rheumatoid Flashcards
if you are thinking about starting DMARDs (hydroxychloroquine or azathrioprine (imuran) on a pt w/ RA, what exam must be done first?
Eye
both can cause retinitis
Is reactive arthritis an HLA-B27 disorder or associated with a post GI/GU infection?
Both
treatment of reactive HLA-B27?
NSAIDS
are HLA-B27 disorders RF positive or negative?
negative
factors of psoriatic arthritis?
pitting nails, psoriasis, uvetitis/conjunctivitis, arthritis (SI and DIP)
tx of psoriatic arthritis?
NSAIDS or sulfasalazine
what lab is 99% positive in lupus?
ANA, double stranded DNA is also highly positive
Name the rash associated with lupus
discoid/butterfly/malar
Is ANA + or - in raynauds?
negative
Is ESR high or low in raynauds?
normal
explain scleroderma?
multi-system autoimmune, deposition of collagen
What syndrome describes the characteristics of scleroderma?
CREST, calcinosis, raynauds, esophageal dysmotility , sclerodactyly-chronic contractures & Telangiectasis
what lab is 95% positive is scleroderma?
ANA
age group & gender affected by scleroderma?
female 30-50
tx for scleroderma
symptomatic
sjogren’s pt are 40x higher risk of what medical condition?
lymphoma
ok
ok
characteristics of scleroderma?
dry eyes, dry mouth, and enlarged saliva glands
describe polymyositis
inflammatory muscle disease associated with proximal muscle weakness
patient is having difficulty raising from chair and brushing her hair, you are concerned about polymyositis, what test can be done?
do a striated muscle biopsy. muscle enzymes may be elevated
rash associated with polymyositis?
heliotrope
stiffness after rest and proximal muscle weakness….think?
polymyositis
20 year old male complains of 3 days hx of joint pain that moves around & experiencing redness & swelling over tendon and knee joint. He also has necrotic pustules over fingers.. he has?
gonococcal septic arthritis
how do gonococcal and septic arthritis present differently?
gonococcal migrates from joint to joint, septic affects one joint
septic arthritis is dx with IV drug user, gram - e.coli, what do you use?
Cipro or TMP-SMX
besides the spine, what other joints does ankyolsing spondylitis affect?
hips & shoulder
best tx for ankylosing spondylitis?
NSAIDS and activity
Name the spondyloarthropathies?
Ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with IBS
all spondyloarthropathies are RF and ANA negative but ___positive?
HLA-B27
pt has pain with urination, pink eye, painful joints and ulcers in his mouth. most likely dx?
reactive arthritis (reiter’s syndrome)
how many triggers point do you need to dx fibromyalgia
11 of 18
tx for fibromyalgia?
tricyclic antidepressant
most common etiology of gout?
95% do not excrete ca+ well enough. only 5% are overproducers
X-ray shows chrondrocalcinosis (linear calcification in articular carriage ) is a _____finding?
pseudogout
HB will have OA?
Lisa Schwantas will have?
herberden’s (DIP) & Bouchard’s (PIP) = OA. Swan’s neck=OA
ulnar deviation & subluxation of the MCP joint
RA
other organs involved in RA?
sicca (dry eyes, pericarditis, CAD, pleural nodules, effusions, carpel tunnel, anemia and vasculitis
i have arthritis in my DIP joint, what type of arthritis is most likely?
OA
AM stiffness
RA
What test is 95% positive in patient with primary biliary cirrhosis?
AMA levels (Anti-mitochondrial antibody)
gold standard to dx addison’s disease
A rise in serum cortisol levels to 20 mcg/dL or more after administration of the synthetic ACTH indicates a normal functioning adrenal cortex. A suboptimal response to the Cosyntropin test confirms the presence of primary Addison’s disease.
A 27 year old African American female presents to your office complaining of persistent aching in her joints for a couple of weeks. She has also had fatigue, and a fever that has lasted for the last 5 days. On physical exam you find range of motion and stability intact in the affected joints, which are also non-tender to palpation. You also note an erythematous rash covering the cheeks and bridge of the nose. Which of the following lab tests is most specific in diagnosing this patient’s condition?
This patient is presenting with symptoms common in systemic lupus erythematosus such as polyarthralgias and a malar (discoid) rash. Anti-DS DNA is the most specific test in detecting the presence of SLE; ANA is the most sensitive test (meaning that most cases of SLE will have a positive ANA test, but that it is not exclusive to this condition)
