Rheum KPs Flashcards
Pain with both passive and active range of motion implies?
pain with only active range of motion is likely due to?
an intrinsic joint condition,
a periarticular condition.
Synovial fluid leukocyte counts - normal? non-inflammatory conditions? inflammatory states?
<200
200-2000
> 2000
Meds that provide similar pain relief for inflammatory conditions as oral NSAIDs with fewer gastrointestinal effects and are preferred for patients 75 years or older
topical NSAIDs
When should patients on steroids get bisphosphonate therapy?
> 4 weeks at doses >5 mg prednisone
Non-Biologic DMARDs?
Chasm Clam
Cyclophosphamide Hydroxychloroquine Azathioprine Sulfasalazine Methotrexate
Cyclosporine
Leflunomide
Apremilast
Mycophenolate
recommended initial disease-modifying antirheumatic drug for most patients?
Methotrexate
Cyclophosphamide is used to treat?
severe and/or life-threatening manifestations SLE
systemic sclerosis, the inflammatory myopathies, interstitial lung disease, and vasculitis
Perk of mycophenolate mofetil?
at least as effective as cyclophosphamide for systemic lupus erythematosus but with fewer, and milder, side effects.
If non-biologics fail, first choice of biologics?
TNF-a inhibitors
vaccines are currently contraindicated for patients on biologic therapies? When should they be given?
Live attenuated
4 weeks before starting
Allopurinol MoA? Avoid in which patients?
purine analogue that inhibits xanthine oxidase; other purine analogues (azathioprine or 6MP)
Feboxustat MoA? Benefit over allopurinol? Avoid in which patients?
non-purine, non-competitive xanthine oxidase inhibitor; less likely to cause hypersensitivity
other purine analogues (azathioprine or 6MP)
Probenecif MoA? Avoid in patients with?
promotes kidney uric acid excretion (uricosuric effect)
CrCl<50
Imaging used to follow course of RA?
Imaging that should not be routinely preformed?
Plain radiography of the hands, wrists, and/or feet
MRI of peripheral joints
Felty Syndrome?
Neutropenia, splenomegaly, and RA
recommended initial disease-modifying antirheumatic drug for most patients with rheumatoid arthritis?
Methotrexate
Benefits of TNF-a inhibitor in psoriatic arthritis?
remission, reduces radiographic progression, nromalizes acute phase reactants, reduce cardiovascular risk
RA drugs contraindicated in pregnancy? Safe in pregnancy?
Methotrexate and leflunomide are absolutely contraindicated in pregnancy
Both hydroxychloroquine and sulfasalazine
radiographic hallmarks of osteoarthritis?
In contrast, radiographic findings seen in RA (which are absent in OA)?
Joint-space narrowing, subchondral sclerosis, and marginal osteophyte formation
periarticular osteopenia and marginal erosions
Intra-articular glucocorticoids reduce osteoarthritis knee pain within?
days to weeks
The most effective surgical intervention for knee or hip osteoarthritis?
total joint arthroplasty
Fibromyalgia is a clinical diagnosis characterized by?
- chronic widespread pain,
- tenderness of the skin and muscles to pressure,
- fatigue,
- sleep disturbance, and
- exercise intolerance.
Initial laboratory evaluation of fibromyalgia?
Tests that should be avoided?
BMP, CBC TSH, ESR, CRP
ANA, RF, anti-CCP, CK
For patients with fibromyalgia, this is critical for functional improvement.
aerobic exercise
FDA approved and modestly effective for fibromyalgia? (3)
Pregabalin, duloxetine, and milnacipran
Severe presentations of reactive arthritis or psoriatic arthritis should raise concern for?
HIV
Arthritis of varying patterns may occur in patients with IBD, but this type parallels IBD activity?
oligoarticular peripheral arthritis
spondyloarthritis - 1st line imaging?
Role of MRI?
Role of CT?
XR
only if conventional radiographs are negative and strong suspicion
only for identifying occult spine fractures and bony erosions.
first-line therapy for ankylosing spondylitis? If inadequate?
NSAIDs
TNF-a inhibitors
first-line therapy for psoriatic arthritis? If inadequate?
NSAIDs for inflammation; non-biologic DMARDs for arthritis and enthesitis
biologics
first-line therapy for inflammatory bowel disease–associated arthritis? If inadequate?
