Rheumatology Flashcards
When in the day do symptoms of growing pains typically present?
Evening
x1 example of pain amplification syndrome (a) generalized and (b) localized
(a) Fibromyalgia
(b) Complex regional pain syndrome
Examples of autonomic changes that occur with pain amplification syndromes?
- Swelling
- Atrophy
- Cold extremities
Definition of arthritis
Joint effusion or swelling
OR =/> than 2 of the following: limited ROM, tenderness/pain with motion, increased heat
DDx for monoarthritis
- Structural: trauma, overuse, orthopedic concerns (AVN, SCFE)
- Infection: acute (SA, OM), chronic (TB, lyme), reactive arthritis
- Inflammatory: JIA, non-bacterial OM, FMF)
- Malignancy
- Hemarthrosis
DDx for polyarthritis
- Structural: hypermobility, skeletal dysplasia
- Infection: acute (viral - parvo, bacterial - gonococcal), post-infectious (reactive, rheumatic fever)
- Inflammatory: JIA, SLE, vasculitis (HSP)
- Malignancy
- Pain syndromes
When would you consider looking for specific antibodies after receiving result of ANA? Example of one
If ANA is positive at a high titre >1:160
-dsDNA
Can routine live vaccines be given to a patient on MTX?
No although could get a booster
Criteria for JIA
- Juvenile: <16 year old at onset of symptoms
- Idiopathic: cannot be explained by another medical condition
- Arthritis: Joint inflammation lasting more than 6 weeks
Classification of Juvenile Idiopathic Arthritis (x6)
- Oligoarticular arthritis
- Polyarticular arthritis
- Systemic JIA
- Enthesitis related arthritis
- Psoriatic arthritis
- Undifferentiated
What type of JIA is more common in males than females?
-Enthesitis-related
What form of JIA is associated most commonly with uveitis?
Oligoarthritis
What form of JIA is associated with acute uveitis (symptomatic)?
Enthesitis-related
What form of JIA is associated with the majority of cases being ANA positive?
Oligoarthritis
What form of JIA is associated with HLA-B27 positive?
Enthesitis-related
Criteria for psoriatic arthritis
- Arthritis + psoriasis
- OR arthritis plus 2 of the following: nail pits, dactylitis, 1st degree relative with psoriasis
How is Complex Regional Pain Syndrome defined (aka criteria)?
- Pain out of proportion of hx and exam
- At least one symptom of autonomic dysfunction
- One symptom of allodynia/hyperalgesia/motor dysfunction
What to treat FMF with and why?
- Colchicine
- To decrease intensity/frequency/duration of episodes + prevent amyloidosis
What is amyloidosis?
-Serum AA = acute phase reactant found in high levels during FMF attacks –> cleaved + deposits into organs
Most common presenting sign of amyloidosis?
Proteinuria
What is the hallmark cutaneous sign of FMF? And where does it typically present?
Erysipeloid erythematous rash
-Ankle/foot
What are some other symptoms in FMF apart from fever and rash (x2)?
- Arthritis
- Serositis (abdo pain, pleurtic chest pain)
What is the treatment plan for oligoarthritis?
- NSAIDs +/- joint injections
- If poor response –> second line DMARDs
What form of JIA is more closely associated with development of MAS?
-Systemic JIA
What is the gold standard for diagnosing JDM?
EMG
What is the most (a) sensitive and (b) specific tests for SLE?
(a) ANA
(b) anti-dsDNA, anti-Smith
What does synechiae mean?
Irregular pupil
Tx for PFAPA
T+A
x1 dose of oral pred at beginning of flare
What dx do you think of with a salmon rash?
sJIA
In terms of # of criteria, what do you need to make a diagnosis of rheumatic fever?
-2 major
-1 major + 2 minor
PLUS evidence of GAS infection
-Exception is chorea
Major + minor manifestations of rheumatic fever
Major = polyarthritis, carditis, chorea, erythema marginatum, subcut nodules Minor = fever, arthralgia, elevated ESR/CRP, prolonged PR
Management of acute rheumatic fever
- Penicillin x10 days
- ASA + NSAIDs for arthritis
- ASA + steroids for carditis
Prophylactic therapy for rheumatic fever
- Without carditis = 5 years or till 21 years of age
- With carditis = 10 years or till 21 years of age
- With carditis + residual disease = 10 years or till 40 years old
For FMF vs PFAPA how long does the fever typically last for?
FMF = <72 hours PFAPA = 5 days
SLE-ACR Classification criteria
- need 4/11*
- Malar rash
- Discoid rash
- Photosensitivity
- Serositis
- Oral/nasal ulcers
- Arthritis
- Neuro: seizures, psychosis
- Heme disorder
- Renal disorder
- Immune disorder
- Positive ANA
Indications for testing for Antiphospholipid Ab Syndrome
- SLE yearly
- Unexplained PTT prolongation
- Multiple abortions
- Thrombosis
Dermatomyositis - criteria
- need 4/5*
- Symmetrical proximal muscle weakness
- Derm changes: heliotrope rash, Gottron’s papules
- Elevated muscle enzymes (CK, AST, LDH)
- Abnormal EMG (although would do MR now)
- Abnormal muscle biopsy
Dermatomyositis - complications
- Dysphagia - swallowing dysfunction
- Dysphonia
- Dyspnea - resp failure with severe weakness
- Interstitial lung disease
- Arthritis
- Joint contractures
- Cutaneous/mucosal ulcerations
- Constitutional features (fever, fatigue)
Dermatomyositis - nail changes
- Drop out
- Dilatation
- Tortuosity
Typical treatment for Dermatomyositis
- Steroids
- MTX
- IVIG for more severe cases
What is an important but often missed step in the examination of a patient with IgA vasculitis or HSP?
GU exam - looking for orchitis
Management of HSP
- Supportive
- Analgesia (NSAIDs) for joint pain
- Steroids if severe abdo pain or renal disease
Monitoring for HSP
- UA + BP weekly until rash resolves
- Then biweekly
- Then monthly for 6 months
What is the other name for Sever disease?
Calcaneal apophysitis
How many degrees on scoliometer would you worry about in office?
> /= 7 degrees
What is the other name for tibia varum?
Blount disease
How to differentiate Blount disease from genu varum?
Measure the metaphyseal - diaphyseal angle on XR
What dx to think of with back pain associated with hyperlordosis, paraspinal muscle spasm, and hamstring tightness?
Spondylolysis
Most common childhood wrist fracture?
Buckle fracture
What dx to think of with quotian fever?
sJIA
What to think of with synechiae?
Uveitis
What common classification of medications can cause exacerbation of Raynaud’s?
Stimulants
If you have a HSP like presentation - what would be the most important bloodtest to do?
CBC - ensure no thrombocytopenia
Recurrent pain to clavicle and jaw bones - what dx + first line tx?
CRMO + NSAIDs
What periodic fever syndrome can have significant peritonitis?
FMF
