Rheumatology Flashcards
Difference between ESR and CRP
a. ESR: nonspecific indicator of inflammation
b. CRP: acute-phase reactant; levels ↑ w/ inflammation and infxn
Rheumatic Factor increases in what 5 conditions
RA
↑ in Sjogren syndrome,
sarcoidosis,
vasculitis,
chronic infxns
Highest specificity for dx of RA
Anti Citrullinated protein antibodies (ACPAs or anti-CCP): higher specificity for dx of RA
+ RF
PE findings of RA ; TXM
PE: symmetrical soft, red, tender, swelling in joints (MCP, PIP, sparing DIP)
e. Bilateral ulnar deviation at MCP, boutonniere deformity, swan-neck deformity
TXM = 1st line = METHOTREXATE DMARDs “hydroxychloroquine”
Due to —> Autoimmune Destruction of Joints
Pathophys of OA
OA is primarily a disease of cartilage
Presumably in response to this loss, chondrocytes initially proliferate and synthesize enhanced amounts of proteoglycan and collagen molecules.
As the disease progresses, however, reparative attempts are outmatched by progressive cartilage degradation.
Due to —> Wear and Tear on Joints
RF for SLE
RF: early age at menarche, OCP use, postmenopausal hormone use, family hx, smoking
Drug induced causes: Hydralazine, INH, Procainamide, Phenytoin, Sulfonamides
PE and Dz of SLE
PE: malar rash (“butterfly” rash) , discoid rash, photosensitivity, oral ulces, arthritis, serositis, renal dz, neurologic dz, hematologic d/o, immunologic abnormalities
Dx: + ANA, anti-dsDNA, anti-Smith antibodies, anti-histone antibodies
TXM and goals SLE
h. Tx
i. NSAIDs ii. Steroids: mainstay and first line for most lupus manifestations → low dose prednisone daily
iii. Biologic therapies: Belimumab iv. Hydroxychloroquine: ↓ number of dz flares
Scleroderma =
Scleroderma (systemic sclerosis): systemic autoimmune dz characterized by varying degrees of skin fibrosis, vascular damage, and organ dysfxn
a. S/Sx: fatigue, stiff joints, pain b. Pt may have tight skin on fingers, facial skin, elbows, knees etc.
Limited or Diffuse
CREST syndrome and assoc w?
CREST syndrome:
calcinosis of skin,
Raynaud’s phenomenon,
esophageal dysmotility,
sclerodactyly,
telangiectasia
ASSOC = Scleroderma
Dx labs for scleroderma
Dx: anti-Scl 70, anti-centromere antibody (specific for limited dz)
Scleroderma TXM
Tx
i. Cyclophosphamide
ii. Tocilizumab and Nintedanib for ILD and IPF
iii. Nifedipine (CCB) for Raynaud’s
S/Sx: low back pain that is worse in morning and improves w/ exercise c. Dx
i. XR shows multiple vertebral fusions (bamboo spine) ii. ↑ ESR
Think? TXM?
Ankylosing spondylitis
Tx
i. NSAIDs
ii. PT
Reiters syndrome often has a preceding what infxn?
GI or Chlamydia
Reiters Sxs / Dx / TXM
b. S/Sx: asymmetric arthritis; conjunctivitis, arthritis, uveitis
c. Dx: + HLA-B27
d. Tx: NSAIDs
Describe acute gouty arthritis
Acute gouty arthritis
1. S/Sx: pain and swelling, usually of single joint
- MC joints: great toe MTP joint (podagra), ankle, knee, and wrist
- Episodes often occur at night
- Severe pain
Gout Dx
Dx: polarized microscopy of synovial fluid showing bright, negatively birefringent, needle-shaped crystals
Discuss urate lowering therapy and px txm
a. Colchicine 0.6mg daily
b. Low-dose NSAIDs
c. Xanthine oxidase inhibitors: reduce uric acid production
i. Allopurinol ii. Febuxstat
d. Uricosurics
i. Probenecid: enhance urinary excretion of uric acid
e. Biologic therapy
i. Pegloticase
Acute gout flares TXM
a. NSAIDs (indomethacin, naproxen, ibuprofen, sulindac)
b. Colchicine
c. Glucocorticoids
Describe pseudo gout / Dx / TXM
b. Pseudogout
i. Caused by calcium pyrophosphate crystals
ii. MC affects knee joint
iii. Dx: joint aspiration shows rhomboid-shaped, weakly positive birefringent crystals iv. Tx: NSAIDs
PE of myositis ; Get what?
e. PE
i. Malar rash ii. Heliotrope rash: purple rash on or around eyelids
iii. Gottron’s papules: erythematous or violaceous atrophic macules and plaques overlying dorsal
interphalangeal joints of hands
Get = CK (elevated)
Myositis TXM
Tx
i. Glucocorticoids
ii. Azathioprine
iii. Methotrexate
sxs and PE of Fibromyalgia
- Fibromyalgia syndrome
a. S/Sx: widespread MSK pain for > 3 mo, nonrestorative sleep, and generalized fatigue
b. PE: tenderness to at least 9 out of 18 anatomic sites (trigger points)
TXM Fibromyalgia
Tx
i. Education
ii. Antidepressants
iii. Avoid opioids
i. S/Sx: monocular visual loss, unilateral HA, jaw claudication
ii. PE: tender, tortuous temporal artery
iii. Dx: ESR > 50
Think? TXM
GCA
TXM = High-dose steroids ASAP
Dx = Bx of temporal artery
S/Sx: asx pulses or BP, HA, arm claudication, visual changes, arthralgia
Anterior Lead STE’s
Takayasu’s Arteritis
S/Sx: HTN, glomerulonephritis, abd pain, testicular pain, mononeuropathy (wrist or foot drop)
Polyarteritis nodosa (PAN): rare, necrotizing inflammatory vasculitis
Buerger’s disease (thromboangiitis obliterans): inflammatory vascular dz
Strongly assoc. w/ tobacco products iii. Dx
1. < 50 y/o
- Current or recent hx of tobacco use
- Distal extremity ischemia
- Typical arteriographic findings of TAO
- Exclusion of autoimmune dz, thrombophilia, DM, and proximal embolic sources
Eosinophilic granulomatosis (Churg-Strauss)
Assoc with?
Sxs?
Assoc. w/ severe asthma and systemic eosinophilia
S/Sx: peripheral neuropathy, mononeuritis, and pulmonary and cutaneous involvement
Abnml proteins in blood clump together at temperatures < 37C
S/Sx: arthralgia, purpura, skin ulcers, glomerulonephritis, peripheral neuropathy, clonal hematologic dz
Think? TXM?
Cryoglobulinemia
Tx
i. Rituximab
ii. Plasma exchange to prevent IgM flare
Diseases assoc. w/ HLA-B27
PAIR:
psoriatic arthritis,
ankylosing spondylitis,
IBD,
reactive arthritis
