Rheumatology Flashcards
What are the normal symptoms of Behcet syndrome?
recurrent oral ulcers, may also have genital aphthae, ocular or neuro disease, skin lesions, arthritis, vascular disease, GI involvement
treatment for Behcet?
Colchicine or apremilast (PDE - 4 inhibitor)
May add steroids tapering or progress to azathioprine, thalidomide, or TNF - alpha inhibitor
What is an autosomal recessive disease that tends to affect people of Arab, Jewish, Turkish descent with multiple episodes of fever, abdominal pain, rash, arthritis for several days?
Familial Mediterranean Fever
What is Familial Mediterranean Fever? what is a long term consequence? what is treatment?
autosomal recessive disease that tends to affect people of Arab, Jewish, Turkish descent with multiple episodes of fever, abdominal pain, rash, arthritis for several days
may also have serositis episodes, long term consequence might include amyloidosis
treatment: colchicine daily
Patient comes in complaining of fever and abdominal pain, also has a rash all over. He says this is the third time this has happened. He is from Turkey. What diagnosis should you consider?
Familial Mediterranean Fever
If someone has low back pain which sounds inflammatory, but radiographs are negative for sacroiliitis, what might you get to help decide if you need an MRI?
HLA-B27
what is treatment for ankylosing spondylitis?
NSAIDs, if fail could consider TNF-alpha inhibitor.
what is a condition that tends to affect men > 45 and is noninflammatory low back pain without SI pain? some changes seen on radiograph which are?
Diffuse idiopathic skeletal hyperostosis (DISH)
flowing linear calcification and ossification of anterolateral vertebral bodies.
Someone comes to you with a rash over their face and chest with sun exposure and they also have bumps over their knees and elbows that look psoriaform, what do they have?
Dermatomyositis. The psoriaform papules are Gottron papules
What bowel disease are people with Ankylosing spondylitis more likely to have?
IBD
what is treatment for lyme arthritis? what joint pattern is expected?
28 days doxycycline or amoxicillin
may need to do second course if not completely resolved
pattern: monoarticular, usually the knee
what is on your differential for a monoarticular arthritis?
infectious, gout, hemarthrosis
what if you can’t use allopurinol in gout?
febuxostat
person comes to you with reduced vision and transient vision loss in one eye, has different BP in the two arms and absent radial pulse in one arm. what diagnosis should you suspect?
Takayasu arteritis.
what organ systems are most commonly affected in PAN?
cutaneous and neuro.
palpable purpura and mononeuritis multiplex.
what drug may be useful in people with refractory gout not responding to prednisone?
Anakinra (IL-1 receptor antagonist)
what should you tell patients using capsaicin to avoid toxicity?
watch for eye contamination
what drugs may help as sialogogues if nonpharm is not working?
cevimeline or pilocarpine (muscarinic agonists)
what is felty syndrome?
RA with neutropenia and splenomegaly
What is induction treatment for ANCA vasculitis?
steroids and rituximab
does dermatomyositis need a muscle biopsy to diagnose?
no. should do cancer screening though!
What is Adult-onset Still disease?
daily evening fevers, salmon pink rash, inflammatory arthritis, sore throat, serositis, increased inflammatory markers/ferritin/leukocytosis.
unknown cause
what should you think of with groin pain on weight bearing, limited internal rotation, pain on hip abduction, normal ESR with risk factors such as renal transplant, steroid use.
And what test should you order?
Avascular necrosis
MRI hip joint (should be ordered to rule out AVN even if signs of joint narrowing are apparent on radiograph as this could also be OA or early AVN, late AVN has crescent sign on radiograph)
what does crescent sign of the hip indicate?
avascular necrosis (late pathognomonic finding)
