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Rheum > Rheum conditions > Flashcards

Rheum conditions Flashcards

1
Q

Types of Spondylarthropathies & how Rx differs

A
  1. Axial Spond - NSAIDs & exercise
    i) nonRadiographic Axial Spond (Golimumab)
    ii) Ank Spond (has radiographic sacroillitis)
    - antiTNF (adalimum, Certolizum, Etanercept, IFX, Gol) improves XR
    - IL 17A blocker (Socukinumab, Ixekizumamb) but WORSENS IBD - use IL12/23
  2. Peripheral Spond (mostly peripheral jts - O/L w/ PsA) - antiTNF & IL17 as above
    + Anti IL12/23 (Ustekinumab) - good for IBD sx but not for spinal sx
    Uveitis: only TNFi & not Etanercept
    Skin: IL17 effective
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2
Q

CPPD - MoA, Fx, Rx

A

CPPD - 3 types (acute, chronic, OA w/ CPPD)
Acute - self limiting monoarthritis lasting ~2wks
KNEE (>50%), v 1st MTP for gout,
Assoc w/ chondrocalcinosis (XR), OA (in jts not usu affected like MCP, wrist, elbow)
CPP crystals activate NLRP3 inflamasome
Look for metabolic disorders: hypoMg/PO4, HyperPTH, haemochromatosis
Rx: NSAIDs, Pred/intra-art CS, low dose colchicine prophylaxis

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3
Q

Types of IBD-assoc arthritis

A

3 types:
Peripheral
- Classic: IBD associated (single, usu LL lrg jt) - correlates w/ dis activity
- Sml polyarthritis: more RA like & doesn’t correlate w/ dis. Use sulfa, anti-TNF

Axial: spinal & sacroiliitis - rule out AS (MRI & HLAB27) then Anti-TNF

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4
Q

GCA - ix (highest sens/spec)

A
  • USS - halo sign (dbl contour in gout) - 80% spec, 50% sens
  • MRI - 80% spec, 94% sens
  • FDG PET = 90% spec, 98% sens
  • PMR shows more uptake in liver than shoulder
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5
Q

GCA - ESR cut off

A

>50

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6
Q

GCA - bx findings

A
  • multinucleated giant cells
  • mononucleare cell infiltration or granulocyte inflammation
  • Vasculitis

Bx only useful to ddx b/w vasculitis forms

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7
Q

GCA - Rx

A

Steroids for years (start hard & taper - maintain for yrs)
- steroid sparing agents eg MTX, cyclophosphamide, AZA

Aspirin 75mg

IL6 Tocilizimab - more effective if added to Pred - GI perf (blunts CRP response)
IL 17 (Secukinumab, Ixekizumab) can dec GC dose
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8
Q

Ank Spond + IBD

A
  • Anti-TNF
  • adalimum, Certolizum, Etanercept, IFX, Gol
  • Could use IL-12/23 although not great for spine
  • Avoid IL 17
  • If nR-AxSpA - Golimumab
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9
Q

Ank Spond + joints

A
  • DMARDs (Sulfasalazine, MTX) -peripheral dis but NOT effective for axial dis
  • IL-17 (if no IBD)
  • TNF-inh
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10
Q

Ank Spond + uveitis

A

TNF-inh (not abatecept)

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11
Q

RS3PE

A

Remitting, seronegative, symmetric synovitis w/ pitting edema syndrome

  • Oedema of dorsum of hand/foot (‘boxing glove’ appearance)
  • Tenosynovitis
  • Seronegative for RF & ACPA
  • Excellent response to glucocorticoids (low dose)
  • Can be paraneoplastic
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12
Q

IDIM Rx

A

1 yr high dose GC

Steroid sparing agents (MTX, Mycophenolate is good if ILD)

IVIG if IMNM

(taper til normal CK)

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13
Q

SRC - RF

A
  • GC: Pred >15mg (hence try to use low dose GC only)
  • Men
  • Early dSSc (<5y)
  • RNA polymerase Abs
  • (Higher BP assoc w/ BETTER prognosis, on ACEi prior is bad)
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14
Q

SRC - Fx

A
  • Tendon friction rubs (Contracture at large joints - specific)
  • Inc BP= BETTER outcome; ACEi Rx prior to SRC has worse
  • MAHA (40%) w/ new pleural/pericardial effusion/HF
  • ⅓ progress to ESKD and 20% die
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15
Q

SRC - Rx

A
  • ACEi - Captopril
  • PLEX if MAHA
  • Involve nephrologist for bx etc
  • IV nitroprusside if CNS involvement
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16
Q

Ssc - Raynauds

A
  1. CCB - DHP long acting : Nifedipine/Amlodipine
  2. PDE5 inh: Sildanefil
    Topical nitrates
    ARBs (not ACE)
    Antiplt/statin
  3. IV Prostacyclin: PGI2 ilioprost
17
Q

AbN SI joints

A

Ank Spond

(rarely - PsA)

18
Q

DIP v PIP joints

A

OA & PsA: DIP

(RA more commonly affects PIP & MCP rather than DIP)

OA: Heberdens nodes (DIP), Bouchards nodes (PIP)

RA: boutionneres (PIP can’t straighten - L shape)

19
Q

Jt space narrowing, subchondral cysts, Osteophytes

A

OA,

BUT can be CPPD if in non-OA joints (eg knee, wrist, shoulder, ankle)
- might not see osteophyes & would see crystals

20
Q

Chondrocalcinosis

A

CPPD

Haemachromatosis (CPPD like fx but sml jts eg MCP)

21
Q

“pencil in cup” on XR (usually hands)

A

PsA

22
Q

Enthesitis

Dactylitis

A

Enthesitis

  • Inflammation of insertion point of tendon
  • typically heel
  • Found in PsA, AnkSpond

Dactylitis

  • Sausage finger
  • PsA, Reactive Arthritis (Ank Spond rare)

Rheum (5 decks)

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