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Final Disease 3 > Rheumatoid > Flashcards

Rheumatoid Flashcards

1
Q

common signs of SLE

A
  • mouth and nose ulcers
  • face (butterfly rash)
  • joints (arthritis)
  • fingers and toes (poor circulation)
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2
Q

patient profile for SLE

A
  • women (8:1)
  • african american > asian > caucasian
  • 15-40 years old
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3
Q

what % chance does a pt with SLE will have Raynaud’s phenomenon?

A

20%

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4
Q

what are the most common 6 drugs that can cause drug induced SLE?

A
  • Procainamide
  • Hydralazine
  • Methyldopa
  • Isoniazid
  • Chlorpromazine
  • Quinidine
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5
Q

what is difference between drug-induced SLE and SLE?

A
  • brain/kidney are spared
  • sex ratio is 1:1
  • clinical features and lab testing revert to normal when drug is stopped
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6
Q

90% of patients have what as an early sign of SLE?

A

joint pain (Arthritis and Arthralgias)

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7
Q

what are the dermatological manifestations of SLE

A
  • malar “butterfly” erythematous rash is the most characteristic, but form and location of the eruption may be quite variable
  • discoid lupus (is a special form of the disease with manifestations limited to the skin)
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8
Q

what is the major cause of morbidity and mortality in SLE

A

renal involvement (either by hypertension or kidney dysfunction)

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9
Q

diagnosis for SLE is having 4 or more of the following criteria:

A
  • macular rash
  • discoid rash
  • photosensitivity
  • oral ulcers
  • arthritis
  • serositis
  • renal disease
  • (+) ANA
  • hemotologic disorders
  • neurologic disease
  • immunologic disease (antibodies to DNA)
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10
Q

what serologic tests tend to be higher in patients with SLE

A
  • anemia (leukopenia, thrombocytopenia)
  • antiphospholipid antibodies
  • ANA
  • anti-native DNA
  • hypocomplementemia
  • RF
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11
Q

3 main external ocular involvement in SLE

A
  1. keratoconjunctivitis Sicca (KSC)- 25% of patients
  2. nodular and diffuse anterior scleritis
  3. discoid lupus of the lids
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12
Q

3 main retinal involvement ocular manifestations of SLE

A
  1. lupus retinopathy: CWS surrounded by hemes
  2. lupus vasculitis: capillary non-perfusion
  3. large vessel disease
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13
Q

4 neuro-ophthalmic involvements in SLE

A
  1. optic neuritis and AION
  2. disc edema
  3. migraines and amourosis
  4. pupillary anomalies and oculomotor disturbances
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14
Q

when may you see a bull’s eye in SLE

A
  • drug induced maculopathy from chloroquinolone and hydroxychloroquinolone
  • < 6.5mg/kg/day is safe
  • usually >60, kidney dz
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15
Q

OCT shows how many % of people have drug-induced maculopathy? is it reversible?

A

1-3%

not reversible

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16
Q

what are the recommended screening tests for chloroquinolone and hydroxychloroquinolone maculopathy?

A
  • automated visual fields
  • SD OCT
  • mfERG
  • FAF
  • microperimetry
  • adaptive optics retinal imaging
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17
Q

treatments for SLE

A
  • NSAIDs
  • Aspirin
  • Methotrexate
  • Cell-Cept
  • TNF/ biologics
  • Benlysta (new FDE approved one for SLE)
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18
Q

patient profile for R.A.

A
  • women 3:1
  • 40-50 (but for men later)
  • maybe exposure to silica dust or cigarette smoking as a causative agent
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19
Q

what are some key features of RA

A
  • early synovial pathology
  • T/B cells continually activated by cytokines and TNF
  • chronic inflammation of joints (symmetrical)
  • MMP effects the destruction of joints and tissues
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20
Q

clinical manifestations of RA

A
  • symmetrical polyarthritis of peripheral joints
  • pain, tenderness, swelling of affected joints
  • worse in the morning, lasting more than 1 hr.
  • joint deformities may develop
  • subcutaneous nodules
  • pericarditis
  • pleural effusion
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21
Q

diagnosis of RA

A
  • X-rays of affected joints
  • RF
  • CCP-AB: early RA (85% showed this)
  • ESR/ C-reactive protein
  • uric acid levels
  • ANA
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22
Q

anterior seg involvement

A
  1. Dry eye (Sjogren’s and non-Sjogren’s): 15-25% of RA patients, KSC
  2. Keratitis (CUK)
  3. PUK (peripheral ulcerative keratitis)
  4. Episcleritis and Scleritis
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23
Q

what type of RA keratitis is associated with scleritis (anterior) and non-inflammed eyes without prominent infiltration

A

CUK (Central Ulcerative Keratitis/ Keratolysis)

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24
Q

what type of RA keratitis is associated with inferior cornea, guttering within the corneal limbus and corneal thinning and resolution is accompanied by corneal neo and subepithelial fibrosis

A

PUK (peripheral ulcerative keratitis)

