Rheumatology Flashcards
Define fibromyalgia
Chronic widespread muscular pain, tenderness, and fatigue for at least 3 months involving all 4 quadrants of the body
- pain above & below the waist
- pain on the left and right sides of body
- Pain in at least 11/18 discrete tender points
MC in middle-aged women
What makes fibromyalgia symptoms worse/flare?
Physical and psychological stress
How do you treat fibromyalgia?
Tricyclic antidepressants –> Cymbalta
Lyrica only med FDA approved to treat fibromyalgia
Neurontin
Purine rich foods to warn patients with gout to avoid
- alcohol
- red meats
- liver
- seafood
- sugary foods & sodas
- yeasts
What is gout? What is tophi?
Gout is an accumulation of uric acid in the tissue of joints & bones –> 80% monoarthropathy
Tophi is a collection of solid uric acid in soft tissue
What medications can cause gout?
Diuretics- thiazide & loop ACE-i Ethambutol ASA ARBs
What is pseudogout?
Calcium Pyrophosphate Dihydrae (CCPD) crystals in connective tissues
Knee most common
**associated with hyperparathyroidism
What is a diagnostic uric acid level for gout?
> 7.5
Acute gout management
- NSAIDs –> Indomethacin
- Colchicine = 2nd line
Chronic gout management
Tophi and/or >2 gout flares per year
Allopurinol + NSAIDs or Colchicine for 6 months to prevent acute flares
Goal is uric acid <6
Pseudogout treatment
Corticosteroids = 1st line
Colchicine = prophylaxis
Polyarteritis Nodosa signs & symptoms
Inflammation of small & medium sized arteries ==> restricts blood flow ==> organ damage
- renal HTN
- myalgias & arthralgias
- peripheral neuropathy
- livedo reticularis / gangrene/ Raynaud’s
The inflammation weakens blood vessels which leads to the formation of aneurysms
MC in middle-aged men 40-60 years old
Polyarteritis nodosa diagnosis
- Tissue biopsy showing necrotizing arteries
- Angiography = aneurysms
- ↑ ESR
** ANA negative**
Polyarteritis nodosa treatment
Prednisone +/- cyclophosphamide
What other conditions is polyarteritis nodosa associated with?
- *Hepatitis B**
- Microaneurysms
Polymyalgia rheumatica definition
An idiopathic inflammatory condition affecting the JOINTS –> PAINFUL synovitis, bursitis, and tenosynovitis
S/S
- proximal stiff joints in pts >50 years old
- shoulders
- hips
- neck - fatigue
- weakness
- “can’t lift arms over head to brush hair”
Physical Exam findings in Polymyalgia rheumatica
- Normal strength
- Limited passive ROM in all directions
What other condition is polymyalgia rheumatica closely related to?
Giant Cell Arteritis aka Temporal Arteritis
How do you treat polymyalgia rheumatica?
-LOW dose corticosteroids
may be required for up to 2 years
Define polymyositis
Chronic idiopathic inflammatory disease of MUSCLE
- symmetrical
- proximal
- PAINLESS
- *muscle weakness**
Physical Exam findings in Polymyositis?
-Decreased strength
Polymyositis diagnosis
- creatine phosphokinase –> indicating muscle injury
- elevated ESR
- ANA
- anti-Jo-1
Confirmed by muscle biopsy
How do you treat polymyositis?
High dose corticosteroids
Define Reactive Arthritis
Autoimmune response to an infection
Common Triggers
- Salmonella
- Shigella
- Chlamydia trachomatis
- Neisseria gonorrhea
Reactive Arthritis symptoms
- *Triad**
- inflammatory arthritis of large joints
- inflammation of eyes = conjunctivitis, uveitis
- urethritis
“Cant see, pee, or climb a tree”
Reactive Arthritis labs
++ HLA-B27
CBC: ↑ WBC, ↑ ESR, ↑ IgG
Treatment of Reactive Arthritis
- NSAIDs
- ABX to treat infection
Define Rheumatoid Arthritis
A chronic autoimmune inflammatory disease with persistent, symmetric polyarthritis
- bone erosion
- cartilage destruction
- joint structure loss
Signs & Symptoms of rheumatoid arthritis
Joint stiffness worse in the morning, >30 minutes…improves throughout the day
• Worse with rest
• Prodrome
-Fevers
-Fatigue
-Weight loss
-anorexia
• Small symmetric joint stiffness
-MCP
-PIP
-WRIST
-KneeRheumatoid Arthritis Diagnosis
Morning stiffness + arthritis in >3 joints for > 6 weeks
+ RF (80%)
+anti-CCP (60%– more specific)
Xrays –> narrowed joint space
- ulnar deviation - swan neck deformity (DIP) - boutonniere deformity (PIP)
Rheumatoid Arthritis Treatment
- Methotrexate
+/- hydroxychloroquine
+/- sulfasalazine
- NSAIDs & low dose corticosteroids for pain control
Sjogren Syndrome definition
Chronic systemic autoimmune inflammatory disorder that affects the exocrine glands
Relatively common – 2nd MC autoimmune disease
Unknown cause
Sjogren Syndrome symptoms
-Parotid gland = dry mouth --> loss of teeth & cavities ==> difficulty swallowing & talking -enlarged -nontender -firm
-Lacrimal gland = dry eyes
Extra glandular symptoms
- arthralgias
- Raynaud’s
- Lymphadenopathy
- Vasculitis
- peripheral neuropathy
What is Shirmer’s test & what condition is it used to diagnose??
-Tear test –> positive if <5mm lacrimation in 5 minutes
Sjogrens Syndrome
How is Sjogren Syndrome diagnosed
+ANA
+anti-SSA (anti-Rho)
+anti-SSB (anti-La)
+RF
Salivary gland biopsy
Treatment of Sjogren Syndrome
- Artificial tears
- Pilocarpine = cholinergic
- Cevimeline = cholinergic
What is scleroderma?
Systemic connective tissue disorder causing…
- tight shiny thick skin due to collagen build up
- systemic involvement –> heart, lungs, kidney, GI
What is CREST syndrome?
another name/form of scleroderma
C= calcinosis cutis => calcium salt crystals in the skin
R= Raynaud’s
E= esophageal motility disorder & GERD
S= Sclerodactyly => claw hand
T= Telangiectasias => dilated capillaries
How is Scleroderma diagnosed?
+ anti-centromere Ab = limited CREST disease, better prognosis
+ Anti-SCL-70 Ab = diffuse disease with multiple organ involvement
+ANA
How do we treat scleroderma?
- DMARDs ==> methotrexate
- Steroids
- Raynauds = calcium channel blockers to vasodilate
- GERD = PPI or H2 blocker
