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Step2 > Rheum > Flashcards

Rheum Flashcards

1
Q

Systemic sclerosis

Clinical

A

Progressive tissue fibrosis
Vascular dysfunction

Systemic: fatigue, weakness
Skin: telangiectasia, sclerodactyly, digital ulcers, calcinosis cutis
Extremities: arthralgias, contractures, myalgias
Gastrointestinal: esophageal dysmotility, dysphagia, dyspepsia
Vascular: Raynaud phenomenon

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2
Q

Systemic sclerosis

Complications

A

Lung: interstitial lung disease, pulmonary arterial HTN
Kidney: HTN, scleroderma renal crisis (oliguria, thrombocytopenia, MAHA)
Heart: myocardial fibrosis, pericarditis, pericardial effusion

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3
Q

Systemic sclerosis

Diagnosis

A

Antinuclear antibody
Anti-topoisomerase I (anti-Scl-70) antibody
Anticentromere antibody

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4
Q

Systemic sclerosis - Limited cutaneous

A

Scleroderma on trunk & UE
Prominent internal organ involvement

Scleroderma renal crisis
Myocardial ischemia & fibrosis
Interstitial lung disease

Anti-Scl-70 (topoisomerase-1) antibodies
Anti-RNA polymerase III antibodies
Worse prognosis

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5
Q

Systemic sclerosis - Diffuse cutaneous

A 
Scleroderma on head & distal UE
    Prominent vascular manifestations
        Raynaud phenomenon
        Cutaneous telangiectasia
        Pulmonary arterial hypertension
CREST syndrome

Anticentromere antibodies
Better prognosis
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6
Q

Sarcoid

A

Young adults, African Americans

Constitutional symptoms
Cough, dyspnea & chest pain
Extrapulmonary findings:
    Skin lesions
    Anterior/posterior uveitis
    Löfgren syndrome
Parotid gland swelling
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7
Q

Sarcoid

Findings

A 
Imaging	
Bilateral hilar adenopathy
Pulmonary reticular infiltrates
Laboratory	
Hypercalcemia/hypercalciuria
Elevated serum ACE level
Biopsy: noncaseating granulomas
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8
Q

Sjogren

Diagnosis

A

Objective signs of decreased lacrimation (eg, Schirmer test)
Positive anti-Ro (SSA) &/or anti-La (SSB)
Salivary gland biopsy with focal lymphocytic sialoadenitis
Classification: primary if no associated CTD, secondary if comorbid CTD (eg, SLE, RA, scleroderma)

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9
Q

Sjogren
Extraglandular
features

A 
Raynaud phenomenon
Cutaneous vasculitis
Arthralgia/arthritis
Interstitial lung disease
Non-Hodgkin lymphoma
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10
Q

Sjogren

Exocrine features

A

Keratoconjunctivitis sicca
Dry mouth, salivary hypertrophy
Xerosis

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11
Q

Polymyalgia rheumatica

Clinical features

A

Almost exclusively in patients age ≥50
Rapid-onset pain & stiffness in shoulders & hips ± neck involvement
Fatigue, weight loss, low-grade fever
~10% associated with GCA (eg, headache, jaw claudication, visual symptoms)

  • Strength remains normal
  • Morning stiffness, gelling (stiffness with inactivity), aching pain, and limited range of motion of the shoulders, hips, and/or neck
  • Patients also often have systemic symptoms (eg, fatigue, fever, weight loss).
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12
Q

Polymyalgia rheumatica

Diagnosis

A

Elevated acute-phase markers (eg, ESR, CRP)

Temporal artery biopsy if symptoms of GCA

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13
Q

Polymyalgia rheumatica

Treatmennt

A

Very rapid response to oral glucocorticoids

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14
Q

Polymyositis

Clinical features

A

Proximal muscle weakness (eg, increasing difficulty climbing up stairs)
Pain mild/absent

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15
Q

Polymyositis

Diagnosis

A

Elevated muscle enzymes (eg, creatine kinase, aldolase, AST)
Autoantibodies (ANA, anti-Jo-1)
Biopsy: Endomysial infiltrate, patchy necrosis

