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Rheumatology 2 Flashcards

1
Q

Symptoms of fibromyalgia

A

MSK pain, fatigue, disordered sleep, multiple somatic symptoms, cognitive problems, psychiatric problems.

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2
Q

Fibromyalgia is more common at what age and in what gender?

A

20-50 year old women

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3
Q

What is allodynia?

A

Experiencing normal sensations as painful

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4
Q

What is hyperalgesia?

A

Pain is more intense and lasts longer

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5
Q

What is commonly the most bothersome area in fibromyalgia?

A

Around neck, shoulders, and low back

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6
Q

What amount of pressure should be applied when examining points of tenderness?

A

4kg/cm^2

enough to whiten the nailbed

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7
Q

Where are the fibromyalgia tender points?

A 
Under sternomastoid muscle
Near the second costochondral junction
2 cm distal to Lateral epicondyle
Greater trochanter
medial fat pad of knee
Insertion of sub occipital muscle
origin of supraspinatus
upper outer quadrant of buttock
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8
Q

T/F? Fibromyalgia does not cause any lab abnormalities

A

True

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9
Q

Initial treatment for fibromyalgia?

A

Pt education, Good sleep hygiene, exercise, +/- CBT, +/- meds

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10
Q

What meds could be appropriate treatment of fibromyalgia?

A 
TCAs (amitriptyline, nortripyline, desipramine)
Cyclobenziprine
SNRIs (duloxetine, milnacipran)
SSRIs (fluoxetine- off label)
Anticonvulsants (lyrica, gabapentin)
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11
Q

Symptoms of polymyalgia rheumatica?

A

Pain and stiffness of the hips and shoulders

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12
Q

Polymyalgia rheumatica is associated with what other condition?

A

Giant cell arteritis

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13
Q

GCA and PMR are more common in what gender and what age group?

A

Females >50, Northern Europeans

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14
Q

Smoking ______ risk for GCA, while DM ______ risk for GCA

A

Increases, decreases

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15
Q

What gene is associated with PMR and GCA?

A

HLA-DR

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16
Q

What type of cells are present in joints affected by PMR?

A

Lymphocytes and monoctyes

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17
Q

What is the pathophys behind GCA?

A

Infiltration of inflammatory cells into vessels causing vasculitis

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18
Q

Classic symptoms of GCA?

A

headache, scalp tenderness, jaw claudication, visual changes (amaurosis fugax or diplopia)

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19
Q

Physical exam findings for GCA?

A

Ill appearing +/- temporal artery changes
Fundoscopic exam: +/-edema of optic disc, cotton wool patches, small hemorrhages,
CV: asymmetry of pulses in arms, aortic regurg, bruits near clavicle

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20
Q

What labs will be elevated in GCR?

A

ESR, CRP

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21
Q

What is the gold standard for diagnosis of GCA?

A

Temporal artery biopsy

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22
Q

T/F PMR is a clinical diagnosis

A

True

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23
Q

Treatment of PMR?

A

Glucocorticoid therapy
Prednisone 10-20mg PO QD
If no improvement after 7 days, increase to 30.

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24
Q

Treatment for GCA?

