- Ideal weight - Avoid excessive use of knees - acetaminophen (1st line) - IA HA or steroids => symptomatic relief. No role of DMARD in OA

Rheuma Flashcards by AlBatool Ali

Thiazide diuretics SE?

High GLUC + Low MgNak

High => Glucose, lipid, uric acid, Ca
Low=> Mg, Na, K

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Medication cause osteoporosis?

Phenytoin 
Glucocorticoid 
Cyclosporine 
Phenobarbital 
Heparin

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Indication of raloxifene?

Osteoporosis in post-menopausal women.

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Lab indications of disease activity in SLE?

Active SLE > high anti-dsDNA + low C3 / C4

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Dx of osteoporosis?

DEXA

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Sensitivity of X-ray in osteoporosis?

Not sensitive until bone density is decreased by >50%

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Dx of ankylosing spondylitis?

X-ray of sacroiliac joint.

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Instructions for alendronate (bisphosphonate)

Empty stomach (food decreases absorption) 
30 min before food.

Remain upright for 30 min (prevent GERD)

With water.

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Rx of male osteoporosis?

Alendronate

Recombinant parathyroid hormone

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Contraindication to using testosterone replacement?

Hx of prostate Ca

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Dx of giant cell arteritis

Biopsy of temporal artery

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Food increase risk of gout?

Red meat
Seafood
Nuts (purine)
Beans (purine)

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Food help in gout?

Milk and dairy products.

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Gout classic?

Acute mono arthritis (MTP) peaks in 10 hr

Warmth, tenderness, swelling

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Gout is associated with what Dz?

HTN

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Dx of gout?

Joint aspirate

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Joint aspirate in gout vs pauedogout?

Gout: needle shaped, negative birefringent, monosodium urate

Pseudogout: rhomboid shaped, positive birefringent, CPPD

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WBC in joint aspirate of gout?

50 x 10^9 mostly neutrophils.

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Importance of glucose level in joint aspirate of gout?

R/o septic arthritis

Glucose is low in SA

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Are there specific X-ray changes in gout?

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Role of pharmacological Rx in preserving joint in OA?

No role.

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Rx of OA?

Ideal weight
Avoid excessive use of knees
acetaminophen (1st line)
IA HA or steroids => symptomatic relief.

No role of DMARD in OA

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Classic X-ray changes in OA?

Decrease joint space
Osteophyte formation
Subchondrial sclerosis
Subchondrial cyst

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What’s raloxifine?

What’s it used for?

SERM (selective estrogen modulator)

Prophylactic of osteoporosis.

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Mechanism of action of raloxifene?

Estrogen agonistic effect on bone and lipids. So lowers lipoprotein cholesterol and augment bone mineral density.

Raloxifene SE?

Hot flushes Leg cramps Risk of thromboembolic

Causes of osteoporosis in men?

``` Obesity Alcohol Hypogonadism Low Vit D Low BMI Steroid use ```

Effect of allopurinol in acute gout?

Worsen Sx

Rx of acute gout?

- NSAIDs (indomethacin 1st choice) - Steroids - Colchicine NB: combination of steroids and colchicine is not recommended.

Poor prognostic factors in SLE?

``` Renal Dz HTN Male Young or elderly Anti-phospholipid syndrome Black race ```

Drugs induce lupus?

``` Procainamide Hydralazine INH Carbamazepine Phenytoin ```

Effect of thiazide on bone density?

Improves bone density

Indication of thiazide in osteoporosis?

Reduce risk of osteoporosis in postmenopausal women

Ankylosing spondylitis (age + sex)

> 40 | Men > F

Osteoarthritis effect in hands?

PIP + DIP of 2-5th fingers | CMC joint of thumb.

Osteoporosis screen in F?

<65 If has > 1 risk factor (other than menopause) > 65 Should be screened regardless of risks

Risk factors of osteoporosis?

``` Petite White Inactive Nulliparity Smoking High caffeine intake Alcohol Postmenopausal F Low Ca intake ```

Most serious association of polymyalgia rheumatica?

Temporal arteritis > Monocular visual loss

Polymayalgia Rheumatica classic?

