Rheumatology Flashcards by Janna Marie Valencia

Rheumatoid Arthritis (Summary)

PIC ASS

Polyarthritis
Inflammatory
Chronic

Autoimmune
Symmetrical
Systemic

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RA Gene Anomaly

HLA-DR4 & HLA-DR1

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Cardinal Signs of Inflammation

Calor (Heat)
Dolor (Pain)
Rubor (Redness)
Tumor (Swelling)
Functio Laesa (Loss of Function)

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RA Extra-articular Manifestation: EYES

Keratoconjunctivitis sicca/Xeropthalmia (Dry Eyes)

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RA Extra-articular Manifestation: NERVES

Mononeuritis Multiplex

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RA Extra-articular Manifestation: LUNGS

Interstitial Lung Dse
Pleuritis
Pleural Effusion
Caplan Syndrome

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RA Extra-articular Manifestation: HEART

Pericarditis

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RA Extra-articular Manifestation: BLOOD

Felty’s Syndrome

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Felty’s Syndrome

Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis

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RA Extra-articular Manifestation: SKIN

Rheumatoid nodules

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MC Location of Rheumatoid nodules

Elbow

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Joint spared in RA

DIP

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RA Articular Manifestation: TMJ

Limited mouth opening

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RA Articular Manifestation: C1 -C2

Subluxation

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RA Articular Manifestation: Thumb

(Z-Thumb)
Hyperextended IP
Flexed MCP
Subluxed MCP

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RA Articular Manifestation: Hand

Swan-Neck
Boutonniere

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RA Articular Manifestation: WRIST

(+) Piano Keys Sign
Distal Radioulnar Instability

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RA Articular Manifestation: ELBOW

Flexion contracture

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RA Articular Manifestation: KNEE

Synovitis
Baker’s Cyst

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RA Articular Manifestation: FOOT

Pes Planus

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Stages of Joint Inflammation

Synovitis
Pannus formation
Ankylosis

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1987 ACR Classification

Rheumatoid factor inc
Finger/Hand involvement

Rheumatoid nodules
Involvement of 3 or more joints
Stiffness in the morning
Erosions/decalcifications
Symmetric

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2010 ACR Classification

Refer to Table

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Functional Capacity in RA: CLASS 1

Complete fxnl capacity

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Functional Capacity in RA: CLASS 2

Adequate fxnl capacity despite discomfort/LOM

Functional Capacity in RA: CLASS 3

Adequate fxnl capacity only few or none of the usual duties

Functional Capacity in RA: CLASS 4

Bedridden, confined to w/c, little or no self-care

Types of JIA

Polyarticular Oligoarticular (Pauciarticular) Systemic (Still’s Dse)

JIA Persistent pain in ____ joints; for at least ____ weeks; commonly seen in _____

1 or more joints 6 weeks <16 y/o girls

Tests for JIA

CRP & ESR elevated (+) HLA-B27 (+) ANA (+) Rheumatoid Factor

Characteristics of SLE

Discoid rash Oral ulcers Photosensitivity ANA Malar/Butterfly rash Immunologic dse Neurologic dse Renal dse Arthritis Serologic Hematologic (Felty's)

Most sensitive test in SLE

(+) Anti-nuclear antibody

Non-erosive, reversible arthritis seen in SLE

Jaccoud's Arthritis

Pathophysio of Scleroderma

Too much collagen production causing scarring/thickening of tissues

Types of Scleroderma

Localized Diffused cutaneous systemic sclerosis Limited cutaneous systemic sclerosis

CREST Syndrome

Calcinosis Raynaud's phenomenon Esophageal dysfunction Sclerodactyly Telangiectasia

Tests for Scleroderma

Anti-centromere (limited) Anti SCL 70 or Anti-topoisomerase (diffused)

