Rheumatologic conditions Flashcards
Who does CFS primarily affect
F>M
average age: 29-35
occurs more frequently among minority populations and those with a lower social-economical status and education level are at a higher risk
what is the pathophysiology of CFS
unclear underling pathophysiology - diagnosis of exclusion
what is fatigue
described as weakness, tiredness and lethargy
what are the clinically concerning factors of fatigue
difficulty initiating activities
difficulty completing activities
memory and concentration difficulties
how is CFS diagnosed
with exclusion criteria - there are no objective physical exam findings.
requires 6 months of fatigue and all self reported symptoms
what are we ruling out when trying to determine CFS
ruling out medical or psychiatric conditions that might be causing fatigue
what is the treatment of choice for CFS
cognitive behavioral therapy and graded exercise
what is cognitive behavioral therapy (CBT)
psychotherapy technique aimed at changing throught/behavior
what is Graded exercise therapy (GET)
home exercise program to improve conditioning and exercise tolerance
what are alternative treatment options for CFS
remaining active, physically and socially.
treat any co-occurring anxiety or affective disorders (common)
what is typically unhelpful in CFS treatment
medications
What is the common patient presentation of fibromyalgia
affects 3-10% of the population
F>M
average age: 20-50
what is the pathophysiology of Fibromyalgia
underling pathophysiology unknown
? abnormal pain perception, ? related to sleep disorder, ? depression, ? viral infectious etiology
what is the typically fibromyalgia presentation
MSK pain and impairment in functioning
chronic, achy pain and stiffness that usually involves the neck, shoulder, low back and hips
associated with
fatigue, sleep disturbances, subjective numbness, headache, IBS
How many tigger pints to diagnose fibromyalgia
11 of the 18 trigger points PLUS widespread chronic pain
how is fibromyalgia diagnosed
symptoms for more than 3 months
there is no specific imaging or lab testing
rule out: amemia, thyroid abnormalities, electrolyte abnormalities
what are the 5 approaches to the treatment of fibromyalgia
- patient education
- non-pharmacologic options
- pharmacologic options
- treat any co-morbid conditions
- identify any available community resouces
what falls under patient education for fibromyalgia treatment
treatments can improve the symptoms, disease is not progressive, ID most distressing symptoms, Set treatment expectations (not complete relief of symptoms)
what falls under non-pharmacologic options for the treatment of fibromyalgia
mindfullness and meditation, exercise, sleep hygiene
managing their pain and function
What are the pharmacologic options for treating fibromyalgia
amitriptyline for sleep, fatigue, and chronic pain
gabapentin/pregabalin for pain
muscle relaxants with one of the above for sleep and pain
tramadol and tylenol for pain
what pharmacologic aids are unhelpful for fibromyalgia
NSAIDs and opioids
What is polymyositis
chronic muscle inflammation and weakness
typically symmetric and proximal
what is the typical patient presentation with polymyositis
F>M
average age: 50-60
african americans > caucasians
what are patients diagnosed with polymyositis at an increased risk for
malignancy
what is the typical presentation of polymyositis
progressive proximal muscle weakness that usually starts in the LE and moves to UE and neck
NO facial or ocular weakness but may include myocarditis, lung and joint involvement
what can polymyositis be coupled with
a dermatomyositis - rash that is dusky red in color and commonly involves one or more of the following: face, upper chest, back, neck and shoulders
what are other skin findings in dermatomyositis
heliotrope rash - periorbital edema and rash over eyelids
Gottron papules - raised violaceous lesions on extensor surfaces of DIP, PIP and MCP joints
Gotton sign - erythematous rash on the extensor surface of fingers, elbows and knees
What is the most specific lab test for polymyositis
Creatinine kinase (CK) - elevated in all patients
What is the gold standard for diagnosis of polymyositis
muscle biopsy - endomysial and perivascular inflammation
What is the mainstay treatment for polymyositis
oral corticosteroids at a high dose (prednisone) and then taper down
if symptoms persist - MTX
hydroxychloroquine for the dermatomyositis rash and avoid the sun
What is the patient population for polymyalgia rheumatica
disease of older adults - most common rheum disease diagnosed in older adults over 50
F>M
predilection for patients of scandinavian descent
what is the pathophysiology of polymyalgia rheumatica
a vasculitis - inflammation of the vessel walls that predominately affects the medium sized vessels that is believed to be autoimmune
associated with HLA gene
what is the presentation of PMR
muscular pain and stiffness that is typically present int he shoulder and pelvic girdle
NO MUSCLE WEAKNESS
often associated with fever, malaise and weight loss in the early presentation
How is PMR diagnosed
primarily clinical and no imaging is necessary
labs can be supportive with elevated ESR, CPR and most patient have associated anemia
how do we treat PMR
corticosteroids - low dose - should see affect within 72 hours - if not reconsider diagnosis
What is giant cell arterities
also known as temporal arteritis
throught to be part of the same disease spectrum as PMR and is also a vasculitis but affects medium AND LARGE vessels
What is associated with giant cell arterities
unclear association with varicella zoster antigen
how does Giant cell arteritis present
headache, scalp tenderness, visual disturbances (amaurosis fugax), throat pain, JAW CLAUDICATION and associated fever
what is Amaurosis fugax
sudden monocular vision loss, partial or complete
CURTAIN COMING DOWN - can lead to blindness
What is the presentation of giant cell ateritis
temporal artery usually normal to palpation but nodular, enlarged, tender and pulseless
what are patients with GCA at greater risk for
17x their risk of thoracic aortic aneurysm
what is the gold standard for GCA
temporal artery biopsy
how is GCA treated?
corticosteroids are first line (high dose)
but urgent biopsy necessary
if vision loss - IV methypred.
What is the difference between Raynauds phenomenon and raynauds disease
raynauds phenomenon tends to be more severe and associated with CT diseases, unilateral (asymmetric), quicker progression, skin changes (ulcerations/gangrene), abnormal allens test
Raynauds disease is idiopathic and the more common form, symmetric bilaterally, slower progression, no skin changes, peripheral pulses present, negative allens test
What is the progression of Raynauds
White, blue, red
Vasospasm - lack of blood flow (white)
lack of arterial flow - cyanosis (blue)
resolution of vasopasm and reprofusion - rebound hyperemia (Pink/red)
What is the treatment for raynauds
lifestyle modifications
prevention of attacks, avoiding cold exposure, warm clothing, avoid smoking and vasoconstrictive drugs and injuries to your hands
