Rheumatology Flashcards
To diagnose RA, symptoms have to occur for _____ weeks
Extra Joint Symptoms
1) Lungs: Pleural effusion, lung nodules
2) Heart: Pericarditis, auto-immune valvopathy
3) Neuro: Mononeuritis multiplex
4) Joint: Boutanierre, Swan Neck
6
RA + Splenomegaly + pancytopenia = _______
Felty Syndrome
______ is a backbone DMARD for RA. Other therapies: Anakinra (Anti IL-1), Tocilizumab, sarilumab (anti IL-6), Adalimumab (TNF)
Severe : Tofacitinib : Janus Kinase inhibitor
Methotextrate
____ condition has the lowest glucose on pleural effusion
RA
Heberden (Distal), Bouchard (Proximal) nodes are features of ______. Best initial test _____
Osteoartheritis
CXR
Joint Fluid, OA leukocyte count
2000
____ is a flavor of arthritis resulting in spinal fusion, but not degenerative disk changes
DISH (Diffuse Idiopathic Spontaneous Hyperostosis)
Seronegative Spondyloarthropathies
1) Ankylosing Spondylitis
2) _______
3) Psoriatic Artheritis
4) Stills Disease
Reactive Artheritis (Reiters Syndrome)
_____ occurs among males<40, AM pain at the SA joints, with most common extra joint reaction: Uveitis
Ankylosing Spondylitis
Testing: X-ray –> MRI —> HLA-B27 ; in this case serum testing is not done first
Tx: NSAIDS, Adalimumab ; MTX does not work on the spine —> Secukinumab (IL-17)
____ characterized post GI/GU infection with monocular/polyarthicular arthritis, conjunctivitis, genital lesion, psoriasis looking lesion feet . Treated with _____
Reactive Artheritis , NSAIDS
Psoriasis Treatment
1) NSAIDS
2) Infliximab
3) _______
4) Ustekinumab (IL 12/23)
5) Orencia: Abatacept (T cell), also for RA
Sekukinumab (IL 17)
Salmon rash, polyartheritis, myalgia, lymphadenopathy, hepatosplenomegaly, high Ferritin
Juvenile idiopathic arthritis, Stills disease
Tx: NSAIDS, Anakinra
Joint pain + diarrhea + weight loss, PAS (+) bowel stain
Tx:_____
Whipple Disease
Bacterim
___ of 11 criteria are needed to diagnose Lupus.
4
All you need is rash (photosensitive, malar discoid), joint pain and ANA/dsDNA to get the diagnosis
Lupus leads to complement consumption, low complement is suggestive
____ marker is used to test for CNS lupus
Ribosomal P
RA, like downs syndrome, may be associated with _______, need to be careful with intubation
C1/C2 cervical spine subluxation
_____ RA drug for mild RA, associated with retinopathy
Hydroxychloroquine
Diagnosis of Ankylosing Spondylitis
1) _____ –> MRI –> HLA-b27
X-ray
Ankylosing Spondylitis associated with : ____, uveitis
Treatment: NSAID, _____
Aortitis
TNF agent, steroids not useful
___ characterized by negative ANA, negative RF, high ferritin, arthritis, fever, myalgia, lymphadenopathy, hepatosplenomegaly, salmon rash
Still Disease, adult onset juvenile artheritis
Tx: NSAID –> Steroid –> Anakinra
Drugs that cause drug induced lupus ___, ____, ____
hydralazine, procainamide, isoniazid
Treatment for mild lupus _____
Hydroxychloroquine —> steroids –> DMARD off flare –> B cell inhibitor (Belimumab)
Most accurate test for Sjogrens ____
Lip biopsy, Ro/La antibody is suggestive
A subset of people with lupus can have Ro/La, useful for ANA negative lupus
Exception to using ACE during pregancy____
Schleroderma, very good for HTN/Renal effects, risk outweighs benefits
Difference between CREST (Limited Schleroderma vs Systemic Schleroderma)
CREST Antibody____
Systemic Antibody_____
Anticentromere
Anti SCL(70): But not reliable, only positive 30% of the time
Systemic disease: Renal hypertension, proteinuria, pulm htn, restrictive cardiomyopathy,
Thick orange skin syndrome, eosinophilia, worse when working out ______
Eosinophilic Fasciitis
Tx: Steroids
Myositis with Jo+ are increased risk of ______
Interstitial lung disease
Both distal/proximal muscle weakness, elevated CK____
Inclusion body myositis
No Treatment
_____ is a mixture of SLE, scleroderma, polymyositis, with antibody____ positive
Mixed connective tissue disorder
Anti U1 ribonucleoprotein
Tx: Steroid, AZT, MTX,
Treatment of fibromyalgia______
Duloxetine, CBT, aerobic exercise, NOT NSAID
Polymyalgia reumatica vs myositis
ESR vs CK , normal electromyogram
Tx: Steroids
Best initial test for PAN_____
CT Angio Abdomen
_____ medication can induce a Churg Struss flare
Montelukast (Leukotriene inhibitors)
A specific therapy for giant cell arteritis apart from steroids_____
Tocilizumab (IL-6 inhibitor)
____ is a large vessel vasculitis, famous for causing loss of pulses, increased stroke risk
Most accurate test _____
Takayasu
MRA, aortography not biopsy
Cryglobinemia associated with vasculitis and _______
Hep C
Tx: Rituximab, cyclophosphamide
oral/genital ulcers, uveitis, sterile skin abscess, pulmonary artery aneurysm _______
Behcet
Steroid /Cyclophosphamide
recurrent abdominal pain, tenderness, fever, episodes of joint and chest pain, elevated ESR with history of multiple negative CT scans/Colonoscopy_______
Familial Mediterranean Fever
Dx: MEFV gene
Tx: Colchicine,
Cx: Amyloidosis
Gout can be induced by this medication_____
Thiazide, Nicotinic acid
Gout
- Acute Treatment _____
NSAID/Colchicine –> Steroids
Gout (Chronic Treatments) Mechanisms
- Allopurinol: _______
- Febuxistate_______
- Rasburicase______
- Probenecid _______
Xanthine oxidase inhibitor (reduces uric acid production)
Xanthine oxidase inhibitor
Converts uric acid to allantois
Urinary excretion of uric acid (not for renal failure)
__________are disease associated with pseudo gout (calcium pyrophosphate)
hemochromatosis, hyperparathyroidism, acromegaly, hypothyroidism
NSAID, colchicine –> steroids
You have to stop bisphosponates _____ weeks before dental surgery
6
Osteoporosis Treatment 1) Bisphosphonates + VitaminD/Calcium 2) Denosumab 3) SERM 4) PTH analogs (Teriparatide) 5\_\_\_\_\_\_\_\_\_
Calcitonin
Pagets disease: high ALP with normal Ca2+/PO43-, urine hydroxyproline
- Most accurate test_____
- Treatment____
Nuclear bone scan
Bisphosphonates