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25
treatment for CUK
restasis, amniotic membrane, biologics and surgical replacement
26
treatment for PUK
PFAT, cyanoacrylate, topical antibiotics, systemic steroids, antimetabolites, T-cell inhibitors and biologics
27
other ocular involvement with RA
1. cranial nerve palsies 2. ocular chrysiasis (very rare) 3. bilateral brown syndrome (rare)
28
associated diseases with Scleritis
"CIGMA" - Connective tissue disease (RA, SLE, PA, AS) - Infectious disease (Herpes Zoster, HS, Lyme Dz) - Granulomatous Disease (Sarcoidosis, Wegener's) - Metabolic disease (thyroid, DM, gout) - Accidental (trauma, ocular surgeries)
29
treatment for RA
- NSAIDs - Methotrexate/ Leflunomide (primary) - TNF (enteracept, infleximab, adalimab) (other: antimalarials, minocyclines, gold salts, azathioprine, penicillamine, corticosteroids, surgery)
30
what is the difference b/w primary and secondary Sjogren's syndrome?
primary is dry mouth and eye without autoimmune dz (secondary has autoimmune dz)
31
biggest clinical manifestations of Sjogren's
- destruction of exocrine glands leading to mucosal dryness - dry mouth (xerostomia) - parotid enlargement - severe dental caries (lipstick sign)
32
what systemic condition can Sjogren's patient be at a 16 fold increased risk of getting?
non-Hodgkin's lymphoma
33
what are the main ocular manifestations of Sjogren's syndrome
- lacrimal gland dysfunction causing decrease in aqueous layer dry eye symptoms - filimentary keratitis secondary to dry eye - corneal ulcers secondary to dry eye
34
what other connective tissue diseases are associated w/ Sjogren's
- Rheumatoid arthritis (#1) - SLE - systemic sclerosis (scleroderma) - polymyositis - polyarteritis nodosa (PAN)
35
lab testing for Sjogrens
-ANCA -anti-Ro -anti-La -RF -ANA -Lyme titer (Sjo- early detection in office)
36
ocular treatment for Sjogrens
- for dry eye: ATs, oral pilocarpine, punctal plugs, surgical - for filamentary keratitis: mucolytic agents
37
patient demographics for Scleroderma
- Oklahoma Choctaw indians and African Americans more common - 4-9x higher in women - 30-50 years onset is peak
38
what type of scleroderma has "CREST syndrome"
limited cutaneous systemic sclerosis
39
what does CREST stand for (in limited scleroderma)
- Calcinosis - Raynaud's (90%+) - Esophageal dysmotility - Sclerodactyly, - Telangiectasia
40
ocular involvement of Scleroderma
- eyelids (very tight) lose elasticity becoming thin, smooth, shiny, and retracted - Ptosis (early edema) - Blepheraphimosis - Dry eye - CWS - hypertensive retinal changes - bacterial keratitis w/marginal ulceration from dry eye
41
lab testing for scleroderma
- ANA (+) 90% - Anticentromere antibody (1%- diffuse, 50% limited) - Antitopoisonmerase (30% diffuse, 20% limited) - RF (+)- 30% - clinical signs (X-ray)
42
treatment (medical) for Scleroderma
- penicillamine - Nifedipine (for Raynaud's) - omeprazole (prilosec for reflux) - IV iloprost for digital ulcers - Bosentan - Antimetabolites and biologics
43
what condition is temporal arteritis frequently associated with
polymyalgia rheumatica
44
clinical manifestations of temporal arteritis
- fever (low grade) - headache - neck pain - night sweats/anorexia - joint swelling - jaw claudication (90% +) - temporal artery tenderness
45
anterior segment ophthalmic involvement in GCA
- uveitis - ocular ischemic syndrome - 4th/6th nerve palsies - pupil abnormalities - Horner's - Tonic pupil - Ptosis - Episcleritis/Scleritis - Cataract - Hypotony
46
posterior seg ophthalmic involvement in GCA
-AAION (78-99%) -CRAO (2-18%) potential for PION, BRVO, or choroidal ischemia
47
ocular manifestations of AAION
- devastating vision loss - TMVL or Amaurosis Fugax or just blur - diplopia - color vision loss - +APD of affected eye - swollen disc with or without flame heme - altitudinal vision loss (or any other VF loss)
48
what do you have to do in a pt >50 y.o. with CRAO w/o evidence of embolic material
GCA workup should be done
49
what lab testing do you need to do on GCA pt
- immediate Westergren ESR - C-reactive protein other: CBC w/differential, CD4/8, anticardiolipin AB, temporal artery biopsy (within 1 week of starting steroids) - possible ocular pneumo. - color doppler ultrasono
50
without steroids, what can happen in unilateral presenting GCA and how fast
contralateral eye (75%) can become involved in 24-72 hours
51
other than high dose steroids for tx or GCA, what recent med was FDA approved for it
Actemra (tocilizumab) | -biologic for this specific type of vasculitis
52
what is lyme disease caused by (pathogen and its name)
- spirochete | - Borrelia burgdorferi
53
what are the 3 stages of lyme
1: local 2: disseminated 3: persistent or late
54
what is the characteristic rash in lyme and what % have it
ECM, 85%
55
what is the most common ocular finding in "early" lyme disease
-conjunctivitis
56
ocular signs with lyme
- facial weakness (7th nerve) - optic neuritis - vitritis - iritis - exudative RD - 3rd/4th/6th CN palsy - conjunctivitis - episcleritis - exposure keratopathy (Bell's) - inflammatory pseudotumor (IOIS)
57
work up for lyme
- serum antibody levels against B. burgdorferi using IFA or ELISA - serum RPR and FTA-ABS - lumbar puncture if neurologic signs - consider HLA DR 2+4
58
3 antibiotics you can use for Lyme
-doxycycline, amoxicillin, or cefuroxime axetil | IV if neurologic -> send out
59
what % of untreated ECM progress to stage 2
40%
60
does antibiotic therapy help with arthritis in lyme
not always
61
what % of Lyme patients experience chronic arthritis or neurologic disease
3-10%

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