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Pance Re-Up > Rheumatologic Precision & Pearls #1 > Flashcards

Rheumatologic Precision & Pearls #1 Flashcards

1
Q

Fibromyalgia is a disorder in which the patient has abnormal pain perception. It is MC in _______ and is characterized by

A

Women ages 20-55

Chronic, widespread MSK pain in 11 of 18 points and pain for 3 or more months

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2
Q

Sleep studies in a patient with fibromyalgia shows…

A

no REM sleep cycle

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3
Q

Treatment for fibromyalgia

A

-Conservative: sleep hygiene, low impact exercise

-Amitriptyline (1st line)
-SSRI’s
-Pregabalin (FDA approved for Fibro)

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4
Q

Gout is ______ deposition in a joint or bone. 90% of this condition occurs in ____.

Name some triggers for gout.

A

uric acid

90% in men

-Purine rich foods (beer, yeast, alcohol, seafood, liver)
-Medications: Thiazides, Loop diuretics, ACE Inhibitors, ARBs (not Losartan), Aspirin, Ethambutol

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5
Q

What are the symptoms of gout

A

-Podagra (first MTP joint of the great toe)
-Lower extremity MC affected
-Erythema, pain, warmth, tenderness, fever

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6
Q

Initial diagnostic for gout and what does it show?

What do the radiographs of a gouty joint show?

A

Arthrocentesis: negatively birefringent needle shaped crystals

Radiographs: mouse or rat bite lesions (punched out erosions with sclerotic and overhanging margins)

Increased WBC, Primarily neutrophils

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7
Q

For an acute gout attack, what is the treatment?

A

-NSAIDs
-Corticosteroids if unable to take NSAIDs (renal problems)
-Colchicine last line

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8
Q

For chronic gout, what should you do?

A

Lifestyle changes: diet, no alcohol

Allopurinol (xanthine oxidase inhibitor) or Febuxostat = both decrease uric acid production

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9
Q

Gout is a problem with the metabolism of what type of molecule?

In gout, what compound precipitates into the synovial fluid?

A

Purine

Sodium Urate

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10
Q

Pseudogout, also known as Calcium Pyrophosphate Dihydrate Deposition Disease (CPPD), is the deposition of _____ in the joint. It occurs MC in what joint? Even though it mimics gout symptoms, what does the arthrocentesis show in this condition?

A

calcium pyrophosphate dihydrate

MC in Knee

Positively birefringent rhomboid shaped crystals

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11
Q

Treatment for pseudogout

A

-Intraarticular steroids if 1-2 joints
-NSAID if > 2 joints
-Colchicine an option as well

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12
Q

Polymyositis is an inflammatory disorder of striated muscle involving ____________. Explain symptoms of this condition.

A

proximal limbs, neck, and pharynx

-Progressive symmetric proximal muscle weakness (shoulders, hips) - combing hair, rising from chair, etc.
-Dysphagia, fever, weight loss
-Decreased muscle strength
-NO RASH!

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13
Q

What diagnostics can be done for polymyositis and what do they show?

A

-Increased CK and aldolase
-Antibodies: Anti-Jo 1, anti signal recognition protein (most specific)

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14
Q

What is the most specific marker for polymyositis?

A

Anti-signal recognition protein

Anti Jo-1 as well is included in this diagnosis

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15
Q

What is the DEFINITIVE diagnostic for polymyositis?

A

Muscle biopsy = endomysial inflammation

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16
Q

Treatment for polymyositis

A

High dose corticosteroids
-Methotrexate if no response to steroids

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17
Q

On the other hand, what is dermatomyositis?

