Rheumatology Flashcards
What are the causes of acute Inflammatory mono articular arthritis?
Septic arthritis
Gout
Viral arthritis
What are the causes of chronic Inflammatory mono articular arthritis?
Psoriatic arthritis
Sarcoidosis
Pseudogout
What are the causes of acute nonInflammatory mono articular arthritis?
Mechanical stuff, trauma
What are the causes of acute Inflammatory peri articular arthritis?
Bursitis, tendinitis, septic bursitis
What are the causes of acute Inflammatory polyarticular arthritis?
Viral (parvovirus), septic
What are the causes of chronic Inflammatory polyarticular arthritis?
RA, psoriatic, Lyme, scleroderma
How do you distinguish inflammatory vs noninflammatory joint swelling?
Inflammatory - morning stiffness. In the case of RA, lasts awhile
Describe common location of psoriatic arthritis swelling
DIP
Decribe acute rheumatic fever
Occurs after event strep, migratory in nature, accompanied by carditis, chores, subcutaneous nodules
describe symptoms associated with a spondyloarthropathy
Arthritis, tendinitis,uveitis, spinitis, enthesitis
What is the presentation of RA?
small joints sparing the DIP - joints are swollen and tender to motion
morning stiffness for more than 1 hour
How is RA diagnosed?
positive anti-CCP antibodies
high IgM rheumatoid factor
What are some of the long term sequellae of RA?
anemia, fatigue, osteoporosis
What are the side effects of methotrexate?
macrocytic anemia, nausea, stomatitis, rash, hepatotoxicity, interstitial lung disease
What is the presentation of whipple disease?
malabsorptive diarrhea, migratory polyarthropathy, protein losing enteropathy, lymphadenopathy,
What is the cause of whipple disease?
tropheryma whipellii
How is whipple disease diagnosed?
ant-PAS positive macrophages with non acid fast bacilli
What is the presentation of reactive arthritis?
arthropathy, conjunctivitis, urethritis following infection
A patient presents with enthesitis, shoulder and hip pain, and stiffness. This is likely…
anklyosing spondylitis
What is Still’s disease?
autoimmune disease characterized by fevers, salmon colored rash, juvenile idiopathic rash
What are the diagnostic criteria of lupus?
4 of the following 11: serositis oral ulcers arthritis photosensitivity blood abnormalities renal dysfunction ANA positive Immunologic testing (anti-SM, anti-dsDNA) Neurologic - psychosis, seizures Malar rash Discoid rash - raised patches with scaling
What tests should be run in considering an autoimmune disease?
C3/C4- low complement associated with flares
Antiphospholipid antibodies - associated with embolic disease
Anti - histone antibodies - associated with drug induced lupus
SSA/SSB - associated with Sjogrens
What are some other important manifestations of lupus?
fatigue, fever, weight loss, raynaud’s, hair loss, miscarriages, lymphadenopathy, marantic fevers
What treatments are available for RA?
start on DMARDs ASAP (methotrexate) - adjunctive therapy NSAIDS, hydroxychloroquine (good for skin flare,s joint disease), glucocorticoids, steroid sparing agents. if those don’t work, (tumor necrosis factor -alpha inhibitors)
How is rotator cuff bursinitis differentiated from other rotator cuff pathology?
inject lido - if it works, it’s rotator cuff impingement
rotator cuff injury also associated with weakness
How does vascular compression of the arm present?
numbness, weakness, swelling of the joint
What side effects are associted with hydroxychlroquine?
retinopathy
What side effects are associated with TNF inhibitors?
infection, demyelination, CHF, malignancy
A patient presents with joint pain worse in the morning for 60 minutes, worsened by activity, non tender, no systemic symptoms. This is likely
DJD
A patient has recurrent lymphadema. This is likely due to
c1 esterase inhibitors
A patient presents with widespread aching and stiffness in hips and shoulders, absence of tender points, inflammatory joints, ESR> 50. This is… (and how do you treat it?)
polymyalgia rheumatica - treat with low dose corticosteroids
What antibodies are associated with RA?
CCA
What does positive anti-centromeres indicate?
CREST syndrome (scleroderma)
What does positive ANA - SCL-70 indicate?
scleroderma
What does positive anti-smith antibody indicate?
lupus
What does anti-Jo antibody indicate?
polymyositis
What does anti- RNP antibody indicate?
mixed connective tissue disease
What does anti-histone antibody indicate?
drug induced lupus
What is the treatment of choice for acute gout?
