rheumatology Flashcards
What do you expect the ANA, RF and ESR to be in patients with ankylosing spondylitis ?
Normal ANA and RF
Normal or mildly elevated ESR
What diagnosis presents with leg and back pain which is worse in the mornings and bending over but is relieved by exercise ? What are two other conditions associated with this disease?
Ankylosing spondylitis - uveitis and IBD
How should you treat a patient with ankylosing spondylitis ?
NSAIDs . Sulfadiazine and methotrexate
What diagnosis presents with ulcers in the mouth and genitals as well as uveitis and arthritis? How would you treat?
Behcet syndrome - steroids
What would you expect the following lab results to be in a patient with behcet syndrome: ANA, RF, ESR and CRP?
ANA and RF normal
Elevated ESR and CRP
What diagnosis would you suspect in a patient with clumsiness, shiny scaly skin on extensor surfaces, periungal lesions and difficulty swallowing ?
Dermatomyositis
What is the most appropriate initial step in the diagnosis of dermatomyositis? How would you treat?
Creatine kinase level
High dose steroids, immunosuppressives and IVIG
Avoid sunlight
Antimalarials sometimes used
Other than hypermobility of joints, what are 2 other findings associated with ehlers danlos syndrome ?
Poor wound healing and easy bruising
How can you distinguish Lowe’s syndrome from ehlers danlos syndrome?
Lowe’s also has hypermobile joints but also has blindness, intellectual disability and hypotonia
What diagnosis presents as blanching purpura on legs, crampy abdominal pain and blood in urine and stool? What lab findings do u expect to be abnormal?
Henoch schonlein purpura - elevated BUN/creatinine, urinalysis with protein and blood and normal platelet count!
What should be suspected when patients with HSP present with abdominal pain?
Ileoileal intussusception
What is the underlying cause/pathology of HSP?
Vasculitis of skin, GI Tract, joints and kidneys - usually after bacterial or viral infection
How can you distinguish the joint manifestations present in HSP from those seen in rheumatic fever ?
HSP involves periarticular disease with the soft tissues around the joints involved (vs articular disease in rheumatic fever)
What are the 8 main causes of polyarticular arthritis ?
Fabry disease Infection Reactive arthritis Rheumatic fever Serum sickness Connective tissue disease iBD Malignancy
What two criteria must be met in order to diagnose JIA?
Age of onset <16
Symptoms >6 weeks
What diagnosis should you suspect in a female with pain and swelling in >5 joints?
Polyarthritis JIA (type 1)
What diagnosis should you suspect in a child who presents with pain and swelling of 3 joints and uveitis?
Oligoarthritis JIA
What can an ANA and RF indicate in JIA?
Most patients are ANA positive and those with positive RF typically have worse disease
Both ANA and RF are usually negative in systemic JIA
What is the term used to describe systemic JIA which presents with extra-articular involvement?
Stills disease
What are 6 main extra-articular manifestations of systemic JIA?
High fever Leukocytosis Rash (red macules with central clearing that coalesce) Hepatosplenomegaly Lymphadenopathy Pleuritis/pericarditis
What is the first line treatment for a patient with morning stiffness & joint pain x 6 weeks, fevers and lymphadenopathy with symptoms that wax and wane? Second line treatment?
NSAIDs (1st line)
steroids and immunosuppressives (2nd line)
What are the abnormal lab findings common in Kawasaki?
Thrombocytosis Leukocytosis Normocytic anemia Elevated CRP/ESR Negative ANA/RF
When should cardiac ECHO be performed in patients suspected of having Kawasaki disease?
At time of diagnosis
2-3 weeks later
6-8 weeks after onset of illness
What is the appropriate treatment for Kawasaki disease ?
IVIG 2g/kg
Aspirin 80mg/kg for 48hr then 5mg/kg for 2 months
What is the difference between measles and Kawasaki disease?
Measles has exudative conjunctivitis and rash typically is descending
What is the cause of Lyme disease?
Immunologic response to borrelia burgdorferi
