Rheum final review pt1

Question 1

What gender/age?

Sjorgen’s syndrome

Answer 1

Females

35-55

Question 2

What gender/age?

SLE

Answer 2

Females

20-40

Question 3

What gender/age?

Osteoporosis

Answer 3

Females

>50 (after menopause)

Question 4

What gender/age?

OA

Answer 4

Females

Usu >65

Question 5

What gender/age?

RA

Answer 5

Females 20-40

But >60: equal in both genders

Question 6

What gender/age?

Fibromyalgia

Answer 6

Females

30-60

Question 7

What gender/age? Mean age?

PMR, GCA, TA

Answer 7

Females

>50, mean age is 73

Question 8

What gender/age?

Myositis

Answer 8

Females

5-15 & 30-50

Question 9

What gender/age?

Gout

Answer 9

Males

40-60

Question 10

The 3 basic presentations of joint sx are
Inflammatory (7), mildly inflammatory (1), & non-inflammatory (1).
What conditions is in each?

Answer 10

Inflammatory - RA, Gout & pseudogout, Spondyloarthropathies (Psoriatic arthritis, Ankylosing Spondylitis, Reactive arthritis, Enteropathic arthritis)
Mildly: Fibromyalgia (he says it really isn’t at all)
Non: Osteoarthritis

Question 11

8 major risk factors for Osteoporosis

besides being being female, which is the #2 risk factor

Answer 11

Increased age - #1 risk factor
Personal history of fracture as an adult
Low BMD
Mother or father had a hip frx
Low body weight (3 months
Rheumatoid Arthritis

Question 12

FRAX scores that warrant therapy: (2)

Answer 12

10 year risk of major fxs > 20%
or
>10 yr risk for hip fracture is >3%

Question 13

Remember in osteoporosis, ____ is very important for maintenance of bone health.

Answer 13

Estrogen

Question 14

X-ray findings in RA (3)

MCP joints in RA, and wrist in RA –> differs RA from OA.

Answer 14

Mouse-bite corner erosion (slide 33)
Erosions and joint space narrowing
Rheumatoid nodules in lungs (slide 20)

Question 15

Three basic presentations of joint symptoms:

Answer 15

1. Inflammatory
2. Non-inflammatory
3. Fibromyalgia

Question 16

Describe the presentation of inflammatory joint symptoms (2)

Answer 16

Morning stiffnes > 30 minutes

-Symptoms improve with activity

Question 17

Describe the presentation of non-inflammatory joint symptoms (3)

Answer 17

Morning stiffness < 30 minutes

- Symptoms worse with activity
- Swelling may or may not be present

Question 18

Describe the presentation of Fibromyalgia joint symptoms (4)

Answer 18

• Stiffness in morning variable but may be prolonged
  
  • Pain with activity
  • Fatigue especially in the afternoon
  • If patient over does it, may be “wiped out” the next day

Question 19

With RA, where is it? What does it look like? Throughout the day?

Answer 19

Synovial inflammation (hallmark)
Symmetric soft tissue swelling of joints
Hand, wrist, foot involvement common
Prolonged morning stiffness (>1/2 hour)
Joint pain lasting >3 months
And all the extra articular manifestations (slide 18)

Question 20

Describe the 1987 ACR Criteria for RA

1. how many joints involved?
2. serology?
3. what other test?
4. duration of sx

Answer 20

a score of 6/10 is needed for classification of a patient as having definite RA)‡
A. Joint involvement (>10)
B. Serology (at least 1 test result is needed for classification): RF or ACPA test
C. Acute-phase reactants (at least 1 test result is needed for classification) abnormal CRP or ESR
D. Duration of symptoms§§ >6 weeks

Question 21

2 lab tests that really dx RA:

higher levels in each means:

Answer 21

Rheumatoid factor
Anti CCp

higher lvls in each = worse prognosis

Question 22

Synovial fluid analysis for these 4 conditions: OA, Trauma, Inflammation, bacteria

Answer 22

Osteo: Yellow, clear, WBC <2000
Inflam: Yellow, cloudy, WBC 3-50000, may have crystals
Bacteria: Purulent, opaque, 50-300000, may have crystals, and a positive culture

Question 23

List the 5 tests you can do with synovial fluid

Answer 23

Color, clarity, WBC lvl, Crystals, Culture & Sensitivity

Question 24

Purulent synovial fluid means it is:

Answer 24

septic

Question 25

The unique sx within

ACR Criteria for KNEE OA

Answer 25

Stiffness <30 minutes