Rheum Flashcards
Tetrad of purpura, abdominal pain, arthritis, glomerulonephritis
Henoch-Schonlein Purpura (HSP)
Immune mediated vasculitis associated with IgA deposition
HSP. A leukocytoclastic vasculitis
how do you dx HSP?
Skin biopsy. Clinical suspicion based on sxs i.e. palpable purpura, abdominal sxs, renal dz, some arthritis
antibodies positive in systemic sclerosis
anti-topoisomerase (SCL-70)
anticentromere
anti RNA polymerase III
features of scleroderma renal crisis
- abrupt onset malignant htn
- acute onset oliguric renal failure (UA reveals only mild proteinuria with few casts)
- MAHA and thrombocytopenia (schistocytes)
hilar adenopathy erythema nodosum acute polyarthritis (involving both ankles). Especially in africans/scandinavians
Lofgren’s syndrome. it is self-limited, try nsaids. Usually need chest imaging for hilar adenopathy
RA typically spares the *** joint
DIP
Behcet syndrome features
Recurrent oral apthous ulcer (>3x/year) + eye/genital/skin (i.e. acne, genital ulcers) lesions.
Unique feature of Positive Pathergy: >2mm papule forming 24-48 hrs after needle inserted into skin
Throbbing pain, skin temperature changes, paresthesia after an injury
Complex regional pain syndrome. Tx with nerve block
Which infections typically precede Reactive arthritis?
Gastroenteritis (i.e shigella, salmonella) and genitourinary (chlamydia)
T/F: Conjunctival sxs are seen in both reactive arthritis (i.e. chlamydia) and disseminated gonococcal infection
False, usually suggest reactive arthritis, not seen in gonococcal
T/F: Serum uric acid levels are elevated during acute gouty attack
False, usually normal or low
tx of acute gout
1st line: nsaids, colchicine, glucocorticoids
*allopurinol not for acute flare
tx for raynauds
CCB (nifedipine, amlodipine)
Abnormal nailfold capillaroscopy test
suggests secondary Raynaud, associated with connective tissue disease
First-line drug for fibromyalgia
TCAs. Pregabalin/duloxetine/milnacipran = approved second line therapies
Goal uric acid for chronic gout mgmt
<6
if tophi, <5
Prophylaxis rules for gout, during urate-lowering therapy
Prevent gout flare while getting to target levels.
Use nsaids, colchicine or low dose prednisone.
No Tophi: Pick whichever is longer
- 6 months past last acute gout flare
- 3 months past target urate level (<6)
Tophi:
-6 months past target urate level (<5)
Crystals and birefringence in gout
Monosodium urate. Negative
What do you need to do in asians before starting allopurinol?
check HLA-B*5801. at risk for hypersensitivity syndrome
When would you use febuxostat for chronic gout mgmt?
Allopurinol and Febuxostat are both xanthine oxidase inhibitors. If can’t tolerate allopurinol especially CKD patients, use Febuxostat
When would you use Pegloticase for chronic gout mgmt?
Refractory tophaceous got
What is the big CI to using second line agent probenicid for chronic gout mgmt?
kidney stones, ckd
Linear calcifications of the meniscus and articular cartilage of the knee
Chondrocalcinosis = PSEUDOGOUT