1. Shoulder + hip pain > 1 mo (bilateral) Affects daily activity 2. Morning stiffness > 1hr 3. Age > 50 (~70) 4. ESR >40-100 5. Rapid response to steroids < 20mg

Not a feature of PMR?

Muscle weakness | Muscle atrophy

Abnormal labs in PMR?

Anemia ESR > 40-100 CRP high

Complication of advance osteoarthritis?

Meniscal tear | Rx doesn't help.

X-ray of osteomyelitis?

Periosteal thickening, cortical thickening, sclerosis

Anaserine bursitis classic?

Nocturnal pain in medial knee region over upper tibia (2-3 cm below medial joint line) Unit or bilateral.

Dx of anserine bursitis?

Local tenderness confined to quarter-sized area of medial tibial plateau. -ve valgus stress Normal X-ray of tibia

Area of de quervain's tendinitis?

Wrist

Medial joint line of knee pain is characteristic of what Dz?

Osteoarthritis. Medial collateral ligament injury Medial meniscal tear Fracture of tibial plateau

Most important factor to improve bone density in anorexia?

Normalizing weight.

Effect of OCP on osteoporosis?

None

Mechanism of action of alendronate?

Decrease bone resorption | Increase new bone formation

Gout vs pseudogout in age, joint

Gout: male + MTP joint Pseudo: female + knee, wrist, ankle.

Fibromyalgia classic?

Childbearing F Generalized pain with multiple point tenderness Sleep disturbance Normal labs

Fibromyalgia Rx?

Amitriptyline Cyclopenzaprine CBT Aerobic exercise

Gonococcal septic arthritis classic?

1. Migratory arthritis 2. Papular rash 3. Multiple sexual partners 4. +/- urogenital Sx 5. Tenosynovitis

Dx of septic arthritis?

Nucleic acid amplification | Cultures of sensitivity

Rx of septic arthritis?

``` IV ceftriaxone (Gonorrhea) Doxycycline (Chlamydia) ```

Rx of bite associated septic arthritis?

IV ampicillin-sulbactam

Risk of gout?

``` Renal failure HTN Obesity Moonshine ingestion (lead) Alcohol Drugs ```

Drugs causing gout?

``` Diuretics (thiazide) Salicylates Niacin Cyclosporine Ethambutol Pyrazinamid ```

How long does acute gout attack take to resolve?

2 weeks

Does colchicine alter high uric acid or prevent tophi?

Triad of reactive arthritis?

Arthritis, Iritis + conjunctivitis Urethritis (+ GI sx + rash)

Source of infection in reactive arthritis?

Urethral | GI

Most effective drug to reduce fracture in osteoporosis?

Bisphosphonate

Raloxifene prevents what fractures?

Vertebral only.

HLA-B27 is associated with what erheumatological Dz?

Reactive arthritis Psoriatic arthritis Ankylosing spondylitis

Myasthenia graves associate with what HLA?

HLA-DR3

Pathophysiology of gout?

Purine metabolism defect > high uric acid.

Risk of hip involvement in osteoarthritis?

``` Obesity High bone mass Old age Female Weight Bearing sports Hypothyroid. ```

Specific labs for rheumatoid arthritis?

RF | Anti-CCP

Indicator of pulmonary vascular fibrosis in scleroderma

TLC/DLCO > 1.6

Pulmonary fibrosis changes in DLCO?

Low DLCO

Side effect of gold salts?

Skin discoloration (mauve + grey) over sun exposed areas.

Minocycline SE?

Photosensitivity Lupus Blue grey skin + teeth Diarrhea.

SE of high dose steroids (>40)?

Psychiatric Sx (esp mood swings)

Fibromyalgia trigger points location?

Along medial scapular borders Posterior neck Upper outer gluteal muscle Medial fat bass of knees

Myopathies associated with high CK?

Polymyositis Dermatomyositis Alcoholic myopathy Hypothyroidism ass myopathy

Myopathy with normal CK at all times?

PMR

Is there a correlation between bone mineral density and risk of fracture in osteoporosis?

No All patient with Hx of fracture should be on Rx regardless of T score.