Explain the symptoms of this condition

A

Polymyositis + skin involvement

-Progressive symmetric proximal muscle weakness
- Decreased muscle strength
-Skin:
–Heliotrope rash: edema/blue eyelids
–Gottron’s Papules: on knuckles
–Shawl Sign: rash of upper back, shoulders, and chest

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18
Q

Diagnostics for dermatomyositis are similar to that of polymyositis. Name them and tell what you find including the tumor markers

A

-CK and aldolase are elevated (muscle enzymes)
-Muscle biopsy = definitive
-Anti Jo-1 and Anti-Mi 2

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19
Q

True or False: Dermatomyositis has an increased risk of malignancy

A

True

25% of cases are associated with cancer

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20
Q

Treatment for dermatomyositis

A

-High dose glucocorticoids
-Methotrexate, Azathioprine, IVIG are other options

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21
Q

Polymyalgia Rheumatica is inflammation of the joints, bursae, and tendon. It is HIGHLY associated with what other condition?

What are the symptoms of PMR?

A

GCA (Temporal arteritis)

-Pain and stiffness in proximal muscles and joints
-NORMAL muscle strength
-May have decreased ROM

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22
Q

Furthermore, to differentiate PMR from polymyositis, what do the labs show?

A

PMR:

-Normal muscle enzymes
-Markedly elevated ESR and -CRP
-Increased platelets (acute phase reactants)

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23
Q

What is the treatment for PMR?

A

Low dose corticosteroids, or Methotrexate

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24
Q

Reactive arthritis, also known as Reiter Syndrome, may be seen 1-4 weeks after _________

However, it also has a high association with….

A

Chlamydia or GI infection

HLA-B27 positivity

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25
Q

Name the triad of symptoms associated with reactive arthritis as well as other symptoms of this condition.

A

-Arthritis + urethritis + conjunctivitis (can’t see, can’t pee, can’t climb a tree)

-Lower extremity MC affected
-Oral lesions
-Keratoderma blennorrhagicum: hyperkeratotic lesions on palms and soles

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26
Q

Treatment for Reactive Arthritis

A

NSAIDs
-Methotrexate if needed
-ABX if chlamydia related

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27
Q

Pathophysiology of Rheumatoid Arthritis

What are some risk factors?

A

Chronic, progressive cartilage destruction and joint structure loss due to destruction by pannus. T Cell mediated

Females, smoking

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28
Q

Symptoms of Rheumatoid Arthritis

A

-Morning stiffness > 1 hour, improves throughout the day
-MC affects small joints (wrist, MCP, PIP, spares the DIP)
-Symmetrically inflamed joints, warm boggy
-Ulnar deviation of the hand at MCP joint
-Swan neck/Butonniere deformities
-Nodules over bony prominences

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29
Q

Regarding RA, what is Felty Syndrome? What is Caplan Syndrome?

A

Felty Syndrome: RA + neutropenia + splenomegaly

Caplan: RA + pulmonary nodules + pneumoconiosis

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30
Q

Labs (which is the most specific) for RA.

What do XR’s show?

A

Rheumatoid Factor positive

Anti-CCP (most specific)

XR: symmetric joint narrowing, osteopenia, erosions, C1-C2 subluxation if the spine is affected

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31
Q

Treatment for RA

Which is the first line for symptom control?

Which drug is safe in pregnancy?

A

-DMARDs: Methotrexate, Leflunomide (first line), + NSAIDs

NSAIDs

Hydroxychloroquine

32
Q

Methotrexate drug facts (MOA and adverse effects)

A

Folic acid antagonist

Hepatitis, bone marrow suppression, interstitial pneumonitis

33
Q

What is the MC type of Juvenile Idiopathic Rheumatoid Arthritis?

What are the symptoms?

A

Still’s Disease (Systemic):
-Daily spiking fevers
-Polyarthralgias
-Salmon colored migratory rash at night

34
Q

Treatment for JRA?

A

NSAIDS, PT
-Anakinra, Methotrexate are also options

35
Q

Lupus (Systemic Lupus Erythematosus) is a chronic multi-organ disorder of connective tissues. It is also a Type _____ hypersensitivity reaction. What are some risk factors for Lupus/SLE?

A

Type III

Female, sun exposure, African American, estrogen use

36
Q

Symptoms of SLE including the triad, as well as other systemic symptoms

A

Triad: joint pain + fever + butterfly malar rash

-Constitutional symptoms, oral ulcers, pleuritis

-If discoid in nature: annular patches on face that heal with scarring

37
Q

What labs are drawn for SLE and what are the specific ones for this condition?

