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Clinical medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Tests in Rheumatology

A
  • Erythrocyte sedimentation rate (sed rate, ESR)
    • Distance that RBCs fall in 1 hour- cells aggregate and settle faster when inflammatory proteins are present (eg indection, inflammation,malignancy)
  • C-reactive protein (CRP)
    • Acute-phase reactant, secreted by liver in response to inflammatory cyrokines
    • High levels (>10) sensitive but nonspecific for inflammatory states
    • Chronic low level elevation (1-10) associated with increased CV risk (high sensitivity or HS-CRP)
  • Rheumatoid factor (RF)
    • Antibodies (IgM) against Fc region of human IgG
  • Anti-citrullinated protein antibody (ACPA)
    • Measures alterations to proteins in the setting of inflammation
  • Antinuclear antibody (ANA)
    • Antibodies to nuclear antigens (DNA, RNA, histone and other proteins)
  • Antiphospholipid antibodies
    • Phospholipid is a component of thrombosis
      • Lupus anticoagulant
        • Antibody w/prothrombotic effects in vivo but prolongs PTT in vitro
        • Observed in patients with lupus, but can occur in patients w/o lupus
      • Anticardiolipin antibody
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2
Q

What does ESR mean?

A

Erythrocyte sedimentation rate (sed-rate)

  • Presence of inflammation causes an elevated rate of sedimentation of RBC
    • Low ESR
      • Polycythemia
      • Leukocytosis
      • Sickle cell
      • Abnormal proteins
    • High ESR
      • Inflammation
      • Infections
      • Cancer
      • Autoimmune
      • Temporal arteritis
      • Polymyalgia
      • Rheumatica
  • Fibrin creates “sticky” cells which clump together and thus fall FASTER = increased rate of sedimentation
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3
Q

What does CRP (c-reactive protein) mean

A
  • Acute phase of active inflammation
  • Chronic low level elevation = assosiated with increased CV risk
  • High level = sensitive for inflammatory state , NOT specific
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4
Q

True or false

CRP and ESR test for nonspecific inflammation

A

True

HIGH reading = inflammation

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5
Q
A

She is right about this potential association - but nothing she needs to worry about

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6
Q

OA vs RA

A
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7
Q
A

B- Rheumatoid arthritis

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8
Q
A

A- Erythrocyte sedimentaion rate (ESR)

C- Rheumatoid factor

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9
Q
A

None of the above

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10
Q
A

C- Arteriovenous nicking

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11
Q
A
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12
Q

Treatment of OA

A

Non-inflammatory

Acetaminophen (Tylenol)

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13
Q

Treatment of RA

A
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14
Q

Hydroxychloroquine and chloroquine can cause retinal toxicity, at which dose is it considered high risk

A

>5mg/kg daily

Standard dose is 200mg BD

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15
Q

57yo female c/o bilateral central photopsias x 2years

  • PMH = Sjogren’s syndrome and inflammatory arthritis
  • Currently on prednisone and methotrexate
  • H/o Plaquenil (hydroxychloroquine) x 10years, 200mg BID = 6.5mg/kg, stopped 1 year ago

RETINAL TOXICITY HIGH RISK = >5MG/KG DAILY

A

Recommendations on screening for Chloroquine and Hydroxychloroquine Retinopathy

  • Screen for maculopathy with baseline eye exam at start of treatment, then annually starting 5 years after treatment initiation if patient is still taking the med and remains low-risk
  • Higher risk- daily dose >5mg/kg, longer duration of treatment (>1000g cumulative dose), poor kidney function, tamoxifen, baseline macular disease (eg ARMD)
  • Appropriate screening tools: SD-OCT imaging, HVF 10-2, mfERG
  • Not approptiate: VA, colour vision, Amsler grig, fundus photos
  • Asia populations will show loss within the arcades instead of around the macula
    • Scan larger area with OCT
    • 24-2 HVF instead of 10-2
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16
Q
A

C

Know GCA well

Ocular emergency

Permanent vision loss can be prevented with early disease recognition and proper management

In absence of frank AAION, good history and strong suspision are critical

Who gets GCA?

  • Caucasians (of N.European descent) >>>>>> Hispanic and black
  • Female > Male
  • Age 50+
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17
Q

Symptoms of GCA

A
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18
Q

Questions to ask when considering GCA

A
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19
Q
A
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20
Q

Polymyalgia Rheumatica (PMR) & GCA

21
Q

~Treatment of GCA

A

*need biopsy for diagnisis

22
Q

Visual prognosis after treatment initioation with steroids for GCA

26
Q

Associated autoimmune disorders Secondary Sjogren’s

27
Q
A

C (malar rash)

28
Q

Systemic Lupus Erythematosis

31
Q

Spondylarthropathies

32
Q

Granulomatous vs non-granulomatous uveitis

A

NB causes!!

Syphilis, Sarcoid, TB

33
Q
A

B

Coumadin - warfarin blood thinner

35
Q

Ankylosing Spondylitis

A
  • Inflammatory spinal pain
    • Most back pain is non inflmmatory
  • Features
    • Insidious(gradual) onset
    • Improved with exercise
    • Morning stiffness and pain at night
    • At least three months duration
  • Ocular features
    • Non-granulomatous anterior uveitis
      • \Acute onset(over several days)
      • Initial episode always unilateral (96%)
      • Recurrences in either eye
      • Cells in vitreous, hypopyon may be seen
    • Conjunctivitis
    • Scleritis
    • Keratitis

Ocular features are frequently the first indication of undiagnosed HLA-B27-associated spondyloarthopathy

37
Q

Sarcoidosis

A
  • Multisystem granulomatous disease of unknown ethiology that may affect any tissue but most prominently involves the lungs
  • Classic histology: noncaseating (non-nectrotizing) granulomas may be preceded by simple mononuclear infiltrate granulomas replaced by scar –> organ damage
38
Q

Epidemiologic features of sarcoidosis

A
  • In US, prevalence in African americans (35/100,000) > caucasians (11/100,000)
  • Worldwide incidence in northern latitudes
    • N.Europe(scandinavia, Ireland, Great Britain) N.America, Japan
    • Women:men = 2:1
    • Onset usually 20-40
39
Q

Sarcoidosis manifestations

41
Q

Will a pathology specimen revel granulomas?

  1. Pneumocytocis
  2. TB
  3. Rheumatoid arthritis
  4. Sarcoid
  5. Giant Cell Arteritis
A
  1. Pneumocytosis False
  2. TB. True
  3. Rheumatoid arthritis False
  4. Sarcoid. True
  5. Giant Cell Arteritis. True

Granulomatous uveitis: sarcoid, Syphilis, Tb

43
Q

Opioids in clinical practice

49
Q

Uveitis

Clinical medicine (8 decks)

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