DMARDS (hydroxychloroquine, methotrexate) Corticosteroids

Increased muscle enzymes (Increased aldolase, creatinine kinase) + Anti-Jo 1 Ab + Anti-SRP Ab

Rheum Flashcards by Garima Khanal

What is the hallmark symptom for polymyalgis rheumatica?

proximal muscle (shoulders, neck, hip girdle) stiffness and aching, especially in the morning

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What is the most specific Dx test for SLE?

Anti double-stranded DNA & Anti-Smith AB

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What inflammatory condition is strongly associated with giant cell (temporal) arteritis?

polymyalgia rheumatica

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What problem associated with temporal arteritis can progress to complete vision loss?

Monocular amaurosis fugax

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What will Muscle Bx of fibro show?

moth eaten appearance

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What systemic sxs are associated with Polymalgia rheumatica?

fever, malaise, weight loss

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Tx for polymyalgia rheumatica

low-dose prednisone

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Drug induced causes of SLE

HIPPS:

Hydralazine

INH

Procainamide

Phenytoin

Sulfonamides

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Tx for Polymyositis and Dermatomyositis

high-dose corticosteroids

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Dx for Sjogrens Syndrome

Anti-Ro, Anti-La

+ Schirmer Test (dec tear production)

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What lab marker is elevated with polymalgia rheumatica?

ESR (erythrocye sedimentation rate) >40 mm/hr

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widespread muscular pain, poor sleep/memory problems

increase in pain perception (increase in substance P)

extreme fatigue

Fibro

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What antibody is specific for Myositis?

Anti-Jo 1 Ab

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recent difficulty grooming (brushing hair), dressing, transferring from seated or supone to standing positions

polymyalgia rheumatica

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Autoimmune disorder that attacks exocrine glands (salivary)–>xerostomia, dry eyes, parotid enlargement

Sjogrens Syndrome

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symptoms worsen after inactivity

which inflammatory disease?

Polymyalgia Rheumatica

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Tx for Sjogrens Syndrome

Pilocarpine (cholinergic for xerostomia)

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idiopathic inflammatory muscle disease of proximal limbs, neck, pharynx.

Polymyositis

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Main Tx for SLE

hydroxychloroquine

NSAIDS, steroids, immunosuppressants

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symmetric aching and stiffness about the shoulders, hip girdle, neck, torso

polymyalgia rheumatica

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What antibody is specific for Dermatomyositis?

Anti-Mi-2 Ab

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Malar Rash

spares nasolabial folds (SLE)

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Malar rash including nasolabial folds

Dermatomyositis

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Dx for Scleroderma

+ Anticentromere AB (limited dz, more specific)

+ Anti-SCL-70 (diffuse dz)

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**Tight, shiny, thickened skin** + **CREST** syndrome

Scleroderma (systemic sclerosis)

Tx for **scleroderma**

**DMARDS** (hydroxychloroquine, methotrexate) ## Footnote **Corticosteroids**

Dx for **Polymyositis**

Increased muscle enzymes (Increased **aldolase, creatinine kinase**) ## Footnote **+ Anti-Jo 1 Ab** **+ Anti-SRP Ab**

What else can be positive in an SLE workup that can come up as a false positive for syphilis?

**Antiphospholipid AB Syndrome:** **Anticardiolipin Ab is +** in this syndrome and is associated w/ a **_false + VDRL/RPR_**

Poikiloderma: photosensitive, erythematous rash on face, neck, anterior chest "v sign"

Dermatomyositis

How can you differentiate **polymyositis and dermatomyositis**?

Dermatomyositis has: **heliotrope (blue-purple) upper eyelid discoloration** AND **Gottron's papules:** raised violaceous scaly eruptions on knuckles

Dx for fibro

11/18 trigger point tenderness \> 3mos

Dx for polymyalgia rheumatica

Clinical

Tx for **fibro**

**TCAs** **Pregabalin** = only FDA approved

Best initial test for SLE

**ANA**

CPx of Polymyositis

**Painless** Progressive **symmetrical proximal muscle weakness**

Difference in Presentation b/w **OA and RA**

OA: **asymmetric** **evening big joint stiffness** that _worsens_ through the day & changes in weather RA: **symmetric morning small joint stiffness** that _improves_ through the day

**boutonniere** deformity and **swan-neck** deformity

**Heberden & Bouchard's node**

Tx for Osteoarthritis

Initially: **Acetaminophen** ## Footnote **NSAIDS (more effective)**

What medication **reduces permanent joint damage** in RA?

