- Juvenile: <16 year old at onset of symptoms - Idiopathic: cannot be explained by another medical condition - Arthritis: Joint inflammation lasting more than 6 weeks

Rheumatology Flashcards by Alexa Geddes

When in the day do symptoms of growing pains typically present?

Evening

How well did you know this?

Not at all

Perfectly

x1 example of pain amplification syndrome (a) generalized and (b) localized

(a) Fibromyalgia

(b) Complex regional pain syndrome

How well did you know this?

Not at all

Perfectly

Examples of autonomic changes that occur with pain amplification syndromes?

Swelling
Atrophy
Cold extremities

How well did you know this?

Not at all

Perfectly

Definition of arthritis

Joint effusion or swelling

OR =/> than 2 of the following: limited ROM, tenderness/pain with motion, increased heat

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Can routine live vaccines be given to a patient on MTX?

No although could get a booster

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Classification of Juvenile Idiopathic Arthritis (x6)

Oligoarticular arthritis
Polyarticular arthritis
Systemic JIA
Enthesitis related arthritis
Psoriatic arthritis
Undifferentiated

How well did you know this?

Not at all

Perfectly

What type of JIA is more common in males than females?

-Enthesitis-related

How well did you know this?

Not at all

Perfectly

What form of JIA is associated most commonly with uveitis?

Oligoarthritis

How well did you know this?

Not at all

Perfectly

What form of JIA is associated with acute uveitis (symptomatic)?

Enthesitis-related

How well did you know this?

Not at all

Perfectly

What form of JIA is associated with the majority of cases being ANA positive?

Oligoarthritis

How well did you know this?

Not at all

Perfectly

What form of JIA is associated with HLA-B27 positive?

Enthesitis-related

How well did you know this?

Not at all

Perfectly

Criteria for psoriatic arthritis

Arthritis + psoriasis

- OR arthritis plus 2 of the following: nail pits, dactylitis, 1st degree relative with psoriasis

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What to treat FMF with and why?

Colchicine

- To decrease intensity/frequency/duration of episodes + prevent amyloidosis

How well did you know this?

Not at all

Perfectly

What is amyloidosis?

-Serum AA = acute phase reactant found in high levels during FMF attacks –> cleaved + deposits into organs

How well did you know this?

Not at all

Perfectly

Most common presenting sign of amyloidosis?

Proteinuria

How well did you know this?

Not at all

Perfectly

What is the hallmark cutaneous sign of FMF? And where does it typically present?

Erysipeloid erythematous rash

-Ankle/foot

How well did you know this?

Not at all

Perfectly

What are some other symptoms in FMF apart from fever and rash (x2)?

Arthritis

- Serositis (abdo pain, pleurtic chest pain)

How well did you know this?

Not at all

Perfectly

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