Rhematology Flashcards
What drugs can induce SLE?
Procainamide (anti arrhythmic)
hydralazine (Direct vasodilation of arterioles)
isoniazid (bacterial cidial against TB)
Systemic Lupus Erythematous
Clinical manifestations
Joint pain 90%
fever
Rash
Serositis: pericarditis, pleuritis
Systemic Lupus Erythematous
systemic signs
CNS involvement cardiovascular glomerulonephritis retinitis oral ulcers
Systemic Lupus Erythematous
Best tests
ANA is best initial test (sensitive not specific)
Anti double stranded DNA and Anti-smith Ab
Sjrogen’s syndrome
Etiology and organs involved
Autoimmune d/o attacking exocrine glands: salivary glands, lacrimal glands and parotid enlargement
Sjrogen’s syndrome
primary symptoms
Dry eyes and dry mouth
Can be associated with other autoimmune conditions:
- SLE and RA etc.
Sjrogen’s syndrome
diagnosis
Anti-SSA (Ro) autoantibodies: anti-sjogren syndrome related antigen A
AntiSS-B (La): Anti-Sjogren syndrome antigen B
Rheumatoid factor
Shirmer test
Sjrogen’s syndrome
Tx
Pilocarpine: cholinergic drug that increases lacrimation and salviation
Cevimeline: stimulates muscarinic cholinergic receptors
Fibromyalgia symptoms
fatigue, muscle tenderness, headaches, poor sleep and memory, increased pain perception
Fibromyalgia treatment
TCA’s, cymbalta, SSRI’s, exercise
Pregabalin only drug FDA approved
Polymyalgia Rheumatica
Etiology
Etiology unknown
Closely liked to giant cell arteritis
Prevalence in Northern european heritage suggests genetic component
Systemic macrophage and T-cell activation
Polymyalgia Rheumatica
s/s
Pain and stiffness of the shoulder and hip girdle
- May have difficulty rising from a chair or raising arms above shoulder.
- Gelling: Stiffness after periods of rest
- Morning stiffness
- No severe muscle weakness
Polymyalgia Rheumatica
Dx and Tx
Dx: ESR, normochronic normoctyic anemia
Tx: Prednisone 10 - 20mg/day
- Lack of response suggests alternative diagnosis
Polymyositis definition and
Etiology
Inflammation of many muscles
-Evidence currently points toward T-cell mediated cytotoxic process directed against unidentified muscle antigens.
Polymyositis s/s
- symmetrical, proximal muscle weakness with insidious onset
- Muscles usually painless
- Dysphagia (30%)
- Difficulty kneeling, climbing or descending stairs
- Weakness in neck extensors
Polymyositis workup
- CBC: may show leukocytosis and thrombocytosis
- ESR or CRP elevated 50% time
- Elevated muscle enzymes levels
- Positive rheumatoid factor: 50% time
- Anti-SRP Ab (signal recognition particle Ab): specific for PM
Dermatomyositis definition and etiology
Idiopathic inflammatory myopathy with characteristic cutaneous findings.
Eti: unknown
implicated: genetic, immunologic, infectious, environmental
Dermatomyositis skin manifestations
Skin disease is often initial manifestation
- Heliotrope rash: purple eyelids which resemble heliotrope flower.
- Gottron’s papules: raised violaceous scaly eruptions on the knuckles
- malar erythema
- poikiloderma in photosensitive distribution
Dermatomyositis work up
Labs: elevated muscle enzymes
- autoantibodies: ANA
- elevated urine myoglobin
Dermatomyositis non derm s/s
Usually: history of insidious muscle weakness
- Difficulty climbing stairs, getting up from chair
- Proximal muscle involvement
Treatment of dermatomyositis and polymyositis
Systemic glucocorticoids: prednisone tapering doses for a years
2nd line alternatives: azathioprine or methotrexate
Rheumatoid arthritis
Definition
Etiology
Chronic inflammatory disease with persistent symmetric polyarthritis and bone erosion.
- T-cell mediated
Rheumatoid arthritis
clinical manifestations
Prodrome: systemic sx: fevers, fatigue, wt loss
- Small joint stiffness: MCP, wrist, PIP, knee, MTP, shoulder, ankle
- > 30 minutes after initiating movement, improves later in the day.
- Symmetric arthritis: swollen, tender, erythematous, boggy joints
- Boutonniere deformity, swan neck deformity
Rheumatoid arthritis
workup
rheumatoid factor: best initial test, sensitive not specific
Anti-citrullinated peptide antibodies: most specific
- Arthritis: 3 joints, morning stiffness, disease duration >6 weeks.
Rheumatoid arthritis
management
DMARDs: methotrexate, hydroxychloroquine, leflunamide, minocycline, azathioprine
NSAIDs for pain, low dose corticosteroids
