Musculoskeletal and Skin Conditions Flashcards
What is systemic juvenile idiopathic arthritis and how does it present
Systemic arthritis seen in < 16 year olds
Usually presents with daily spiking fevers, salmon pink macular rash, arthritis (commonly 2+ joints)
What commonly occurs w systemic JIA
Anterior uveitis
Lab findings of systemic JIA
Leukocytosis, thrombocytosis, anemia, increased ESR & CRP
Tx of systemic JIA
NSAIDs, steroids, methotrexate, TNF inhibitors
What is Sjogren syndrome and seen in whom
Autoimmune disorder characterized by destruction of exocrine glands (especially lacrimal and salivary) by lymphocytic infiltrates
In females 20-40 years
Findings in Sjogren syndrome
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
How does Sjogren’s occur
Its commonly primary but can be secondary to other autoimmune disorders (e.g RA, SLE, systemic sclerosis)
Complications of Sjogren
Dental caries, MALT lymphoma (shows as parotid enlargement), higher risk of giving birth to baby with neonatal lupus
Dx of Sjogren
Focal lymphocytic sialadenitis on labial salivary gland biopsy can confirm
Common causes of septic arthritis
S aureus, Streptococcus, and Neisseria gonorrhoeae
Usually unilateral
Presentation of septic arthritis
Affected joint is swollen, red, and painful
Synovial fluid purulent (WBC > 50,000/mm3)
Tx of septic arthritis
Antibiotics, aspiration, and drainage (+/– debridement) to prevent irreversible joint damage
Define disseminated gonococcal infection
STI that presents as either purulent arthritis (eg, knee) or triad of polyarthralgia, tenosynovitis (eg, hand), dermatitis (eg, pustules)
What is seronegative spondyloarthritis
Arthritis without rheumatoid factor (no anti-IgG antibody)
Subtypes: Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis (PAIR)
Gene in seronegative spondyloarthritis
Strong association with HLA-B27 (MHC class I serotype)
Presentation in seronegative spondyloarthritis
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
What does psoriatic arthritis present with + x-ray
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
What is ankylosing spondylitis
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
X-ray findings in ankylosing spondylitis
Bamboo spine (vertebral fusion)
Complications of ankylosing spondylitis
Costovertebral and costosternal ankylosis may cause restrictive lung disease
Monitor degree of reduced chest wall expansion to assess disease severity
What enteropathic disease is often associated with spondyloarthritis
Inflammatory bowel disease (Crohn’s, UC)
Classic triad of reactive arthritis
Conjunctivitis, urethritis, arthritis
“Can’t see, can’t pee, can’t bend my knee.”
Microorganisms associated w reactive arthritis
Infections by Shigella, Campylobacter, E coli, Salmonella, Chlamydia, Yersinia
“She Caught Every Student Cheating Yesterday and overREACTed.”
What is SLE
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
What are the gene associations in SLE
Deficiency of early complement proteins (eg, C1q, C4, C2) = decreased clearance of immune complexes
Classic presentation of SLE
Rash, joint pain, and fever in a female of reproductive age
Prevalence of SLE
Black, Caribbean, Asian, and Hispanic populations in the US
Complications in SLE
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
Common causes of death in SLE
Renal disease (most common), infections, cardiovascular disease (accelerated CAD)
“Lupus patients die with Redness In their Cheeks”
How does neonatal lupus occur, complications
In an anti-SSA ⊕ pregnant patient, there’s an increased risk
Congenital heart block, periorbital/diffuse rash, transaminitis, and cytopenias at birth
Symptoms in SLE
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”
Define mixed connective tissue disease
Features of SLE, systemic sclerosis, and/or polymyositis
Associated with anti-U1 RNP antibodies (speckled ANA)
Define APS
Antiphospholipid syndrome
1° or 2° autoimmune disorder (most commonly in SLE)
Dx of APS
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
Tx of APS
Systemic anticoagulation
