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MSK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Gout Characteristics

A
  1. systemic disease of altered purine metabolism

2. more common in men until women until menopause

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2
Q

Gout Clinical Features

A
  1. initial attack of metatarsal phalangeal joint of greater toe
  2. tophi in chronic gout form adjacent to affected joint
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3
Q

Gout Diagnostic Studies

A
  1. Joint fluid analysis (rod-shaped, negatively birefringent urate cystals)
  2. uric acid above 8mg/dL
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4
Q

Non-pharm Gout Treatment

A
  1. elevation and rest

2. dietary modifications (etoh, red meats)

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5
Q

Pharm Gout Treatment

A
  1. NSAIDs (indomethacin)
  2. colchicine
  3. corticosteroid injections
  4. between acute attacks: colchicine, probenacid, sulfapyrazine, allopurinol (not during acute attack), febuxostat
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6
Q

Calcium pyrophosphate dihydrate (CPPD)/pseudogout general characteristics

A

affects peripheral joints, usually lower extremity, results from intra-articular deposition of calcium pyrophosphate

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7
Q

Pseudogout Clinical Features

A

most common joints are knees, wrist and elbows

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8
Q

Pseudogout Diagnostic Studies

A
  1. Rhomboid-shaped, positively birefringement crystals

2. linear calcifications (chondrocalcinosis)

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9
Q

Pseudogout Treatment

A
  1. NSAIDs

2. colchicine

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10
Q

SLE General Characteristics

A
  1. autoimmune disorder characterized by inflammation, positive ANA, involvement of multiple organs
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11
Q

Who does SLE most commonly affect?

A
  1. women of child-bearing age

2. prevalance among familial and ethnic groups (most common in African Americans)

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12
Q

Clinical Features of SLE

A
  1. positive ANA
  2. 4/11 criteria (malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disease, hematologic, immunologic, neurologic)
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13
Q

Drug-Induced Lupus

A
  1. Histone ANA
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14
Q

SLE diagnostic studies

A
  1. CBC, BUN, creatinine, UA, ESR, C3/C4
  2. Antibodies to smith antigen, dsDNA
  3. postive ANA
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15
Q

SLE treatment

A
  1. regular exercise
  2. sun protection
  3. NSAIDs for MSK pain
  4. Antimalarials (hydroxyxholoquine)
  5. corticosteroids
  6. methotrexate
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16
Q

Polymyositis Characteristics

A
  1. inflammatory disease of striated muscle affected the proximal limbs, beck, pharynx
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17
Q

Dermatomyositis

A
  1. skin manifestation of polymyositis

2. related to underlying malignancies

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18
Q

Clinical Features of Dermatomyositis

A
  1. heliotrope
  2. Grottens Papules (rash on knuckls)
  3. Shawl sign
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19
Q

Clinical Features of Polymyositis

A

painless muscle weakness

20
Q

Polymyositis Diagnostic Studies

A
  1. elevated CPK/ESR
  2. elevated aldolase
  3. muscle biopsy with myopathic inflammatory changes
21
Q

Polymyositis Treatment

A
  1. High-dose steroids

2. methotrexate/azathioprine

22
Q

Polymyalgia Rheumatica Characteristics

A
  1. 50yo+

2. women more than men

23
Q

Polymyalgia Rheumatica Clinical Features

A
  1. pain/stiffness in the neck, shoulder, pelvic girdles (especially morning)
  2. fever, fatigue, weight loss, depression
  3. MSK symptoms symmetrical, bilateral, proximal
24
Q

Giant Cell Arteritis Clinical Features

A
  1. scalp tenderness
  2. jaw claudication
  3. temporal artery tenderness
  4. BLINDNESS
25
Q

Giant Cell Arteritis Diagnostic

A
  1. Temporal Artery Biopsy
26
Q

Polymylagia Rheumatica Diagnostic Study

A
  1. ESR very elevated
27
Q

Polymylagia Rheumatica Treatment

A

Low dose steroids (may be required for up to 2 years)

28
Q

Polyarteritis Nodosa Characteristics

A
  1. medium arteries
  2. male more than females
  3. 40-60yo onset
  4. associated with Hep B
29
Q

Polyarteritis Nodosa Clinical Features

A
  1. fever, anorexia, weight loss, abd pain, pripheral neuropathy, arthralgias, arthritis
  2. palpable purapura
  3. livedo reticularis
  4. renal involvement (HTN, edema, oliguria, uremia)
30
Q

Polyarteritis Nodosa Diagnostic Studies

A
  1. ANCA
  2. vessel biopsy
  3. angiography
  4. elevated ESR/CRP and protein uria
  5. hep B antibody possible
31
Q

Polyarteritis Nodosa Treatment

A

high dose steroids

32
Q

Scleroderma (Systemic) Characteristics

A
  1. collagen deposition in skin, heart, lungs, stomach
  2. females more than males
  3. 30-50yo onset
33
Q

Scleroderma Clinical Features

A
  1. Raynauds
  2. collagen depositions
  3. puffy hand stage
  4. nailfold involvement
  5. watermelon stomach, GI dismotility
  6. pHTN
34
Q

CREST Clinical features

A 
C- calcinosis cutitis
R- Raynauds
E- esophageal dysfunction
S- sclerodactyly (thickening of skin on fingers)
T- telanigctasia (dilated small vessels)
35
Q

Diagnostic Studies of CREST

A

+ANA with centromere pattern

36
Q

Diagnostic Studies of SS

A
  1. +ANA (speckled pattern)

2. anti-SCL-70

37
Q

Scleroderma monitoring

A

PFT’s annually!! screening for phtn

38
Q

Scleroderma Treatment

A 
1. No cure
Organ-specific:
2. PPI for reflux
3. ACE inhibitors for renal disease
4. Ca-channel blockers for Raynauds
5. immunosuppresives for pHTN
39
Q

Sjogren Characteristics

A
  1. autoimmune disorder that destroys salivary and lacrimal glands
  2. could be secondary to to RA, SLE, polyomyostitis, scleroderma
40
Q

Sjogren Clinical Features

A
  1. xerostomia (dry mouth)
  2. xerophthalmia (dry eyes)
  3. swollen parotid gland
41
Q

Sjogren Diagnostic Studies

A
  1. Shirmer test
  2. +RF
    • ANA
  4. anti-Ro antibodies
  5. anti-La antibodies
  6. lower lip biopsy
42
Q

Sjogren Treatment

A

Symptomatic

  1. pilocarpine (increase salia flow)
  2. cyclosporine (ocular sxs)
43
Q

Fibromylagia Characteristics

A

Central pain diorder

44
Q

Fibromylagia Clinical Features

A
  1. nonarticular MSK aches, pains, fatigue, sleep disturbances, multiple tender “trigger” points
  2. fatigue, sleep disruption, mood changes, cognitive disturbances, anxiety, depression, HA, IBS
45
Q

Fibromylagia Diagnostic Studies

A

exclusion of other dxs

46
Q

Fibromylagia Treatment

A
  1. SSRI
  2. TCA
  3. Pregabalin (Lyrica)
  4. aerobic exercise
  5. patient education! (stress reduction, sleep assistance)

MSK (9 decks)

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