Pathophysiology for Polymyositis

CD8 cells against ENDOmysium Test: Anti Jo-1

Pathophysiology for Dermatomyositis

CD4 cells against PERImysium Test: Anti Mi-2

Pathognomonic skin findings in Dermatomyositis

Gottron papules Heliotrope rash

Type 1 PM/DM

Primary Idiopathic Polymyositis

Type 2 PM/DM

Primary Idiopathic Dermatomyositis

Type 3 PM/DM

PM/DM with Malignancy

Type 4 PM/DM

PM/DM in Children

Type 5 PM/DM

PM/DM with other Vascular Disease

Type 6 PM/DM

Inclusion Body Myositis

Exocrine gland destruction secondary to lymphocyte infiltration

Sjogren's Syndrome

Triad of Sjogren's

Xeropthalmia (Dry Eyes) Xerostomia (Dry Mouth) Arthritis

bilateral parotid gland enlargement

Mikulicz Syndrome

painful intercourse d/t dry vagina

Dyspareunia

Tests for Sjogren's

Anti-Ro/SSA antibodies Anti-La/SSB antibodies Schirmer Test Lip/Parotid gland biopsy

Most dangerous complication related to Sjogren's

Non-Hodgkin Lymphoma

inflammation of sites where tendons and/or ligaments insert into the bone

Enthesitis

Arthritis mutilans

(+) Telescoping Sign (Opera glass hand)

Psoriatic Arthritis (X ray)

Pencil in cup deformity

Characteristics of Psoriatic Arthritis

Telescoping Sign Auspitz Sign DIP joint affectation Onycholysis Koebner Phenomenon Asymmetric

Hallmark of Ankylosing Spondylitis

Bilateral Sacroiliitis

Calcification of annulus fibrosus

Syndesmophytes

Ankylosing Spondylitis (X ray)

Squaring of vertebral bodies Syndesmophytes (+) Bamboo spine (late stage)

Ankylosing Spondylitis (Extra-articular manifestations)

Aortic regurgitation Acute anterior uveitis

Triad of Reactive Arthritis

Arthritis (Oligoarticular) Conjunctivitis Urethritis

MC bacteria in genitals causing Reactive Arthritis

Chlamydia

MC bacteria in bowel causing Reactive Arthritis

Campylobacter Salmonella

Types of Inflammatory Bowel Disease

Ulcerative Colitis (MC: rectum) Chron's dse (MC: ileum & colon)

Affects peripheral & axial joints (MC: Knee)

Enteropathic Arthritis

Findings in Polymyalgia Rheumatica

Auntie (F>M) Uber HighESR & CRP Negative (Seronegative) Temporal arteritis/Giant cell arteritis In the morning, pain & stiffness Elderly (>50 y/o) Proximal joint (MC: Shoulder) cOrticosteroids Low dose Yun ang Hallmark

Hallmark of Polymyalgia Rheumatica

Low dose Corticosteroids

Hallmark of Gout

Tophi

Hallmark of Pseudogout

Chondrocalcinosis

Crystals (Gout)

Monosodium urate (uric acid)

Crystals (Pseudogout)

Calcium pyrophosphate dihydrate

Joint involvement (Gout)

MC: 1st MTP (Podagra) Knee (Gonagra) Wrist (Cheiragra)

Joint involvement (Pseudogout)

MC: Knee Wrist, Shoulder, MCP (2nd & 3rd)

Hallmark of Osteoarthritis

Asymmetric loss of cartilage space

MC Clinical finding in Osteoarthritis

Crepitus

MC Joint Involvement in OA

Knee

MC Spine Involvement in OA

C5-C6

Kellgren & Lawrence Classification (Grade 0)

No x-ray changes

Kellgren & Lawrence Classification (Grade 1)

Doubtful joint space narrowing

Kellgren & Lawrence Classification (Grade 2)

Possible joint space narrowing Definite osteophytes

Kellgren & Lawrence Classification (Grade 4)

Marked narrowing of joint space Large osteophytes Definite deformity

Kellgren & Lawrence Classification (Grade 3)

Definite narrowing of joint space Moderate multiple osteophytes Possible deformity

FIBROmyalgia Findings

Fatigue; F>M Insomnia Blues (Depression, Anxiety) Rigidity (Stiffness) Ouch (Pain)

Tender Points (Fibromyalgia)

Occiput Lower cervical Trapezius Shoulder Supraspinatus 2nd rib Lateral epicondyle Buttocks/Gluteals Greater trochanter Knee