Rheum final review pt3 Flashcards
NY 1984 Criteria for Ankylosing Sponylitis:
- **Low back pain and stiffness for more than 3 months that improves with exercise, but is not relieved by rest (this shows it’s an inflammatory-type)
- Limitation of motion of the lumbar spine in both the sagittal and frontal planes
- Limitation of chest expansion relative to normal values correlated for age and sex (b/c costal junctions may be fused)
Nondrug therapy for Spondyloarthropathies
sx improves with exercise
infectious organisms in GI (1), GU (4) that lead to reactive arthritis:
GU: Chlamydia trachomatis
GI: SHIGELLA, SALMONELLA, CAMPYLOBACTER, YERSINIA
Classic triad of Reactive Arthritis
ARTHRITIS
UVEITIS/CONJUNCTIVITIS
URETHRITIS
(can have 2 of 3 though)
of fishing trip with subsequent Campylobacter and resultant ___
Reactive Arthritis
Pattern associated w/ IBD-Associated Arthritis (Crohn’s, UC) (a little bit different) (2)
Arthritis may precede GI tract symptoms
Can occur in a peripheral axial joint pattern or mixed pattern
Skin and nail findings in Psoriatic Arthritis (5)
skin/nail: Nail pitting, Onycholysis (transverse ridging), Dactylitis of the second toe, sausage digits & rash,
Distinguishing x-ray finding of Psoriatic Arthritis
*Psoriatic Arthritis has both erosive component & an overgrowth of bone
GI complaints can be in any type of __
arthritis
Genetic association of Spondyloarthropathies:
HLA-B27
HLA-B27 is a key genetic factor to test for in:
AS
Avg age of getting Crystal-induced arthritis
75-80 years old
Gout vs Pseudogout crystals
Gout: Uric acid crystal
Pseudogout: calcium pyrophosphate
1 in 4 patients develop gout who have ___
hyperuricemia
What is the mechanism for Gout?
Hyperuricemia with elevated serum uric acid (uric acid pool)
2 key clinical sx of Acute Gout
acute monoarticular arthritis with crystal deposition
What x-ray finding is an overlap between OA and RA?
Subchondral cyst formation
The 3 ways you do x-rays in Rheumatology:
weight-bearing
standing
bilateral
What is a prognosticator for anterior uveitis (with Juvenile Rheumatoid Arthritis)?
ANA positive
4 control points of FMS:
Mid-forehead
Thumbnail
Volar surface of mid-forearm
Anterior mid-thigh
a key sx of FMS is ___ sleep
Non-restorative
Name the 4 big types of Spondyloarthritis
Which is prototypical?
Ankylosing spondylitis (AS)* - Prototypical
Psoriatic arthritis (PSA)* - primarily in spine, not in peripheral joints
Reactive arthritis (ReA)* - caused by infxn
Inflammatory Bowel disease (IBD) associated arthritis*
Crohn’s disease
Ulcerative colitis
If a patient has Advanced Sacroilitis (late stage ankylosing spondylitis), don’t ever _____.
Do what instead?
Don’t ever inject the tendon.
Put on NSAIDs
What is the tx for Reactive Arthritis? (if they can handle it)
Why wouldn’t they be able to handle it?
Full dose NSAIDs
Won’t tolerate if: Salmonella or other GI acute ill infxn
Psoriasis
5 most common sites of skin involvement
Elbows Knees Behind ear Umbilicus Gluteal cleft
Lupus big car scenario:
Lupus is an Autoimmune complex – body recognizes nucleus of cell as foreign. Then a whole bunch of autoimune antibiotics attack & make very large proteins. So these are like big trains with big cars. These big protein immune complexes get stuck in areas that transfer fluid from one space into another. So the kidney (nephritis), BBB, skin (through diff mechanism), lung pleura (fluid in pleural space), lining of heart (pericarditis). We don’t know why it happens
What distinguishes the Malar rash of SLE from Rosacea?
SLE malar rash does not spare nasolabial folds*
The main medication for SLE is:
Hydroxychloroquine (Plaquenil)
Limited vs systemic/diffuse Scleroderma
Above elbow crease or knee crease = diffuse, systemic.
CREST Syndrome is a variant of ____. What does it stand for?
Scleroderma.
calcinosis raynaud’s esophageal dysmotility sclerodactyly telangestasia
The 2 key phys exam symptoms of Sjorgen’s Syndrome
Dry eye, dry mouth
What is the unique, symptom of Myositis?
WEAKNESS in proximal muscles (not pain or stiffness, but weakness)
Name 2 common autoantibodies found in Myositis
Anti-PM-Scl
Anti-Jo-1
