Rheumatology Flashcards
in what condition should you always order an arthrocentsis
concern for septic joint
what is WBC count in arthrocentsis in setting of inflammation or infection
> 2000
what is WBC count in setting of trauma in athrocentesis
<2000
what is wbc count in athrocentsis in lupus patient
> 5000
septic arhtritis wbc count on jointtap is
> 50,000
this condition is usually diagnosed in kids under the age of 16 and symptoms have to be present for at least 6 weeks. Involvement is usually the large joints and you wont see rhematoid nodules like you do in adults
JIA
what markers are present in JIA
ANA, RF can be seen but doesnt have to be if it is seen it is poorer prognosis
which kind of JIA is mainly in girls and involves 4 or less joints, silent eye issues are involved and although ANA is + RF is usually negative
Oligoarticular JIA
what exams need to be don in O-JIA
serial slit lamp because uveitis will be silent
what kind of JIA has involvement of 5 or more joints and is more common in young girls
polyarticular JIA
this kind of JIA is seen in both boys and girls and has the presence of a salmon-colored evanescent rash ( comes and goes quickly) that is present with spiking fevers, HSP and extremely high leukocytosis.
systemic JIA
which JIA is associated with Koebner Phenomena (linear skin lesions appearing along sites of injury, rubbing or scratching)
systemic JIA
how to treat polyarthritis
start with NSAIDs for a few weeks and then move on to DMARDS (methotrexate) or tnf inhibitors
children who have to take methotrexate also need what
folic acid or leucovorin (folinic acid)
which antibodies are present in SLE
anti-DNA and anti- Smith ( most diagnostic and specific)
in SLW complement is
low ( low C4,C3 and CH50)
what is the condition associated with SLE that consists of micro ischemia and seizures that can result in neuropsychiatric manifestations?
Lupus cerebritis
how to dx lupus cerebritis
CT or MRI will show brain lesions.
what meds are used to treat lupus
- NSAIDs if mild
- steroids
- hydroxychloroquine
- methotrexate
what is associated with neonatal lupus
third degree heart block with bradycardia or hydrops fetalis
how to dx neonatal lupus
Anti - Ro/La antibodies of mom
what kind of drugs cause drug induced luus
- lithium
- hydralazine
- quinidine
- sulda drugs
- antiseizure medication
what is the chronic inflammatory condition that involves fusion of the spine and inflammation of the hips, more common in boys
juvenile ankylosing spondylitis
when is pain worse in ankylosing spondylitis
with rest
give an example of a seronegative spondyloarthropathy
reactive arthritis ankylosing spondylitis ( inflamm markers are normal, ANA is negative and ESR is only slightly elevated)
iritis, urethritis and arthritis
reactive arthritis
aphthous ulcers, genital ulcers, GI symptoms, arthritis and uveitis
bechet’s syndrome
describe onset and key features of psoriatic juvenile idiopathic arthritis
presnts in children less than 6, more common in grils and presents with
- dactylitis
- arthritis or wrists hands and feet
- older children can have enthesitis ( pain at insertion sites)
- 50% of kids will have psoriass
any child with psoriatic JIA can have what
uveitis
what kind of weakness and nail findings will someone with dermatomyositis have
telengiectasia of the nails and proximal mucle wekaness
how to dx dermatomyositis
mucsle bx
what is high in dermatomyositis
CK level
what condition can be associated with calcinosis cutis ( calcium depositis in skin)
dermatomyositis
this disease presents with early pink, blanching flat or urticarial rash that turns into palpable purpura
HSP
plt count is what in HSP
nl
sometimes hsp initially presents how
abdominal pain (colic), blood in stool, intussusception, GB hydrops
biopsy of hsp would show
deposits of IgA, IgG and C3
how to treat HSP
self limited can give NSAIDs if kidneys aren’t affected, severe cases might need IV steroids.
multisystem complaints + hilar LAD should make you think of
sarcoidosis
hilar LAD and peribronchial infiltrates that show noncaesating granulomas when bx is due to
sarcoidosis
what is sjrogen caused by
lymphocytic infiltration of exocrine glands
how to dx sjrogens
schirmers test ( paper to eye, lack of tear production)
how to confirm dx of sjrogrens
bx of salivary gland will show lymphocytic infiltration
wegners granulomatosis presents wih
multisystem vasculitis
sinusitis
lung issue
kidney issue
(+C-ANCA)
