Rheum

Question 1

Inflammatory s/sx

Answer 1

Morning stiffness <1 hr

soft tissue swelling
systemic, symmetric, worse with inactivity
joint inflammation, inflammatory markers

Question 2

Synovial fluid analysis

Answer 2

Noninflammatory:
“string sign” - high viscosity
less than 2000 cells, less than 25% PMNs

Inflammatory: 2000-75000 cells, >50% PMNs.

Septic: >60K cells, >80% PMNs

Question 3

Non-articular

Answer 3

1/2 joints: bursitis, tendonitis,

multiple: fibromyalgia

Question 4

Genders autoimmune

Answer 4

male: A.S, gout
female: RA, OA, SLE

Question 5

Ages autoimmune

Answer 5

Young: JIA, SLE, GC
Middle: gout, OA, RA
Old: PMR, GCA

Question 6

Gout/Pseudogout

Answer 6

Pseudo: Positively birefringent, Prisms

Gout: Negatively, needle. CAN Have normal uric acid

Presence of crystals does not exclude septic arthritis

Question 7

ESR/CRP

Answer 7

Normals vary by age/gender

ESR: lags at onset. whole blood, tied to fibrinogen

CRP: acute, 4-6 hours onset, peaks 2-3 days. serum/plasma. “technically more accurate”

0.3-1: mild elevation/normal ish
1-10: moderate elevation / systemic inflammation
10-50: infection, systemic vasculitis, trauma
>50: severe

Question 8

ANA:

Answer 8

Negative? no SLE
Positive? maybe
no correlation to dz activity

Question 9

Anti-DsDNA

Answer 9

for lupus

Question 10

Rheum factor

Answer 10

positive on 15-20% of healthy pts

also: sjogren’s, SLE, SBE, viral, TB

doesn’t fluctuate w/ disease

Question 11

Anti CCP

Answer 11

very specific, positive earlier,

more than 2x expensive as RF
40% positive in pts who are RF neg
also lyme

Question 12

Drug induced SLE

Answer 12

anti-histone

Question 13

Anemia of chronic dz

Answer 13

2nd most common anemia, must be ruled out

decreased response to EPO, shorter life of RBCs