Rheumatic Disorders Flashcards
Are men or women more likely to be effected by SLE?
What ethnicities are more commonly effected?
Women
African American
Hispanic
Native America
What are the most common causes of death in SLE patients in the USA?
Heart Disease and Stroke
Malignancies (Lung CA)
Infection
Renal Disease
Should patients with discoid lupus avoid the sun?
Yes!
What are DEFINITE medications that can cause drug induced lupus?
(Theres a lot)
Procainamide Hydralazine Minocycline Diltiazem Penicillamina Isoniazid Quinidine Anti-TNFs Methyldopa Chlorpromazine
What are the ELEVEN classifications for SLE?
How many of these are needed for a diagnosis?
Malar Rash Discoid Rash Photosensitivity Oral/Nasopharyngeal Ulcers Arthritis Serositis (Pericarditis/Pleuritis) Renal Involvement (Proteinuria) Neurologic Disorder (Seizure) Hematologic Involvement (Anemia, Leukopenia) Immunologic Disorder (+ Anti-dsDNA or SM) Positive ANA
What are examples of medications approved for the treatment of SLE?
Corticosteroids Cyclophosphamide Methotrexate Mycophenolate mofetil Azathioprine Hydroxychloroquine Belimumab Aspirin
Why do SLE patients taking hydroxychloroquine need eye examinations every 6-12 months?
Due to retinal Toxicity
A 23-year-old Hispanic female with no past medical history presented to the emergency department (ED) with an 8-week history of joint pain and swelling in the hands, knees, and ankles; fever; myalgias; pleuritic chest pain; weight loss; and a facial rash that worsened with sun exposure. She had been seen initially at a local clinic and treated for “cellulitis” with oral Keflex. Two days prior to this presentation, she was seen in another ED, found to have a temperature of 103F, proteinuria, and anemia; she was told it was a “viral syndrome” and discharged home.
On examination today, she has painless ulceration on the palate, erythematous malar rash, diffuse lymphadenopathy, and synovitis of the MCP/PIP joints.
Her blood work today show leukopenia and elevated protein, but is otherwise unremarkable. Her urinalysis shows proteinuria with hematuria present.
What is your suspected diagnosis and what antibodies would be present to confirm this?
SLE
+ ANA
+ Anti-dsDNA
+ Anti-Sm
This rheumatic disorder is characterized as a drying of mucus producing glands.
Sjogren’s Syndrome
Is Sjogren’s Syndrome more common in men or women?
Women
What are the ‘classic’ symptoms of Sjogren’s Syndrome?
Dry Eyes Dry Mouths Vaginal Dryness Dental Carries Parotid Swelling Arthralgias
What test in the eye is commonly used to diagnosis Sjogren’s Syndrome?
Schirmer Test
What laboratory tests are specific to Sjogren’s Syndrome?
SS-A (Ro)
SS-B (La)
Rheumatoid Factor
What vascular phenomenon is seen in Systemic Sclerosis (Scleroderma)?
Raynauds
How would the body hair appear on a patient with Systemic Sclerosis (Scleroderma)?
Loss of appendicular hair
What might the stomach be described as in a patient with Systemic Sclerosis (Scleroderma)?
Watermelon Stomach
What is the ‘classic’ finding in the hands of a patient with Systemic Sclerosis (Scleroderma)?
Thickening, Tightening, and Hardening of the skin
Loss of the ability to create folds and creases
T/F: Raynaud’s Phenomenon can lead to necrosis?
True
What composes CREST Syndrome?
Calcinosis Cutis Raynaud Phenomenon Esophageal Dysmotilty Sclerodactyly Telangiectasia
CREST Syndrome is associated with a ___________ ANA pattern.
Centromere
What is the classic presentation of Polymylgia Rheumatica (PMR)?
Proximal Pain Without Weakness
The pneumonic “SECRET” is often used in PMR…..
What does it stand for?
Stiffness Elderly (>50, commonly 70-80) Constitutional Sx (also causcasian) Rheumatism Elevated ESR Temporal Arteritis
Are imaging studies need when working up Polymyalgia Rheumatica?
No
A 76 y.o. female presents 4 weeks of neck pain, bilateral shoulder pain, and a new onset of bilateral hip pain. She complains that these symptoms are worse in the morning. She has been able to ambulate fairly well, but the pain in her shoulders has effected her ROM. Prior to this, she denied any injuries and was otherwise healthy. On examination, she has slightly decreased ROM in the shoulders but she has 5/5 muscle strength throughout all extremities. Otherwise, her exam is unremarkable.