A

Prednisone 40-60mg PO QD

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25
Takayasu Arteritis mostly affects what vessels?
Aorta and its main branches
26
Describe the typical TA patient.
Asian women between 10 and 40 years old
27
Physical exam findings in a patient with TA?
BP differential between arms. Asymmetrical arterial pulses. Bruits.
28
Treatment for TA?
Prednisone 45-60mg. PO Qam. | Taper when symptoms are controlled and labs improved.
29
What surgical interventions are options for patients with TA?
PCTA (percutaneous transluminal angioplasty) Bypass grafting Aortic repair
30
What is reactive arthritis?
Asymmetric polyarthritis that develops after a GI or GU infection.
31
What joints are commonly affected by ReA?
Large lower extremity joints
32
What infections can trigger ReA?
GI infections - Shigella, salmonella, yersinia, campylobacter, E. coli, C. diff STIs - Chlamydia, ureaplasma urealyticum
33
What gene predisposes people to having ReA?
HLA-B27
34
Patients with ReA may have enthesitis and/or dactylitis. What does this mean?
Enthesitis - swelling at tendon insertion | Dactylitis - sausage joint
35
What are the extra articular manifestations of ReA?
General - Fever, fatigue, weight loss Eye - Conjunctivitis, anterior uveitis Mucocutaneous - Balanitis, stomatitis, kertoderma blennorrhagicum Nails - mimics psoriasis
36
T/F synovial fluid analysis will grow bacteria in ReA?
False.
37
Treatment for ReA?
Treat underlying infection | NSAIDs (naproxen, diclofenac, or indomethacin)
38
If a patients symptoms of ReA do not improve after treatment with NSAIDs, what are some other options?
Intraarticular glucocorticoids PO glucocorticoids DMARD(sulfasalazine or methotrexate)
39
How long does a typical case of ReA last?
3-5 months | Most patients remit within 6-12?
40
What is Sjogrens syndrome?
Autoimmune disease that effects the lacrimal and salivary glands.
41
What are the symptoms of Sjogrens?
Xerostomia and keratoconjunctivitis sicca
42
T/F? Sjogrens is always secondary to another disease.
False, can be primary or secondary
43
Describe the typical Sjogrens patient.
Middle aged female | Women:men = 10:1
44
What genes are involved in Sjogrens?
HLA-DQ, HLA-DB
45
What test is used to check tear production?
Schirmer test
46
What tests can be used to check for saliva production?
Saxon test | Saliometry
47
What lab tests should be positive in a Sjogrens patient?
ANA Anti-Ro Anti-La RF
48
Gold standard of diagnosis for Sjogrens?
Salivary gland biopsy
49
Treatment for oral symptoms of Sjogrens?
Regular dental visits with fluoride treatment Artificial saliva Pilocarpine or cevimeline
50
Treatment for ocular symptoms of Sjogrens?
Artificial tears Q2-4 hours Ocular ointment at night Cyclosporine eye drops if artificial tears doesn't help Topical steroids if Cyclosporine doesn't help Punctal plugs
51
Treatment of systemic manifestation of Sjogrens?
Hydroxychloroquine or methotrexate
52
Is RA more common in women or men?
Women
53
What genes are associated with RA?
HLA-DR MHC
54
Morning stiffness lasts how long in RA?
>30 minutes
55
IS RA symmetric or asymmetric?
symmetric
56
Joints commonly affected by RA?
PIP joints, MCP joints, wrist, elbow, shoulder, hip, knee, MTP joints, PIP joints of foot
57
Joints commonly affected by OA?
DIP joints, 1st MCP joint, C-Spine, L-spine, hip, knee, 1st MTP joint
58
Describe the hands of a patient with RA.
Ulnar deviation of MCP joints Swan neck deformity Boutonniere deformity Z deformity
59
Your patient with RA develops hard sub Q nodules on extensor surfaces of forearms. What are these called?
Rheumatoid nodules
60
What secondary syndrome can be due to RA?
Secondary Sjogrens
61
Felty syndrome is a complication of RA. What are the symptoms?
``` SANTA Splenomegaly Anemia Neutropenia Thrombocytopenia Arthritis ```
62
What labs are likely to be positive in RA?
Anti-CCP RF Elevated ESR/CRP
63
What is the most specific bloodwork for RA?
Anti-CCP
64
What imaging modality is most specific for RA?
Radiographs
65
What is needed to dx RA?
Inflammatory arthritis of > 2 joints Positive RF and or CCP Elevated ESR and/or CRP Duration> 6 weeks
66
What does a patient with RA need screening for before treatment is initaited?
``` Hep B and C Baseline CBC, Cr, LFTs, ESR, CRP Ophthalmic screening Latent TB screening Baseline radiographs ```
67
What medication helps with symptoms but not with disease course in RA?
NSAIDs
68
What medication is good for symptoms relief and slowing rate of joint damage while bridging to a DMARD?
Corticosteroids 5-20mg PO QD
69
What is the initial DMARD of choice in RA?
Methotrexate 7.5mg PO weekly
70
What supplement should be prescribed to patients on methotrexate?
Folic acid 1mg PO QD
71
What is the first choice TNF inhibitor for RA treatment?
Etanercept
72
What is the downside to TNF inhibitors?
Expensive | SQ or IV
73
What is PAN?
Polyarteritis nodosa | It is a systemic nercrotizing vasculitis
74
What arteries are affected by PAN?
Medium or small muscular arteries
75
What organ is usually spared by PAN?
Lungs
76
PAN is associated with what infection?
Hepatitis B
77
What are common clinical features of PAN?
Lower extremity ulcers Hypertension and renal insufficiency Abd pain Mononeuritis multiplex
78
What organ is most commonly affected by PAN?
Kidneys
79
How does mononeuritis multiplex present?
Foot drop
80
What are some diagnostics that can be used for PAN?
Biopsy of organ showing necrotizing inflammation of medium sized arteries Angiogram
81
What angiogram finding is seen in PAN?
Rosary sign
82
PAN treatment
If patient has viral hepatitis, treat with antiviral Mild disease - high dose corticosteroids Mod-severe - high dose corticosteroids and immunosuppressant (cyclophosphamide)

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