Rheum

Question 1

Pseudogout (Acute calcium pyrophosphate crystal arthritis)

Answer 1

Acute joint arthritis
Peripheral joints (knee), most common
Rhomboid shape crystals with + bifringence
inflammatory effusion
Chondrocalcinosis on Xray

Tx: Steroid shots, NSAIDs, colchicine

Question 2

Sjogren’s Syndrome

Answer 2

Autoimmune disease causing inflammation of the exocrine glands.
Dry eyes, dry mouth (cavities), vaginal dryness (all this together is called Sicca syndrome)

Can occur on its own or with SLE, RA, or Scleroderma

Question 3

Sjogren’s Labs

Answer 3

Anti Ro or Anti La

Question 4

Sjorgren’s associated problems

Answer 4

Raynauds, cutaneus vasculitis, arthralgias/arthritis, interstitial lung disease, non hodgkins lymphoma

Question 5

RA Presentation

Answer 5

Morning pain that gets better with activity, commonly in PIP, MCP, MTP. Will have nodules on elbows. Can involve the C spine and cause spinal cord compression. Sometimes have trigger finger.

Question 6

Ankylosing Spondylitis Presentation

Answer 6

Onset less than 40yo, pain relieved by exercise but not rest, symptoms for more than 3 months.

Exam findings: arthritis, reduced chest expansion and spinal mobility, aortic regurgitation, tendon tenderness, swollen fingers and toes, uveitis.

Complications: vertebral fractures, aortic regurgitation, cauda equina

increased ESR and CRP, HLAB27 (not diagnostic)
Dx: SI xray or MRI

Question 7

Psoriatic Arthritis

Answer 7

Occurs in 5-30% of patients with psoriasis, mainly involves DIP with associated morning stiffness. Sausage digit with nail pitting is common.

NSAIDS, Colchicine, anti TNFa

Question 8

Kawasaki’s Disease

Answer 8

Age less than 5, fever for 5 days with at least 4 of the following:

• conjunctivitis
• mucositis
• polymorphus rash
• extremity edema, erythema, and desquamation
• cervical lymphadenopathy

Increased CRP, ESR, and sterile pyuria.
can cause coronary artery aneurysm and MI
Tx: Aspirin, IVIG

Question 9

Mixed Cryoglobulinemia

Answer 9

Found in HIV, HCV, SLE
Fatigue, arthralgias, glomerulonephritis, HTN, dyspnea, pleurisy, Palpable purpura
Low C4

Question 10

Type I Cryoglobulinemia

Answer 10

Found in lymphoproliferative and hematologic disorders (Multiple Myeloma)

Can be asymptomatic, can have symptoms of hyperviscosity, livedo reticularis, purpura

Complement levels normal

Question 11

Osteoarthritis

Answer 11

Boney enlargement, bland effusion
X-ray: Joint space narrowing, osteophytes, possible subchondral sclerosis.
Tx: Strengthening/Wt loss –> NSAIDs –> Intra articular glucocorticoids

Question 12

Tx of OA

Answer 12

Weight loss, exercise –> NSAIDs –> Topicals, joint injections (steroids/hyaluronic acid) –>Surgery

Question 13

Felty Syndrome

Answer 13

RA + Neutropenia + Splenomegaly

Question 14

SLE Neuropsych

Answer 14

Psychosis, depression, mania, anxiety, seizures, HA, peripheral neuropathy, chorea, and strokes.

Look for rash, joint pain, hematuria, proteinuria, throbocytopenia

Question 15

Takayasu Arteritis

Answer 15

Female, asian, age 10-40

Fevers, weight loss, claudication and ulcers in the upper extremities, arthralgias.

BP descrepancies, pulse deficits, arterial bruits.

Aortic dilatation and widening of mediastinum on xray

Tx: glucocorticoids.

Question 16

RA lab findings

Answer 16

Positive anti CCP, increased ESR and Sed, High IgM Rheumatoid factor.

Question 17

SLE Presentation

Answer 17

Rash, joint, renal, serosal, possible psych involvement.

Question 18

SLE Labs

Answer 18

Anemia, leukopenia, thrombocytopenia
Positive ANA, anti dsDNA, anti-Smith
Low complement levels, increased immune complexes

Question 19

Most common extra-articular finding in Ankylosing Spondylitis

Answer 19

Anterior Uveitis

Question 20

systemic juvenille idiopathic arthritis

Answer 20

arthritis, leukocytosis, thrombocytosis, increased ESR, and waxing/waning fever.

Question 21

Mixed connective tissue disease

Answer 21

Features of SLE, SS, and polymyositis
Raynaud’s, swelling of hands and fingers, inflammatory arthritis, and polymyositis.

Anti U1 ribonucleicprotein +

May have additional features such as malar rash but renal and brain involvement is generally mild.

Question 22

Henoch Schonlein Purpura

Answer 22

IgA vasculitis

Palpable purpura, arthritis, abdominal pain/intusseption, renal diesease.

Normal platelets and coagulation studies, hematuria, RBC casts, and proteinuria.

Tx: Fluids and NSAIDs/Glucocorticoids

Question 23

Polymyositis

Answer 23

Proximal muscle weakness, mild to absent pain

Elevated muscle enzymes, ANA, Anti Jo1
Bx: Endomysial infiltrate, patchy necrosis

Question 24

Polymyalgia rheumatica

Answer 24

Age >50, stiffness and pain in shoulders and hips
ESR and CRP elevated
associated with GCA
Tx: steroids

Question 25

Monoarticular pain and fever in the setting of OA, RA, gout or prosthetic joint

Answer 25

Infectious arthritis

Question 26

Nail pitting on exam

Answer 26

think psoriatic arthritis

Question 27

Systemic Sclerosis Presentation

Answer 27

Fatigue, weakness, raynauds, sclerodactyly, digital ulcers, arthralgias/myalgias, contractures, esophageal dysfunction

Anti-topoisomerase is most specific
Most will be ANA+ also but not specific to the disease

Question 28

SS Labs and Complications

Answer 28

Anti-topoisomerase is most specific
Most will be ANA+ also but not specific to the disease

Can have Pulm HTN, Pulm fibrosis, HTN, renal crisis (oliguria, MAHA, thrombocytopenia), Myocardial fibrosis, pericarditis, pericardial effusions

Question 29

Acute gout flare in patient with anticoagulants or heart failure

Answer 29

Use colchicine over NSAIDs

Question 30

Infectious pediatric arthritis

Answer 30

Both present after a recent illness
Reactive synovitis: generally self-limiting and mild
Septic arthritis: high fever, increased ESR, leukocytosis. Must drain and treat with abx.