Rheumatology Flashcards
Henoch schonlein purpura
IgA mediated vasculitis involving skin, J, GI, kidney
epi: 75%
kawasaki cause of disease
phase 1: acute phase 1-2wks. ESR and CRP incr. high dose ASA for anti inflm
phase 2: subacute phase wks to mo. incr plt, decr ESR and CRP. low dose ASA for anti-plt effect. when aneurysms occur
phase 3 convalencnet phase wks-y. labs normalize
juvenile rheumatoid arthritis
chronic joint inflm w/wo extra articular involvment.
epi: most common per rheum disease.
onset 1-3yo. F>M excpet M=F in systemic onset and M> F in late onset pauciarticular JRA.
3 types classified by sx of 1st 6mo: pauciarticular, polyarticular, systemic
pauciarticular JRA
8yo. HLA-B27+. hips and sacroiliac J. less uveitis. risk spondyloarthropathy
polyarticular JRA
> 4J. 40% JRA
if have serum rheumatoid factor (RF): >8yo, more severe, rheumatoid nodules.
RFneg- any age. deforming arthritis
systemic onset JRA (Still’s disease)
20% of JRA. spiking high fever >102.2=39 in afternoon or evening. in dd of fever of known origin.
transient salmon colored rash. evanescent with fever spikes then fades. nonpruritic
hepatosplenomeglay, lymphadenopathy. fatigue, anorezia, wt loss, FTT. serositis, CNS invoed, myositis, tenosynovitis
Dx: onset J, >6wk, exclusion of other arthritis
lab: nonspecific- anemia, incr ERS/CRP, ana
tx: NSAID for inflm, mechanical and phsycial therapy to min contractors.
50% resolve, 50% C
SLE
peaks in adolescence.
F>M, bf 10yo rare. cause unknown
Dx: SOAP BRAIN MD
Serositis (pleuritis or pericaridal inflm), Oral or nasl mucotaneous ulceration, Arthritis-noneurosis/migratory, Photosensitivity, Blood cytopenias (leukopenia, hemolytic anemia, thrombocytopenia, pos coombs), renal disease or raynaud’s phenomenon, ANA pos, Immunoserolgy abn, neuro sx (enceph, sz, psychosis), Malar rash, Discoid lupus
anti-dsDNA is specific -marker of active disease.
anti-SMith ab are less prevalent but specific.
anto-ppl= risk for thrombotic event
decr C3/4 = immune complex activation.
mostly die from infection /2 to immunosuppression, renal failure, CNS C
cyclophosphamide
IV pulsed for kids with severe lupus nephritis
tx lupus complications
thrombosis or anti ppl ab need heparin or warfarin. renal failure need dialysis, fluid management, renal transplant
Dermatomyositis etio, epi, P
progressive M weakness.
5-14yo
F>M
P: constituional yuckiness, sun exposed area get periorbital violaceous heliotrope rash, gottron’s papule (skin over metacarpal and PIP J become erythematous and hypertrophic). proximal M weakness (hip girdle and legs), insidious onset. pos Gowers’ sign. neck flexor weakness, calcinosis, nail bed telangiectasis, constipation, dysphagia, cardiac
dermamyositis dx, tx, C, prog
dx: P, abn electromyography, abn M bx, incr M enzymes (CPK, aspartate trasnferase lactate DeH.
tx: corticosteroids. Vit D+ ca.
C: aspiration pneumonia bc decr gag, intestinal perfoation, osteopenia duet o steorid tx.
prog- better in kids than adults. no association with malig in kids.
rheumatic fever P
C of GABHS-pharyngitis infection with info of CT. most affect heart, vessels, J, CNS, skin
Cardiac: 50%, all layers but endocarditis most common- insufficiency of material and aortic. V. myocarditis if tacky >fever or dilatation/ HF.
migratory, asymmetric polyarthritis. no chronic J disease
sydenham’s chorea- mo after pharyngitis. reflect involvement of basal ganglia and caudate nuclei. start as hand clumsiness then choreoathetoid mV and emotional lability
skin: erythema marginatum- spread centripetally with central clearing over trunk and limbs
subQ nodules- associate with severe cardiac prob
rheumatic fever dx lab tx
dx: Jones criteria2 major or 1 major + 1minor
major: migratory polyarthritis, carditis, sydenham’s chorea, eryythema marginatum, subQ nodules
minor: fever, arthralgia, previous RF, leukocytosis, elevated ESR or CRP, prolong PR
lab: antistreplysin -O titer inducate recent GABHS infection. AntiDNase and anti hyaluronidase ab
tx: penicillin. NSAID(only after dx is certain)
haloperidol for severe sydenham chorea
lyme disease stages
borrelia burgorferi.
early disease 1-4mo: 1)localized cutaneous innovation and inflm, erythema migrans- annular/target like. fever, HA, myalgia, arthralgia, LA
2)early disseminated disease: skin, neurotic -aseptic meningitis, facial N palsy, encephalitis, carditis-heart block
late disease: 5-15mo. arthritis
lyme dx, tx
dx: P. lab- nonspecific. ab to b burdorferi. WLISA, western blot
tx: eradicate B burgdorferi. doxy or amoxicillin for early localized disease or late disease with arthritis.
carditis and meningitis - IV ceftriazone or penicilllin