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16
Q

Fibromyalgia

Clinical features

A

Young to middle-aged women
Chronic widespread pain
Fatigue, impaired concentration
Tenderness at trigger points (eg, mid trapezius, costochondral junction)

17
Q

Fibromyalgia

Diagnosis

A

≥3 months of symptoms with widespread pain index or symptom severity score
Normal laboratory studies

18
Q

SLE

Clinical

A

Constitutional: fever, fatigue & weight loss
Symmetric, migratory arthritis
Skin: butterfly rash & photosensitivity
Serositis: pleurisy, pericarditis & peritonitis
Thromboembolic events (due to vasculitis & antiphospholipid antibodies)
Neurologic: cognitive dysfunction & seizures

19
Q

SLE

Findings

A

Hemolytic anemia, thrombocytopenia & leukopenia
Hypocomplementemia (C3 & C4)
Antibodies:
ANA (sensitive)
Anti-dsDNA & anti-Sm (specific)
Renal involvement: proteinuria & elevated creatinine

20
Q

RA

Diagnosis

A
  1. Inflammatory polyarthritis (joint swelling is the most common sign)—can involve every joint in the body except the DIP joints.

a. Pain on motion of joints/tenderness in joints.
b. Joints commonly involved include joints of the hands (PIP, MCP) and wrists, knees, ankles, elbows, hips, and shoulders.
c. Characteristic hand deformities.

  • Ulnar deviation of the MCP joints
  • Boutonnière deformities of the PIP joints (PIP flexed, DIP hyperextended)
  • Swan-neck contractures of the fingers (MCP flexed, PIP hyperextended, DIP flexed)
  1. Constitutional symptoms can be prominent
    a. Morning stiffness (present in all patients)—improves as the day progresses.
    b. Low-grade fever, weight loss.
    c. Fatigue can be prominent because this is a systemic disease.
  2. Cervical spine involvement is common at C1-C2 (subluxation and instability), but it is less common in the lower cervical spine.
21
Q

RA

Diagnosis

A

Laboratory findings
a. High titers of RF are associated with more severe disease and are generally nonspecific. RF is eventually present in 80% of patients with RA (may be absent early in the disease), but is also present in up to 3% of the healthy population.
• RF titers rarely change with disease activity and are not useful for following patients.
b. Anticitrullinated peptide/protein antibodies (ACPA)—sensitivity is 50% to 75%, specificity is over 90%.
c. Elevated ESR, C-reactive protein.
d. Anemia of chronic disease.

  1. Radiographs
    a. Loss of juxta-articular bone mass (periarticular osteoporosis) near the finger joints.
    b. Narrowing of the joint space (due to thinning of the articular cartilage) is usually seen late in the disease.
    c. Bony erosions at the margins of the joint.
  2. Synovial fluid analysis is nonspecific
22
Q

RA

Diagnosis (brief)

A
  1. Inflammatory arthritis of three or more joints—MCP, PIP, wrist, elbow, knee, ankle, MIP joints
  2. Symptoms lasting at least 6 weeks
  3. Elevated CRP and ESR
  4. Positive serum RF or ACPA
  5. Radiographic changes consistent with RA (erosions and periarticular decalcification)
23
Q

RA

Felty Syndrome

A
  • Triad of RA, neutropenia, and splenomegaly
  • Also anemia, thrombocytopenia, and lymphadenopathy
  • Associated with high titers of RF and extra-articular disease
  • Increased susceptibility to infection
  • Usually occurs fairly late in the disease process
24
Q

RA

extra-articular manifestations

A
  • Cardiac involvement may include pericarditis, pericardial effusions, conduction abnormalities, and valvular incompetence.
  • Pulmonary involvement—usually pleural effusions (pleural fluid characteristically has very low glucose and low complement); interstitial fibrosis may occur.
  • Ocular involvement—episcleritis or scleritis.
  • Soft tissue swelling (rather than bony enlargement).
  • Drying of mucous membranes: Sjögren xerostomia.
  • Subcutaneous rheumatoid nodules over extensor surfaces may also occur in visceral structures—for example, lungs, pleura, pericardium.a. Pathognomonic for RA.
    b. Nearly always occurs in RF+ patients

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