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Blood and Lymph Section III > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the etiology of osteoarthritis?

A

Mechanical - Joint wear and tear destroys articular cartilage

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2
Q

What are the joint findings in osteoarthritis?

A

Subchondral cysts, sclerosis, osteophytes, eburnation, Heberden nodes, Bouchard nodes, no MCP involvement.

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3
Q

What are the predisposing factors for osteoarthritis?

A

Age, obesity, joint deformity, trauma

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4
Q

What is the classic presentation of osteoarthritis?

A

Pain in weight bearing joints after use (e.g. at end of day) improves with rest. Knee cartilage loss begins medially (bowlegged), Noninflammatory, no systemic symptoms.

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5
Q

What is the treatment for osteoarthritis?

A

NSAIDs, Glucocorticoids.

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6
Q

What is the etiology of Rheumatoid arthritis?

A

Autoimmune - inflammatory destruction of synovial joints. Mediated by cytokines and Type III and Type IV hypersensitivity reactions.

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7
Q

What are the joint findings of Rheumatoid arthritis?

A

Pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules (fibrinoid necrosis), ulnar deviation of fingers, subluxation, Baker cyst (in popliteal fossa), no DIP involvement.

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8
Q

What are the predisposing factors for Rheumatoid arthritis?

A

Females > males, 80% have RF, anti-cyclic citrullinated peptide antibody is more specific, Strong association with HLA-DR4.

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9
Q

What is the classic presentation of Rheumatoid arthritis?

A

Morning stiffness lasting > 30 minutes and improving with use, symmetric joint involvement, systemic symptoms (fever, fatigue, pleuritis, pericarditis).

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10
Q

What is the treatment for Rheumatoid arthritis?

A

NSAIDs, glucocorticoids, disease modifying agents (DMARDs - methotrexate, sulfasalazine, TNF-a inhibitors)

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11
Q

What is the etiology of Sjogren syndrome?

A

Autoimmune disorder, characterized by destruction of exocrine glands (esp. lacrimal and salivary), Predominantly affects women 40-60 years old.

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12
Q

What are the signs and symptoms of Sjogren syndrome?

A

Xerophthalmia (dec. tear production and corneal damage), Xerostomia (Dec. saliva production), Antinuclear antibodies (SS-A, SS-B), Bilateral parotid enlargement.

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13
Q

What are the predisposing factors for Sjogren syndrome?

A

Can be primary disorder or secondary to other autoimmune disorders (e.g. RA) Complications include dental caries, and MALT lymphoma.

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14
Q

What is gout?

A

An acute inflammatory monoarthritis caused by precipitation of monosodium rate crystals in joints. Crystals are needle shaped and not “birefringent” (yellow under parallel light, blue under perpendicular light)

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15
Q

What condition is gout associated with and what causes this condition?

A

Gout is associated with hyperuricemia, which can be caused by: Underexcretion of uric acid (90% of cases) which is idiopathic or exacerbated by thiazide diuretics; or by Overproduction of uric acid (10% of cases) as in Lesch-Nyhan syndrome, tumor lysis syndrome (inc cell turnover) PRPP excess.

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16
Q

What are the symptoms of gout?

A

Asymmetric joint distribution. Joint is swollen, red, and painful. Classically MTP joint of big toe, Tophus formation, acute attack tends to occur after big meal or alcohol intake.

17
Q

What is the treatment for gout?

A

NSAIDs, glucocorticoids, colchicine; preventives: xanthine oxidase inhibitors (allopurinol, febuxostat)

18
Q

What differentiates pseudo gout from gout?

A

Pseudogout is the deposition of calcium pyrophosphate crystals in a joint space. Basophilic, rhomboid crystals, weakly birefringent (blue in parallel light), Usually affects large joints (knees) Associated with hemochromatosis, hyper- and hypo-parathyroidism.

19
Q

What is the definition of a seronegative spondyloarthropathy?

A

Negative for Rheumatoid factor and ANA, Strong association with HLA-B27, also known as Axial Arthropathies sometimes with peripheral arthropathy, Affect Enthesis, subdivided into Ankylosing Spondylitis, Psoriatic arthritis, reactive arthritis, and IBD related arthritis.

20
Q

High points of Psoriatic arthritis

A

Joint pain and stiffness associated with psoriasis, Asymmetric and patchy joint involvement usually upper extremity, PIP, DIP, MCP, also may have Dactylitis (sausage fingers),

21
Q

High points of Ankylosing Spondylitis

A

Chronic inflammatory disease of spine and sacroiliac joints, “Ankylosis” stiff spine due to fusion of joints, uveitis, aortic regurgitation. Males 16-40 y/o, “Bamboo spine”

22
Q

High points of IBD associated Arthritis

A

Crohn disease and ulcerative colitis are often accompanied by ankylosing spondylitis or peripheral arthritis

23
Q

High points of reactive arthritis (Reiter syndrome)

A

Classic triad: Conjunctivitis and anterior uveitis, Urethritis, Arthritis (“can’t see, can’t pee, can’t bend my knee”) Follows GI infection by shigella, salmonella, yersinia, campylobacter, or Chlamydia infection.

24
Q

What are the symptoms of Systemic Lupus Erythematosus?

A

Classic presentation: Rash, joint pain, fever most commonly in females of reproductive age and African descent, Lupus nephritis: Type III hypersensitivity reaction, may be diffuse proliferative glomerulonephritis or membranous glomerulonephritis.

25
Q

What are common lab findings in SLE?

A

ANA, Anti-dsDNA antibodies, Anti-Smith antibodies (against snRNPs), Anti-histone antibodies (drug induced lupus), Anticardiolipin antibodies (prolonged PTT but with inc. risk of arteriovenous thromboembolism), dec C3, C4, and CH50 due to immune complex formation.

26
Q

What are treatments for SLE?

A

NSAIDs, steroids, immunosuppressants, hydroxychloroquine

27
Q

What are the signs/symptoms of Polymyositis?

A

Progressive symmetrical proximal muscle weakness, characterized by endomysial inflammation with CD8 T-cells (inside the muscle fibers). Often involves shoulders.

28
Q

What are the signs/symptoms of Dermatomyositis?

A

Similar to Polymyositis, but involves perimysial inflammation with CD4 T-cells (outside the muscle fibers). Also may show: malar rash, Gorton papules, heliotrope rash, shawl sign, mechanics hands, and increase in occult malignancy.

29
Q

Lab findings common to PM and DM?

A

Inc. CK, Positive ANA, anti-Jo-1, anti-SRP, anti-Mi-2 antibodies.

30
Q

What is the treatment for PM and DM?

A

Steroids

Blood and Lymph Section III (2 decks)

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