Methotrexate or sulfasalazine
TNF-a
All patients with systemic lupus erythematosus should be evaluated for nephritis with?
Cr, Urine protein-creatinine ratio, urinalysis
Most common cause of death for older patients with SLE?
ischemic heart disease
Anti-U1? (3)
Associated with Raynaud phenomenon and esophageal dysmotility; also seen in MCTD
Antiribosomal P?
Associated with CNS lupus and lupus hepatitis
Med that should be initiated in every patient with systemic lupus erythematosus who can tolerate?
Hydroxychloroquine
initial therapy for acute manifestations of systemic lupus erythematosus?
Steroids
Maternal antibodies associated with neonatal lupus erythematosus?
anti-Ro/SSA or anti-La/SSB
Patients with Sjögren syndrome have a ~30-fold increased risk for? (most common type?)
lymphoma (DLBCL and MALT)
If diagosis of Sjögren syndrome is unclear, can biopsy?
lip biopsy demonstrating minor salivary gland inflammation
Prognosis of MCTD v SLE? Why?
Increased. PAH more common in MCTD
“treat-to-target” approach for gout - targets?
<6.0 in patients without tophi
<5.0 in patients with tophi
Gout flare prophylaxis?
colchicine and NSAIDs
Calcium pyrophosphate deposition is associated with these diseases?
hyperparathyroidism, hemochromatosis, hypomagnesemia, and hypothyroidism
Management of symptomatic basic calcium phosphate deposition (Milwaukee shoulder syndrome?)
NSAIDS, joint aspiration adn tidal lavage, and intra-articular steroids
disseminated gonococcal infection present with these two syndromes
1) arthritis, tenosynovitis, and dermatitis
2) purulent monoarthritis or oligoarthritis.
Musculoskeletal Mycobacterium tuberculosis typically presents as?
spondylitis, vertebral osteomyelitis, or hip or knee arthritis. - NO CONSTITUTIONAL SYMPTOMS
nterstitial lung disease in patients with dermatomyositis or polymyositis is associated with these antibodies?
with antisynthetase antibodies, including anti–Jo-1
pt with dermatomyositis or polymyositis - cancer screening?
age-appropriate + ovarian (no CT or PET unless additional risk factors)
Treatment of polyarteritis nodosa includes?
high-dose prednisone and cyclophosphamide.
Primary angiitis of the central nervous system presents with?
recurrent headaches and progressive encephalopathy
Kawasaki disease symptoms?
high spiking fevers, conjunctivitis, rash, and mucositis of the lips and oral cavity.
Microscopic polyangiitis typically involves? patients classically express?
the kidneys and lungs
p-ANCA and antimyeloperoxidase (MPO)
Remission induction of both granulomatosis with polyangiitis and microscopic polyangiitis consists of?
high-dose glucocorticoids plus cyclophosphamide or rituximab, followed by maintenance therapy
characteristic rash in type II cryoglobulinemia? Other organs involved?
Palpable purpura; Peripheral nerves and kidneys
Diffuse cutaneous systemic sclerosis is characterized by?
extensive distal and proximal skin thickening (chest, abdomen, and arms proximal to wrists) and is commonly accompanied by internal organ fibrosis.
Limited cutaneous systemic sclerosis is characterized by ?
distal (face, neck, and hands), but not proximal, skin thickening; it is usually unaccompanied by internal organ fibrosis but is more likely to be associated with pulmonary arterial hypertension.
autoantibody testing for systemic sclerosis?
antinuclear, anti–Scl-70, anticentromere, and anti-RNA polymerase III
How to distinguish secondary Raynaud phenomenon associated with systemic sclerosis from primary Raynaud phenomenon?
Nailfold capillarioscopy (abnormal in systemic sclerosis)
Med that decreases mortality among patients with scleroderma renal crisis
ACE inhibitor
annual monitoring of this is recommended for all patients with systemic sclerosis?
PAH
Relapsing polychondritis is characterized by? (4)
- chondritis of the ears, nose, and/or respiratory tract;
- nonerosive inflammatory polyarthritis;
- ocular inflammation;
- cochlear and/or vestibular dysfunction.
Relapsing polychondritis - ear findings?
Spares earlobe