A

-ANA (initial)
-Anti double stranded DNA and Anti Smith
-Antiphospholipid antibodies = increased risk of arterial and venous thromboses
-Decreased complement levels (C3 and C4) mark progression of disease

38
Q

Treatment for SLE

A

-Skin: Sun protection, Hydroxychloroquine for lesions
-Arthritis: NSAIDs or Acetominophen
-+/- pulse-dose corticosteroids
-Methotrexate, Belimumab if no response to other treatments

39
Q

Drug Induced Lupus is SLE caused by drugs such as

A

Quinidine, Hydralazine, Isoniazid, and Procainamide

40
Q

What labs are drawn for drug-induced SLE?

A

Positive ANA
Anti-histone antibodies (hallmark)

41
Q

Antiphospholipid syndrome is a disorder of thromboses due to antibodies against negatively charged phospholipids. This results in what symptoms?

A

-Increased risk of thromboses: DVT, PE, recurrent miscarriages, atherosclerosis, stroke, TIA, cognitive deficits

42
Q

What diagnostics are done to prove the patient has antiphospholipid syndrome?

A

-Lupus anticoagulant: increased PTT
-Failure to correct PTT with mixing studies
-Prolonged Russell Viper Venom Test: most specific

43
Q

Treatment for antiphospholipid syndrome

A

-Lifelong Warfarin Therapy or LMWH for pregnant

44
Q

Scleroderma (Systemic Sclerosis) is a connective tissue disorder in which collagen deposition leads to fibrosis of skin and internal organs. Explain what CREST (Limited) is and what Diffuse types are.

A

-Limited (CREST): tight, shiny, thick skin on face, neck, and distal to knees and elbows. Spares trunk.
–Calcinosis Cutis: calcium spots under skin
–Raynaud’s
–Esophageal motility disorder
–Sclerodactyly
–Telangiectasias

Diffuse: shiny, thick skin of trunk and proximal extremities. Greater organ involvement.

45
Q

What labs are specific to scleroderma?

A

Anti centromere antibodies (CREST)

Anti SCL 70 antibodies & anti-topoisomerase (diffuse)

ANA positive

46
Q

Sjogren Syndrome is an autoimmune disorder of the ________ (_____)

Symptoms of this condition include

A

Exocrine glands (salivary and lacrimation)

-Dry mouth (xerostomia), dry eyes, dry vagina (dyspareunia)
-Parotid gland enlargement
-Dental caries

47
Q

What diagnostics are done for Sjogren’s (which labs are specific, what eye test is done, and what is definitive?)

A

Labs: AntiSS-A (Ro) and AntiSS-B (La)

Schirmer Test: <5mm after 5 minutes

Lip or Parotid Biopsy: definitive

48
Q

Treatment for Sjogren’s Syndrome

A

-Increase fluid intake
-Use of artificial tears
-Pilocarpine or Cevimeline: cholinergic drugs that increase lacrimation and salivation

49
Q

Pilocarpine increases salivation and lacrimation. However, what are some adverse effects of this medication?

A

Diaphoresis, bradycardia, flushing, diarrhea, nausea, vomiting, blurriness

50
Q

What’s one complication of Sjogren’s (in other words, what does it increase the risk of?)

A

Non-Hodgkin Lymphoma

51
Q

Behcet’s Syndrome is characterized by

A

Recurrent, painful oral and genital ulcers, erythema nodosum, uveitis/conjunctivitis, arthritis, and CNS involvement (can mimic MS)

52
Q

What population is at increased risk for Behcet’s Syndrome?

What diagnostic is definitive?

What’s the treatment?

A

Asians, Mediterranean, Middle Eastern

Biopsy

Corticosteroids

53
Q

Takayasu Arteritis is a large vessel vasculitis that affects

What diagnostic confirms this

A

aorta, aortic arch, and pulmonary arteries

Angiography

54
Q

What are some symptoms of Takayasu Arteritis?