NSAIDs, colchicine
What is the prophylactic treatment for gout?
allopurinol
What are the poor prognostic signs of RA?
positive anti-CCP antibodies and subcutaneous nodules
A patient presents with migratory arthritis, pancarditis, erythema marginatum and subcutaneoous nodules. What titer would be elevated (And what is this?)
anti-streptolysin titers elevated - this is acute rheumatic fever
A patient presents with arthralgias, palpable purpura, lymphadenopathy, nephropathy and neuropathy. What titers would be elevated and what disease does this patient likely have?
low C3, cryoglobulin levels elevated - this patient likely has hepatits C
What are the classic findings of hemachromatosis at the joints?
squared off bone ends and hook like osteophytes
What does CREST syndrome stand for?
calcinosis, raynaud’s, esophageal dysmotility, sclerodactyly, telangectasias (on the face and hands)
A patient presents with hx of RA, enlarged kidneys and enlarged liver. What test should be performed next?
renal biopsy and staining with congo red to look for amyloid until red-green birefuringence
Is the arthritis associated with SLE permament?
nope!
A patient presents with a facial rash, difficulty rising from a seated position, a dusky malar rash and violaceous periorbital edema. What is this associated with?
this is dermatomyositis - associated with malignancy
What autoantibody is associated with dermatomyositis?
anti-Mi-2 (against helicase)
What are the cautions given when starting methotrexate?
don’t plan on getting pregnant, no drinking, no renal disease or liver disease; check for hep B and hep C
A patient presents with fever, leukocytosis and redness and swelling of the knee and crystals aspirated show rhomboid shaped, positively birefringent. This will show up on X ray with
chondorcalcinosis - this is pseudogout
A patient with gout is aspirated - what is the appearence of the crystals found?
needle shaped, negatively bifuringent crystals
A patient presents with right sided neck pain and numbness over the posterior forearm. What is the most likely finding on radiograph?
bony spurs - this is cervical spondylosis
A patient presents with joint pains, right heel pain, urethritis, conjunctivitis with sterile synovial fluid. What is tx?
NSAIDs for reactive arthritis
A patient presents with headaches, sudden loss of vision, a swollen pale disc with blurred margins and elevated ESR. What is the next step of treatment?
This is giant cell arteritis (also known as temporal arteritis) - start on high dose steroids immediately to avoid vision loss
A patient presents with chronic aching pain, stiffness in the neck and shoulders and has multiple tender spots all over her body. What is the appropriate treatment?
amitryptaline for fibromylagia rheumatica
What is the most important intervention to prevent gout flares?
alcohol cessation
A patient taking regular steroids for sarcoid presents with hip pain - this is…
ostenecrosis of the bone ; can also be caused by chronic alcohol use and antiphospholipid antibody syndrome. Eval with MRI
A patient presetns with slowly progressing back pain as well as sacroilitis - what other condition is she at risk for?
anterior uveitis
Episcleritis should be suspected in patients with ..
RA and IBD
A patient presents wtih anterior knee pain that is worse when climbing stairs. This is likely…
patellofemoral syndrome
A patient presents with recurrent genital ulcers, anterior uveitis and skin lesions as well as a positive pathergy test. This is..
Behchet’s syndrome
A young patient presents with bloody diarrhea, low back pain (sacroilitis) and positive P-ANCAs this is..
ulcerative colitis (IBD)
A patient presents with back pain that is improved with sitting and leaning forward. What is this and how is it diagnosed?
neurogenic claudication from spinal stenosis - diagnose with MRI
A young mother presents with pain in her thumb worsened with passive stretching of the thumb. This is..
De Quervain tenosynovitis
A patient presents wtih 1 week of fever and joint pain in the small joints, pos RF. She stops feeling pain a few weeks later. This is..
viral arthritis
An African American pt. presents with mild fevers, fatigue, blurry vision. X ray shows reticulonodular infiltrates and hilar adenopathy. This is..
sarcoid
A patient who has pruritis in the shower presents with severe pain in his toe. This is…
polycythemia vera related gout
A patient presents with recent constipation, fatigue and frequent urination. His serum levels show elevated Ca and he has a stiff knee. Knee aspiration will show
positively bifurigent crystals - he has hyperparathyroidism and therefore is at risk of pseudogout
A patient presents with a tender mass in the right popliteal fossa. This is likely…
Baker’s cyst caused by inflamed synovium
