autoimmune disease
Organ damage primarily due to a type III hypersensitivity reaction and, to a lesser degree, a type II hypersensitivity reaction

Question 24

What are the gene associations in SLE

Answer 24

Deficiency of early complement proteins (eg, C1q, C4, C2) = decreased clearance of immune complexes

Question 25

Classic presentation of SLE

Answer 25

Rash, joint pain, and fever in a female of reproductive age

Question 26

Prevalence of SLE

Answer 26

Black, Caribbean, Asian, and Hispanic populations in the US

Question 27

Complications in SLE

Answer 27

Libman-Sacks Endocarditis
Lupus nephritis (glomerular deposition of DNA-anti-DNA immune complexes) can be nephritic or nephrotic (causing hematuria or proteinuria) - most common and severe type is diffuse proliferative

Question 28

Common causes of death in SLE

Answer 28

Renal disease (most common), infections, cardiovascular disease (accelerated CAD)
“Lupus patients die with Redness In their Cheeks”

Question 29

How does neonatal lupus occur, complications

Answer 29

In an anti-SSA ⊕ pregnant patient, there’s an increased risk
Congenital heart block, periorbital/diffuse rash, transaminitis, and cytopenias at birth

Question 30

Symptoms in SLE

Answer 30

Rash (malar/discoid), Arthritis (nonerosive), Serositis (eg, pleuritis, pericarditis), Hematologic disorders (eg, cytopenias), Oral/nasopharyngeal ulcers (usually painless), Renal disease, Photosensitivity, Antinuclear antibodies, Immunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid), Neurologic disorders (eg, seizures, psychosis)
“RASH OR PAIN”

Question 31

Define mixed connective tissue disease

Answer 31

Features of SLE, systemic sclerosis, and/or polymyositis
Associated with anti-U1 RNP antibodies (speckled ANA)

Question 32

Define APS

Answer 32

Antiphospholipid syndrome
1° or 2° autoimmune disorder (most commonly in SLE)

Question 33

Dx of APS

Answer 33

Based on clinical criteria including history of thrombosis (arterial or venous) or spontaneous abortion along with laboratory findings of lupus anticoagulant, anticardiolipin, anti-β2 glycoprotein I antibodies
*Anticardiolipin antibodies can cause false positive VDRL/RPR
*Lupus anticoagulant can cause prolonged PTT that is not corrected by the addition of normal platelet-free plasma

Question 34

Tx of APS

Answer 34

Systemic anticoagulation