Rheum Flashcards
Which antibody should be done for lupus first?
The Anti nuclear antibody (ANA) is the most sensitive test for Lupus - it should be done first–>If negative, then it is probably not Lupus
Anti-double-stranded DNA and Anti-Smith antibodies are both specific for Lupus.
Which antibodies should be assessed for Rheumatoid arthritis?
Both the RF and the Anti-cyclic Citrullinated Peptide Antibodies should be assessed. If either is positive, as long as diagnostic criteria for RA is met, the patient has RA.
RF is more sensitive
Anti-CCP more specific
What must you do BEFORE starting a biologic such as infliximab?
Check for TB exposure
Screen for Hepatitis B and Hepatitis C
When is Probenecid used in the treatment of gout?
probenecid is used in under-excreters of uric acid
Urine studies will be shown that reveal low uric acid levels in the setting of repeated gout attacks.
Patient will be described as unable to use Allopurinol
When is Allopurinol used in the treatment of gout?
Allopurinol, a xanthine-oxidase inhibitor, is useful for controlling gout flares long-term
Indicated when there are two or more attacks of gout in a single year.
Goal is to lower uric acid levels to less than 6, which will hopefully reduce the frequency of gouty flares.
Don’t start it during an active flare
When is the treatment for gout flare?
Treatment is preferred in this order but will depend on contraindications:
1) NSAIDs- avoid if high bleeding risk
2) Colchicine- Dose limited diarrhea
3) Prednisone-
How will a pt with RA present?
bilateral, symmetric swelling of fingers that spare the DIPs
Morning stiffness
Hematologic findings (anemia) Bony erosions and periarticular osteopenia on XRays
What is psoriatic arthritis?
patient who have psoriasis and arthritis
Or test may say no rash but give nail pitting and arthritis
Either way:
nail pitting and arthritis = psoriasis;
psoriatic plaque + arthritis = psoriatic arthritis.
Two ways to get there.
tx with methotrexate
What is the management of rheumatoid arthritis?
Methotrexate is the drug of choice for initial therapy of RA, with additional DMARDs or biologics added if the disease progresses.
NSAIDs for symptomatic relief (never as monotherapy in RA)
Steroids for RA flares
Usually DMARD (MTX) & Biologics (rituximab) combo is best
What is the treatment for ankylosing spondylitis?
NSAIDs—meloxicam, naproxen, etc.— are the first step in medication therapy for patients with ankylosing spondylitis, especially when there is only axial involvement
if one NSAID doesn’t work, you should try another NSAID before moving onto the next line of defense: TNF-alpha inhibitors, like etanercept.
Nonbiologic disease-modifying anti-rheumatic drugs, (DMARDs), such as methotrexate, sulfasalazine, and hydroxychloroquine, are more helpful for peripheral disease.
What does arthrocentesis of gout look like?
Negatively birefringent needle-shaped crystals.
What does arthrocentesis of pseudogout look like?
Positively Birefringent Rhomboid-Shaped Crystals are for psueodgout.
What does arthrocentesis of septic arthropathy look like?
Gram positive cocci in clusters (Staph) or Gram Negative Diplococci (gonorrhea) would be a septic arthropathy
white blood cells >50,000 means septic arthritis
Managment of acute gout flare?
NSAIDs AND Colchicine is preferred for gouty flares. NSAIDs are contraindicated in kidney disease and bleeding. Colchicine is not preferred when used in a gout regimen 14 days before the flare, in AKI, or in bone marrow suppression.
If can’t give either then put them on short term prednisone
How is scleroderma renal crisis treated?
All you have to see is renal failure + scleroderma = ACE-inhibitor, such as Lisinopril
Carpal tunnel vs RA?
A seemingly clear case of carpal tunnel syndrome may actually be the initial presentation for rheumatoid arthritis, especially if bilateral.
What antibody will you see in drug induced lupus?
Anti-histone antibody
Think anti-Histone for Hydralazine
What antibody is associated with CREST (limited scleroderma)?
CREST (limited scleroderma) is associated with anti-centromere antibodies.
C- calcinosis R- Raynaud's E- esophageal dysmotility S- sclerodactyly T- telangiectasia.
What antibody is associated with Systemic Scleroderma?
Disseminated Systemic Sclerosis includes features of CREST but then goes deeper. It causes interstitial lung disease, renal disease, and will have an anti-topoisomerase antibody (also called Scl70).
Side effects of steroids?
low dose prednisone– osteoporosis
high dose prednisone–>Cushing’s syndrome–> obesity and diabetes
What antibodies is Sjogren’s syndrome associated with?
Sjogren’s syndrome presents with dry eyes (keratoconjunctivitis) and a dry mouth (xerostomia)
Associated with Ro and La antibodies.
Tx with eye drops and saliva replacement
What will the arthrocentesis of osteoarthritis show?
few white blood cells, no crystals, and no organisms.
What is enteropathic arthritis?
arthritis in patients with inflammatory bowel disease—usually UC more than Crohn’s
asymmetric arthritis
seronegative with an elevated ESR
Patients with ankylosing spondylitis and screening?
Patients with ankylosing spondylitis are at higher risk of fractures from even mild trauma. This can be easily and quickly assessed with a plain radiograph.
Septic arthritis due to gonorrhea
Septic arthritis in a patient who endorses unprotected sex is most likely due to Gonorrhea, even if the organism is not seen on initial gram stain and culture (hard to grow)
Perioperative evaluation of patients with RA
RA is systemic seropositive arthropathy that can also target the spine, specifically C1 and C2
So, perioperative evaluation of patients with RA must include an x-ray of the neck.
Golfer’s Elbow
Medial epicondylitis
Pain with resisted wrist flexion
Tender at medial epicondyle
Tennis Elbow
Lateral epicondylitis
Pain with resisted wrist extension and possible supination
Tender at lateral epicondyle
