Rheum in STEP 1 Book Flashcards
What happens to joints in Osteoarthritis?
Wear and tear destroys articular cartilage
What does Osteoarthritis look like in patients?
Sclerosis, bone spurs, Heberden nodules in DIPs, Bouchard nodes (PIP), no MCP involvement
What can predispose for osteoarthritis?
Age, obesity, and joint trauma
What should trigger you to an Osteoarthritis case?
Pain in weight bearing joints, cartilage loss begins medially, noninflammatory
How do you treat Osteoarthrits?
Acetaminophen
NSAIDS
Intra-articular glucocorticoids
What causes RA?
Autoimmune reaction mediated by cytokines and type 3 and 4 hypersensitivity reactions
What do the joints look like in RA?
Pannus formation
Subcutaneous rheumatoid nodules
Ulnar deviation of fingers
Swan neck and Boutonniere deformities
RA has strong association with HLA what?
HLA DR4
Patient key characteristics that can help focus in on RA?
Morning stiffness more than 30 minutes
Systemic symptoms
Symmetric joint involvement
Treatment for Rheumatoid Arthritis?
NSAIDS
Glucocorticoids
TNF-a inhibitors
Sjogren’s syndrome destroys what?
Exocrine glands such as salivary and lacrimal with lymphocytic infiltration
What primary disorder can Sjogren’s be associated with?
RA
Complications of Sjogren’s?
Dental carries
Lymphoma (parotid enlargement)
Mucosa associated Lymphoid Tissue (MALT)
Patient findings in Sjogren’s?
Inflammatory joint pain
Decreased tears or saliva
Antinuclear antibodies SS-A SS-B
Bilateral parotid enlargment
What crystal causes gout?
Monosodium urate crystals
What two things can cause hyperuricemia?
Underexcretion
Overproduction
Which is the more likely cause of hyperuricemia?
Underexcretion
Shape and color of gout crystals?
Needle shaped and yellow under parallel light, blue under perpendicular. - birefringent
Symmetric or asymmetric in gout?
Asymmetric
Classic manifestation of Gout?
Swollen, red, and painful MTP joint of big toe
In Gout tophi normally form where?
External ear, olecranon bursa, or Achilles tendon
Interaction between uric acid metabolism and alcohol?
Alcohol metabolites compete for same excretion sites in kidney as uric acid which leads to acid buildup in blood
Treatment for Gout?
NSAIDS
Glucocorticoids
Xanthine oxidase inhibitors
What crystals are involved in Psuedogout?
Calcium pyrophospahte
Which joint does Pseudogout normally hit?
Knee in those older than 50
What color are Pseudogout crystals?
Blue when parallel to the light
Disease associated with Psuedogout?
Hemochromatosis
Hyperparathyroidism
Osteoarthritis
Treatment for Pseudogout?
NSAIDS
Glucocorticoids
Colchicine for prophylaxis
Common causes for infectious arthritis?
Staph aureus
Streptococcus
Neisseria gonorrhoeae
How does Gonococcal arthritis present?
Migratory arthritis with asymmetric pattern
3 main symptoms of Gonococcal arthritis?
Synovitis (Knee)
Tenosynovitis (Hand)
Dermatitis (Pustules)
(STD mnemonic)
What are seronegative spondyloarthropathies?
Arthritis without RF, strong association with HLA B27 that occurs more often in males
What gene is coded for by HLA B27?
MHC Class 1
Diseases that fall into the category of Seronegative spondyloarthopathies? (PAIR mnemonic)
Psoriatic arthritis
Ankylosing Spondylosis
Inflammatory Bowel Disease
Reactive Arthritis (Reiter’s Syndrome)
What does Psoriatic Arthritis present as?
Asymmetric and patchy involvement
Sausage fingers
Anylosing spondylosis presents as?
Chronic inflammatory disease of spine and sacroiliac joints, Stiff spine, vertebral fusion, uveitis, aortic regurgitation
Inflammatory bowel disease presents as?
Inflammatory diseases such as Chron’s disease and ulcerative colitis often accompanied by ankylosing spondylitis or peripheral arthritis
Classic triad of Reiter’s Syndrome? (Can’t see, can’t hear, can’t bend my knee”)
Conjunctivits
Urethritis
Arthritis
What can trigger Reiter’s syndrome ?
Post-GI infection
Classic presentation of SLE?
Rash, joint pain, and fever
What type of hypersensitivity reaction is SLE?
Type 3
Common causes of death in SLE?
Cardiovascular disease (Wart like vegetations on heart valves)
Infections
Renal disease
Anti-dsDNA antibodies in SLE say what?
Poor prognosis (renal disease) Specific
Antihistone antibodies sensitive for what?
Drug induced lupus
Immune complex formation causes what changes to complement?
Decrease in C3, C4, and CH50
How to you treat SLE?
NSAIDs
Steroids
Immunosuppressants
Hydroxychloroquine
What is Antiphospholipid syndrome?
Primary or secondary autoimmune disorder most commonly in SLE
What lab findings are there in Anti-phospholipid syndrome?
Lupus anticoagulant
Anti-cardiolipin
Anti-B2 glycoprotein antibodies
How do you treat Anti-phospholipid syndrome?
Systemic anticoagulation
Anticardiolipin and Lupus anticoagulant can cause what?
False positive VDRL and prolonged PTT
RASH OR PAIN mnemonic for SLE?
Rash Arthritis Soft Tissues Hematologic disorders Oral/nasopharyngeal Renal Disease, Raynaud's Photosensitivity, Positive VLDR Antinuclear antibodies (ANA) Immunosuppresents Neurologic disorders