DMARDS: **Methotrexate**

1st line Tx for RA

DMARDS: **Methotrexate**

1st line Tx for **pain control** in RA

**NSAIDS** 2nd line: **CS**

SES of **Methotrexate**

**hepatotoxicity** **stomatitis** **interstitial pneumonitis**

Main SE w/**Hydroxychloroquine**

**Retinal Toxicity:** fundoscope exam q 6-12 mos

What medical condition must you rule out prior to starting any DMARDS?

**Must do a PPD to r/o TB**

chronic **large-vessel vasculitis** that affects the **Aorta, Aortic Arch & Pulmonary Arteries**

**Takayasu's Arteritis**

CPx of **Takayasu's Arteritis**

**vessel stenosis/occlusion/ischemia**: Coronary Artery MI, TIA, CVA **Lower extremity claudication**

What will PE of **Takayasu's Arteritis** show?

**arterial bruits** **diminished pulses** **asymmetric BP measurements**

Dx for **Takayasu's Arteritis**

**Angiography**

Tx for **Takayasu's Arteritis**

**High Dose Corticosteroids**

**Asthma** **Hypereosinophilia** **Chronic Rhinosinusitis**

**Eosinophilic Granulomatosis with Polyangiitis**

adult onset asthma

**Eosinophilic granulomatosis w/ polyangiitis**

What will labs show in EPA

**Increased EOS** **+P-ANCA**

Tx for EPA

**corticosteroids**

**Granulomatosis w/polyangiitis (Wegener's)** affects which 3 parts of the body?

**Nose** (Upper Respiratory) **Lungs** (Lower Respiratory) **Kidneys**

**Upper Resp Tract** sxs in **Granulomatosis w/ Polyangiitis**

**saddle-nose deformity** **refractory sinusitis**

**Lower Respiratory Tract Sxs** in **Granulomatosis w/ Polyangiitis**

**hemoptysis** **SOB** CXR: **cavitating lung nodules**

Tx for Granulomatosis w/ Polyangiitis (Wegener's)

**CS + Cyclophosphamide**

Labs in Wegener's

Wegener just C-ant: **+ C-ANCA**

Difference between **Granulomatosis w/ Polyangiitis** & **Microscopic Polyangiitis**

Microscopic Polyangiitis **does not have necrotic or granulomatous inflammation** like GPA **No upper resp. tract sxs** like in GPA

CPx of **Microscopic** **Polyangiitis**

**Palpable purpura** **Mononeuritis Multiplex** **acute glomerulonephritis**

Dx for MPA

**+P-ANCA**

Tx for MPA

CPx of **Henoch Schonlein Purpura** (HSP

**"HSP** affects Ig**A"** ## Footnote **H**ematuria **S**ynovial: arthritis/arthralgias **P**alpable Purpura **A**bdominal Pain

Dx for **Henoch Schonlein Purpura** (HSP)

Kidney Bx: mesangial IgA Deposits Normal COags & Normal Platelets

Tx for Henoch Schonlein Purpura

Supportive

CPx of **Goodpasture's Disease**

Think **"GP"** **Glomerulonephritis** (rapidly progressing) + **Pulm hemorrhage** (hemoptysis)

Dx of **Goodpasture's Disease**

Biopsy: **Linear IgG deposits in glomeruli or alveoli**

Tx for **Goodpasture's Disease**

**G**lucocorticoids **P**lasmapheresis

Which diseases are **+P-ANCA?**

**Microscopic Polyangiitis** **EPA** **Ulcerative Colitis** **Primary Sclerosing Cholangitis**

Which diseases are **+C-ANCA**?

**Wegener's Granulomatosis**