You order labs wisely, and her CBC is normal, but she has an elevated ESR. She has a negative ANA, Anti-dsDNA, and RF as well.
What is your suspected diagnosis?
Polymyalgia Rheumatica
A 80 y.o. female presents to the ED with complaints of a right temporal headache. She noted the the headache has gradually worsened over the last week. She described it as a dull, throbbing, ache. Interestingly, she has recently noted a cramping pain with eating, which is new. In addition, brushing her hair on the right side is painful and bothersome. She denied any history of similar in the past. She denied any fever, chills, neck pain, or motor weakness associated with the headache. On examination, you note the the right temple is tender to palpation and the right temporal pulse is reduced. She also has the presence of carotid bruits. Her visual acuity is WNL however there is the presence of cotton wool spots on fundoscopy.
What lab would you expect to see elevated?
ESR
A 80 y.o. female presents to the ED with complaints of a right temporal headache. She noted the the headache has gradually worsened over the last week. She described it as a dull, throbbing, ache. Interestingly, she has recently noted a cramping pain with eating, which is new. In addition, brushing her hair on the right side is painful and bothersome. She denied any history of similar in the past. She denied any fever, chills, neck pain, or motor weakness associated with the headache. On examination, you note the the right temple is tender to palpation and the right temporal pulse is reduced. She also has the presence of carotid bruits. Her visual acuity is WNL however there is the presence of cotton wool spots on fundoscopy.
What would be most diagnostic in this patient’s case
Temporal Artery Biopsy is the most definitive diagnostic study for Giant Cell Arteritis (GCA)
A 80 y.o. female presents to the ED with complaints of a right temporal headache. She noted the the headache has gradually worsened over the last week. She described it as a dull, throbbing, ache. Interestingly, she has recently noted a cramping pain with eating, which is new. In addition, brushing her hair on the right side is painful and bothersome. She denied any history of similar in the past. She denied any fever, chills, neck pain, or motor weakness associated with the headache. On examination, you note the the right temple is tender to palpation and the right temporal pulse is reduced. She also has the presence of carotid bruits. Her visual acuity is WNL however there is the presence of cotton wool spots on fundoscopy. Temporal artery biopsy confirms GCA.
What would be the most concerning complication of this disease?
Vision Loss
T/F: GCA is an ophthalmological Emergency
True
How is PMR treated when compared to GCA?
PMR:
15 mg/day Prednisone
Up to 1-2 year taper
GCA:
60 mg/day prednisone
Long time
______ _______ is described as a systemic necrotizing vasculitis typically affecting medium-sized muscular arteries.
Polyarteritis Nodosa
What organs are typically involved in polyarteritis nodosa?
Kidney Skin Joints Muscles Peripheral Nerves GI Tract
Polyarteritis Nodosa is typically idiopathic, but it can be associated with what diseases?
Hep B
Hep C
Hairy Cell Leukemia
What are examples of skin manifestations of polyarteritis nodosa?
Tenderness
Erythematous Nodules
Pupura
Livedo Reticularis
Would a patient with polyarteritis nodosa have symmetrical or asymmetrical polyneuropathy?
Asymmetrical
What is a GI manifestation of polyarteritis nodosa?
Mesenteric Arteritis (Intestinal Angina)
What is a cardiac manifestation of polyarteritis nodosa?
CAD
Can aneurysms be present in polyarteritis nodosa?
Yes
What nerve in the upper extremity can be effected in polyarteritis nodosa?
What is a clinical manifestation of this?
Radial Nerve
Wrist drop
What are classic clinical manifestations of Polymyositis?
Heliptropic Rash (Eye Lids) Periungal Abnormalities (Nails) Gottron's Papules (Hands)
________ is a syndrome associated with chronic-wide spread pain, fatigue, stiffness, poor sleep, and discreet tenderness.
Fibromyalgia
For a diagnosis of fibromyalgia, a patient must have a total of _______ tender points for longer than __ ______ without another discernible cause of the pain.
> 11 tender points for longer than 3 months
What THREE medications are FDA approved medications for fibromylagia?
Pregabalin (Lyrica)
Duloxetine (Cymbalta)
Milnacipran (Savella)
