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F3 E2 Shea > Rheum 1 > Flashcards

Rheum 1 Flashcards

1
Q

What disease..

Metabolic systemic disease: Altered Purine metabolism ->sodium urate crystal deposition in synovial fluid

More patients are men over age 30

*Many patients with chronic hyperuricemia never develop _____*

A

Gout

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2
Q

What disease’s risk factors are

High fructose diet, CKD, Overuse of Thiazids, Loop diuretics, high purine diet, EtOH abuse

A

Gout

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3
Q

What type of Gout has pain at night, Podagra, and red tender joint pain?

A

Acute Gout

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4
Q

What type of Gout has Tophaceous gout with granulomatous inflammation

  • Tophi is Diagnostic and can be on many joints
A

Chronic Gout

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5
Q

What disease is diagnoised with Synovial Fluid Analysis: Monosodium urate crystals, needle like rods, and Negative birefringent crystals

Xray: pouched out erosions = “rat bites”

A

Gout

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6
Q

What time of Gout is Tx with

Elevation, rest, decreased purines and alcohol, NSAIDs (Naproxen), Colchicine, Corticosteroid injection

A

Acute Gout

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7
Q

How can you prophylactically give Gout?

A

—Xanthine oxidase inhibitors (Allopurinol, febuxostat ), Side effects:TEN

—Weight loss

—Alcohol avoidance

—Dietary purine restriction

—Avoid thiazide and loop diuretics – inhibit renal excretion of uric acid

—Niacin – raises serum uric acid levels

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8
Q

What disease has the following complications?

A

Nephrolithiasis + Chronic Urate nephropathy

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9
Q

What disease…

  • Affects peripheral joints
  • Deposits of calcium pyrophosphate dihydrate
  • Most common in knee, wrist, elbow
  • Deposits in cartilage – chondrocalcinosis
A

CPP crystal arthritis – pseudogout

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10
Q

What disease is diagnosed with

  • X-ray: Chondrocalcinosis on radiographs (Fine, linear densities in articular tissues)
  • Joint aspiration: Calcium pyrophosphate crystals (Rhomboid-shaped)
  • Positively birefringent with light microscopy
A

Pseudogout

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11
Q

What disease is treated with NSAIDs, Colchicine, Intra-articular corticosteroid injection + Resembles Gout

A

Pseudogout

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12
Q

Name the disease

—Most common joint disease

—Leading cause of disability and pain

—Tends to occur in weight-bearing joints

—Occupation (knee)

A

Osteoarthritis

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13
Q

What disease presents with

  • Joint pain
  • Insidious onset
  • Worse with activity
  • Relieved with rest
  • Stiffness
  • Decreased range of motion
  • Crepitus
A

Osteoarthritis

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14
Q

T/F OA is diagnosed with these Xray findings

—Joint space narrowing

—Osteophytes

—Subchondral sclerosis

—Cysts

A

True

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15
Q

What disease is treated with

  • Weight loss, Excercise, Walking aids
  • APAP, NSAIDs, Capsaicin, Duloxetine, 4 Intra-joint steroids, and Hyaluronic acid
A

Osteoarthritis

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16
Q

T/F: OA treatment can be a joint replacement or Meniscectomy?

17
Q

Name that disease

  • Chronic, progressive, systemic inflammatory disease (Synovitis)
  • Synovitis -> erodes cartilage, bones, & ligaments
  • causes joint destruction, disability, and shorter life expectancy

Early aggressive treatment is important

A

Rheumatoid Arthritis

18
Q

What disease SPARES THE SPINE, and has

Symmetric Multiple joints swelling with tenderness and pain

*PIPs, MCPs, wrists, knees, ankles, MTPs*

Pain with turning a knob, Opening a jar, widen forefoot

A

Rheumatoid Arthritis

19
Q

What are some Extra-articular manifestations of ______ ______

Subcutaneous nodules, Episcleritis, scleritis, uveitis, iritis, Mouth dryness, Pleuritis, pleural effusion, Pericarditis, myocarditis, CAD, HF

A

Rheumatoid Arthritis

20
Q

What disease is Diagnosed with

Juxta-articular demineralization, soft tissue swelling

Joint erosions + space narrowing + Serology (RF and Anti-CCp)

A

Rheumatoid Arthritis

21
Q

What disease is treated with

NSAIDS (only Sxs)

DMARDS (MTX, Sulfasalazine, Leflunominde, Hydroxychloroquine)

A

Rheumatoid Arthritis

22
Q

What RA drug is this?

