Rheumatology 3 Flashcards
What is the catch all term for patients <16 years old, with arthritis in at least 1 joint for longer than 6 weeks?
Juvenile Idiopathic arthritis
What is the most common presenting symptom for JIA?
Joint swelling, not joint pain
What is the most common subtype of JIA?
Oligoarticular AKA pauciarticular JRA
Is oligoarticular JIA asymmetric or symmetric?
Asymmetric
How many joints are typically involved in oligoarticular JIA?
Less than 5
Most common joint affected by oligoarticular JIA?
Knees
Lab findings in oligoarticular JIA?
60% have positive ANA
What is the major complication of oligoarticular JIA?
Increased risk of uveitis, so patients need regular slit lamp exams until age 18.
Polyarticular JIA resembles what adult disease?
RA
How many joints are typically affected by polyarticular JIA?
greater than 4
What lab findings are common in polyarticular JIA?
RF
Increased ESR
What is SOJIA?
Systemic onset JIA AKA Still’s disease
Symptoms of SOIJA?
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.
Lab findings in SOIJA?
High leukocytosis, very high ESR, elevated ferritin
How many and what size joints does psoriatic arthritis affect?
At least 1 joint. Usually small or medium
Is psoriatic arthritis symmetric or asymmetric?
Asymmetric
Symptoms of psoriatic arthritis?
DIP synovitis, dactylitis, nail pitting, psoriatic rash of FH of psoriasis
Psoriatic arthritis increases risk of what ocular condition?
acute anterior uveitis
What is enthesitis related JIA?
JIA at tendon insertion sites.
Enthesitis related JIA is connected to what gene?
HLA B27
Common symptom for enthesitis related JIA?
Sacroiliac tenderness
Patients with enthesitis related JIA should be referred to what specialty?
Pediatric rheumatology
Treatment for enthesitis related JIA?
NSAIDs and intraarticular joint injections
Some may need a DMARD (methotrexate)or steroids
What JIA has the highest mortality?
SOJIA
What is scleroderma (systemic sclerosis)
Chronic systemic autoimmune disorder with fibrosis of the skin and other organs
What are the two forms of scleroderma?
Limited and diffuse
Describe the symptoms of limited scleroderma
CREST syndrome Calcinosis cutis (calcium deposits in skin) Raynaud phenomenon Esophageal dismobility Sclerodactyly Telangiectasia
Watermelon stomach makes you think of what condition?
Scleroderma
What manifestation of scleroderma is an emergency?
Scleroderma renal crisis
Sudden onset of malignant HTN
What labs will likely be positive in scleroderma?
ANA
Anti-SCL
Treatment for scleroderma?
Treatment targeted to organs affected.
Leading cause of mortality in patients with scleroderma?
Lung disease
Most common symptoms of lupus (SLE)
Fatigue, joint pain, rash, arthralgia and nonerosive arthritis, glomerulonephritis, secondary sjogrens syndrome
Describe the typical SLE patient
Women of childbearing age
Describe the pathophysiology of lupus
Lupus autoantibodies target intracellular particles, activating the inflammatory pathway. Immune complexes are deposited in organs causing symptoms.
What type of lupus is characterized by a malar butterfly rash that spares the nasolabial folds.
Acute cutaneous lupus erythematosus
What type of lupus causes scaly erythematous papules that spare the face?
Subacute cutaneous lupus erythematosus
What is the most common type of lupus, that has raised erythematous plaques with scale.
Chronic cutaneous lupus erythematosus (discoid lupus)
Which type of lupus is most photosensitive?
Subacute cutaneous lupus erythematosus
What is verrucous endocarditis?
Wart like vegetations on mitral valve
What lab findings are positive in lupus?
ANA - sensitive but not specific
Anti-dsDNA - specific but not sensitive
Anti-Sm - 99% specific but not very sensitive
What infection can cause a false positive for ANA?
syphilis
How can you differentiate drug induced lupus from non drug induced lupus?
Drug induced doesn’t have CNS involvement
Lab abnormalities and symptoms normalize when drug is discontinued
How many criteria need to be positive in order to diagnose lupus?
4/11 or 4/17
Treatment for lupus?
Sun protection, antimalarials, topical glucocorticoids or intralesional injection, NSAIDS or tylenol, ACEI or ARB, immunosuppressant
What poses the highest mortality risk in SLE patients?
renal disease
What condition do SLE patients have a much higher risk for?
MI
What is polymyositis?
Autoimmune myopathy characterized by proximal muscle weakness
What lab will likely be elevated in polymyositis?
CK
Gold standard for diagnosing polymyositis?
Biopsy of an effected muscle (deltoid or quadriceps are good options)
Treatment for polymyositis?
Steroids 1mg/kg/day x4-6 weeks
Is psoriatic arthritis symmetric or asymmetric?
Can be either, but symmetric is more common
How long does morning stiffness typically last in psoriatic arthritis?
> 30 minutes
What are the common domains of psoriatic arthritis?
Peripheral arthritis Axial disease Enthesitis Dactylitis Skin and nail disease
When do arthritis symptoms usually occur in relation to psoriasis symptoms?
Usually after or at the same time of onset of psoriasis
What deformity is indicative of PsA?
Pencil in cup deformity
How many points are needed in the CASPAR criteria to diagnose PsA?
3
Treatment for PsA?
NSAIDs
More severe or unresponsive to NSAIDs: DMARDs or Biologic TNF inhibitors
Downsides to biologic TNF inhibitors?
Expensive, SQ or IV, immunosuppression, reactivation of latent TB
