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Cam's Cards COPY > Rheumatology 3 > Flashcards

Rheumatology 3 Flashcards

1
Q

What is the catch all term for patients <16 years old, with arthritis in at least 1 joint for longer than 6 weeks?

A

Juvenile Idiopathic arthritis

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2
Q

What is the most common presenting symptom for JIA?

A

Joint swelling, not joint pain

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3
Q

What is the most common subtype of JIA?

A

Oligoarticular AKA pauciarticular JRA

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4
Q

Is oligoarticular JIA asymmetric or symmetric?

A

Asymmetric

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5
Q

How many joints are typically involved in oligoarticular JIA?

A

Less than 5

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6
Q

Most common joint affected by oligoarticular JIA?

A

Knees

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7
Q

Lab findings in oligoarticular JIA?

A

60% have positive ANA

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8
Q

What is the major complication of oligoarticular JIA?

A

Increased risk of uveitis, so patients need regular slit lamp exams until age 18.

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9
Q

Polyarticular JIA resembles what adult disease?

A

RA

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10
Q

How many joints are typically affected by polyarticular JIA?

A

greater than 4

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11
Q

What lab findings are common in polyarticular JIA?

A

RF

Increased ESR

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12
Q

What is SOJIA?

A

Systemic onset JIA AKA Still’s disease

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13
Q

Symptoms of SOIJA?

A

Daily Quotidian fever, salmon colored evanescent macular rash on trunk and extremities.
Can also have really bad symptoms such as hepatomegaly, splenomegaly, LAD, serositis pericarditis or macrophage activation syndrome.

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14
Q

Lab findings in SOIJA?

A

High leukocytosis, very high ESR, elevated ferritin

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15
Q

How many and what size joints does psoriatic arthritis affect?

A

At least 1 joint. Usually small or medium

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16
Q

Is psoriatic arthritis symmetric or asymmetric?

A

Asymmetric

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17
Q

Symptoms of psoriatic arthritis?

A

DIP synovitis, dactylitis, nail pitting, psoriatic rash of FH of psoriasis

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18
Q

Psoriatic arthritis increases risk of what ocular condition?

A

acute anterior uveitis

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19
Q

What is enthesitis related JIA?

A

JIA at tendon insertion sites.

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20
Q

Enthesitis related JIA is connected to what gene?

A

HLA B27

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21
Q

Common symptom for enthesitis related JIA?

A

Sacroiliac tenderness

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22
Q

Patients with enthesitis related JIA should be referred to what specialty?

A

Pediatric rheumatology

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23
Q

Treatment for enthesitis related JIA?

A

NSAIDs and intraarticular joint injections

Some may need a DMARD (methotrexate)or steroids

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24
Q

What JIA has the highest mortality?

A

SOJIA

25
Q

What is scleroderma (systemic sclerosis)

A

Chronic systemic autoimmune disorder with fibrosis of the skin and other organs

26
Q

What are the two forms of scleroderma?

A

Limited and diffuse

27
Q

Describe the symptoms of limited scleroderma

A 
CREST syndrome
Calcinosis cutis (calcium deposits in skin)
Raynaud phenomenon
Esophageal dismobility
Sclerodactyly
Telangiectasia
28
Q

Watermelon stomach makes you think of what condition?

A

Scleroderma

29
Q

What manifestation of scleroderma is an emergency?

A

Scleroderma renal crisis

Sudden onset of malignant HTN

30
Q

What labs will likely be positive in scleroderma?

A

ANA

Anti-SCL

31
Q

Treatment for scleroderma?

A

Treatment targeted to organs affected.

32
Q

Leading cause of mortality in patients with scleroderma?

A

Lung disease

33
Q

Most common symptoms of lupus (SLE)

A

Fatigue, joint pain, rash, arthralgia and nonerosive arthritis, glomerulonephritis, secondary sjogrens syndrome

34
Q

Describe the typical SLE patient

A

Women of childbearing age

35
Q

Describe the pathophysiology of lupus

A

Lupus autoantibodies target intracellular particles, activating the inflammatory pathway. Immune complexes are deposited in organs causing symptoms.

36
Q

What type of lupus is characterized by a malar butterfly rash that spares the nasolabial folds.

A

Acute cutaneous lupus erythematosus

37
Q

What type of lupus causes scaly erythematous papules that spare the face?

A

Subacute cutaneous lupus erythematosus

38
Q

What is the most common type of lupus, that has raised erythematous plaques with scale.

A

Chronic cutaneous lupus erythematosus (discoid lupus)

39
Q

Which type of lupus is most photosensitive?

A

Subacute cutaneous lupus erythematosus

40
Q

What is verrucous endocarditis?

A

Wart like vegetations on mitral valve

41
Q

What lab findings are positive in lupus?

A

ANA - sensitive but not specific
Anti-dsDNA - specific but not sensitive
Anti-Sm - 99% specific but not very sensitive

42
Q

What infection can cause a false positive for ANA?

A

syphilis

43
Q

How can you differentiate drug induced lupus from non drug induced lupus?

A

Drug induced doesn’t have CNS involvement

Lab abnormalities and symptoms normalize when drug is discontinued

44
Q

How many criteria need to be positive in order to diagnose lupus?

A

4/11 or 4/17

45
Q

Treatment for lupus?

A

Sun protection, antimalarials, topical glucocorticoids or intralesional injection, NSAIDS or tylenol, ACEI or ARB, immunosuppressant

46
Q

What poses the highest mortality risk in SLE patients?

A

renal disease

47
Q

What condition do SLE patients have a much higher risk for?

A

MI

48
Q

What is polymyositis?

A

Autoimmune myopathy characterized by proximal muscle weakness

49
Q

What lab will likely be elevated in polymyositis?

A

CK

50
Q

Gold standard for diagnosing polymyositis?

A

Biopsy of an effected muscle (deltoid or quadriceps are good options)

51
Q

Treatment for polymyositis?

A

Steroids 1mg/kg/day x4-6 weeks

52
Q

Is psoriatic arthritis symmetric or asymmetric?

A

Can be either, but symmetric is more common

53
Q

How long does morning stiffness typically last in psoriatic arthritis?

A

> 30 minutes

54
Q

What are the common domains of psoriatic arthritis?

A 
Peripheral arthritis
Axial disease
Enthesitis
Dactylitis
Skin and nail disease
55
Q

When do arthritis symptoms usually occur in relation to psoriasis symptoms?

A

Usually after or at the same time of onset of psoriasis

56
Q

What deformity is indicative of PsA?

A

Pencil in cup deformity

57
Q

How many points are needed in the CASPAR criteria to diagnose PsA?

A

3

58
Q

Treatment for PsA?

A

NSAIDs

More severe or unresponsive to NSAIDs: DMARDs or Biologic TNF inhibitors

59
Q

Downsides to biologic TNF inhibitors?

A

Expensive, SQ or IV, immunosuppression, reactivation of latent TB

Cam's Cards COPY (93 decks)

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