  • Initial DMARD of choice
  • Decrease in WBCs and platelets due to bone marrow suppression
  • Hepatotoxicity
  • Teratogenic
A

Methotrexate

23
Q

What RA drug has hemolysis with G6pD patients and should be avoided in ASA sensitivity?

A

Sulfasalazine

24
Q

What RA drug requires eye exams due to the pigmentary retinitis effects?

A

Hydroxychloroquine

25
What considerations do you needs with DMARDS? (HOT)
* Hep B/C * Opthalmologic * Tb (Xray)
26
When would you use Biologic DMARDS in RA and what are they?
Biologic DMARDS are: Well tolerated Janus kinase inhibitor: Tofacitinib (Janus eats Tofu) Anti-cytokine therapies * TNF-alpha inhibitors (CAGE the Alpha Tiger) * Etanercept (Enbrel) * Infliximab (Remicade) * Adalimumab (Humira) * Golimumab (Simponi) * Certolizumab pegol (Cimzia) * IL-1 receptor antagonist: anakinra (Kineret) * IL-6 antagonist: tocilizumab (Actemra)
27
What is the T-cell blocker: Anti-CD20 B-cell:
Aba**T**acept Rituxima**B**
28
What disease sees Boutonniere and Swan neck. Whats the difference between the two?
Rheumatoid Arthritis Boutonniere's = Flex PIP, Extended DIP Swan Neck = Ext PIP Flex DIP
29
What disease has a Hallmark: intermittent, daily fevers and arthritis Treat like RA (DMARDS, Tcell, Bcell, NSAIDS
Systemic Juvenile Idiopathic Arthritis (sJIA)
30
What disease is this? Chronic inflammatory disease of joints of axial skeleton Gradual, intermittent back pain Progressive stiffening of the spine Swelling of Achilles tendon, plantar fasciitis (enthesopathy) Decreased chest expansion (Think Steve Nash)
Ankylosing Spondylitis
31
What disease is diagnosed with Lab: (Elevation of ESR (in 85%), **Negative RF** and **anti-CCP antibodies** **HLA B27 +** in **92% of white patients** and 50% of black patients with AS XRAY: Bamboo spine
Ankylosing Spondylitis
32
How do you treat Ankylosing Spondylitis? Think RA w/o MXT,
* **NSAIDs** first line * **Sulfasalazine** (peripheral arthritis) * **TNF-α inhibitors**: Etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), certolizumab pegol (Cimzia) * **Corticosteroids** – minimal impact, can cause osteopenia
33
What disease is this ## Footnote Nail pitting, **onycholysis**, **SI joint** involvement common, **Sausage swelling** of digits Diagnose: **Negative ESR, RF**
Psoriatic Arthritis
34
What disease is treated with * NSAIDs * Methotrexate (if no responce to NSAIDs) * Phosphodiesterase-4 inhibitor - apremilast (Otezla) * TNF-alpha inhibitors (IL 1/6, -zumab) * Corticosteroids - watch for psoriasis
Psoriatic Arthritis
35
What disease was called Reiter syndrome and is HLA-B27 positive Popcorn: Keratoderma Blennorrhagicum Cant see, pee, climb a tree
Reactive Arthritis
36
What disease is diagnosed with Sterile Synovial fluid, Stool culture from diarrhea, & Chlamydia testing,
Reactive Arthritis
37
How do you treat Reactive Arthritis?
* NSAIDs * Antibiotics (STI) * Sulfasalazine, methotrexate, TNF inhibitors

F3 E2 Shea (14 decks)

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