A

-LE claudication
-HTN crisis
-TIA/Stroke
-Asymmetric BP between arms
-Decreased pulses
-Bruits
-Arm claudification

Think of all the arteries and symptoms that would affect them

55
Q

Treatment for Takayasu

A

High dose corticosteroids

56
Q

What is Kawasaki Syndrome?

A

Small and medium vessel vasculitis involving the coronary arteries

57
Q

Kawasaki Syndrome MC occurs in what population?

What are the symptoms of this condition (think warm).

A

Children <5, Asian, boys

Warm + CREAM
–Fever >5 days + 4/5 of:
—Conjunctivitis
—Rash
—Edema/Erythema
—adenopathy (cervical)
—Mucositis (strawberry tongue)

58
Q

Treatment for Kawasaki Syndrome

A

-IVIG + Aspirin

59
Q

Eosinophilic Granulomatosis with Polyangitis can be a rare side effect of which two medications?

What is the triad of symptoms with this condition?

A

Montelukast and Zafirlukast

Asthma + Eosinophilia + Chronic rhinosinusitis

60
Q

What labs are seen with Eosinophilic Granulomatosis with Polyangitis, what is the definitive diagnostic and treatment?

A

P-ANCA positive + Eosinophilia

Biopsy = definitive

Glucocorticoids + Cyclophosphamide

61
Q

Granulomatosis with Polyangitis (GPA - Wegener’s) is small vessel vasculitis of …..

This means the triad of symptoms with this condition is…

A

Nose, lungs, and kidneys

-Upper Respiratory tract involvement (nasal congestion, otitis media) + lower respiratory tract involvement (cough, wheezing, hemoptysis) + glomerulonephritis (rapidly progressive with RBC casts)

62
Q

What labs are seen with GPA, what is definitive, and what is the treatment?

A

C-ANCA positivity

Biopsy

Glucocorticoids + Cyclophosphamide

63
Q

Microscopic Polyangitis (MPA), much like GPA, is small vessel vasculitis. However, what is the difference?

A

No naspopharyngeal symptoms and does affect the capillaries

64
Q

Symptoms of MPA

A

-Fever, palpable purpura
-Rapid acute glomerulonephritis with RBC casts

65
Q

Diagnostics for MPA

Treatment

A

-P-ANCA positive
-Biopsy definitive

Glucocorticoids + Cyclophosphamide

66
Q

Immunoglobulin A Vasculitis (Henoch-Schonlein Purpur) is an Ig-A mediated small vessel vasculitis. This occurs MC in what population? What precipitates it?

A

90% in kids

After infection (URI, GABHS, Parvovirus B-19)

67
Q

Symptoms of HSP

A

HSPA
-Hematuria
-Synovial (arthritis or arthralgia)
-Palpable purpura
-Abdominal pain (GI bleed?)

68
Q

A kidney biopsy is definitive for IgA vasculitis (HSP), what is shown on it?

What is the treatment?

A

Mesangial IgA deposits

Supportive

69
Q

Anti-GBM Antibody Disease (Goodpasture’s Disease) is IgG antibodies against Type IV collage of alveoli and glomerular basement membrane of kidneys. What are the symptoms?

A

Only in lungs and kidneys
–Hemoptysis
-Cough
-Hematuria
-Oliguria

70
Q

UA for Anti-GBM shows:

What antibodies are present?

What is definitive and what is seen?

A

RBC casts

Anti-GBM antibodies

Linear IgG deposits

71
Q

Treatment for Goodpasture’s

A

Gluco + Cyclophosphamide + Plasmapheresis

72
Q

Psoriatic Arthritis is associated with _______ and what labs?

A

HLA-B27 positivity

RF -, ANA -

73
Q

Name some symptoms of psoriatic arthritis

A

-Arthritis
-Dactylitis
-Sacroilitis
-Chronic Uveitis
-Psoriasis

74
Q

What do radiographs of psoriatic arthritis show?

A

Pencil in cup deformities: thin end of one bone being inserted into a thicker bone

75
Q

What is the treatment for psoriatic arthritis?

A

-Mild: NSAIDs
-Moderate: Methotrexate
-TNF Inhibitors (-mab): if no response

Pance Re-Up (76 decks)

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