Rheumatology Flashcards
Differential for hot swollen joint?
Septic arthritis, gout, pseudogout, hemarthrosis
How to work up hot and painful joint?
Tap it
Appearance of normal joint fluid
Serous,
Appearance of OA joint fluid
Normal! Serous
Appearance of inflammatory joint fluid
Cloudy, between 5 and 50,000 WBC
Poly predominance
Appearance of crystal arthropathy fluid?
Cloudy, between 5 and 50,000 WBC
Poly predominance. Intracellular crystals
Appearance of septic joint fluid
> 50,000 WBC, Opaque, 90% polys. + gram stain (except for GC)
Sexually active female with hot swollen joint?
Think gonococcal arthritis. Careful because it doesn’t gram stain well
ANA
Lupus
Anti-CCP
RA
RF
RA
Anti-histone
Drug induced lupus, procainamide, isoniazid, hydralazine
Anti ds DNA
Lupus, correlates with renal disease
Centromere
CREST
Anti topoisomerase
Scleroderma (systemic)
Anti smooth muscle
Autoimmune hepatitis
Ro+lA
Sjogrens
Antimitochondrial
PBC
Anti Jo
Myositis
Lupus
Autoimmune complex formation and deposition
Symptoms of LUPUS
MD SOAP BRAIN
Malar Rash Discoid rash Serositis oral ulcers arthritis photosensitivity blood (decreased ph and decresed hgb) Renal failure ana immunologic complex neuro (cerebritis, transverse myelitis)
Liebman sach’s endocarditis
How to diagnose lupus
Need 4 sxs with ANA and DSDNA
U/A with biopsy for nephritis
Get complement levels (will be decreased) during a flare
ESR and CRP to track progress
How to treat Lupus?
Treat arthritis and serositis with NSAIDS (or hydroxychloroquine)
Treat flare with steroids
Treat severe disease with cyclophosphamide
RA
Autoimmune, affects women>men >40 years old. Pannus formation with joint destruction. Periarticular osteopenia.
Symptoms of RA
Symmetric joint involvement that spares dips. Morning stiffness, nodules filled with cholesterol, C1 and C2 spinal involvement
Diagnosis of RA
Anti CCP and RF
How to treat RA?
NSAIDs for symptomatic relief
DMARDS for everybody –MTX
If severe, then biologics like infliximab.
Steroids during a flare
Felty syndrome
RA + neutropenia + splenomegaly
Scleroderma
Collagen deposition that replaces smooth muscle
CREST and systemic
CREST syndrome
Calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasias
Systemic sclerosis
Interstitial lung disease and scleroderma renal crisis (malignant hypertension with renal failure, hemolytic anemia and thrombocytopenia)
Pulmonary hypertension in scleroderma
Happens in both crest syndrome and systemic sclerosis
How to treat scleroderma
Can’t do anything, can, however, treat interstitial lung disease with cyclophosphamide.
How to treat scleroderma renal crisis?
ACE inhibitors
Sjogren’s Disease
Lymphocytic infiltration of exocrine glands,
dry eyes, dry mouth, parotid swelling. Shermer test
Treat with artificial tears and saliva.
Inclusion body myositis vs polymyositis vs dermatomyositis pathogenesis
Inclusion - t cell mediated
polymyositis - t cell mediated
dermatomyositis - immune complex deposition
How do patients with myositis present
Proximal muscle weakness with painful muscles.
Grotton’s papules, heliotrope rash, shawl sign
How to diagnose myositis
EMG, muscle biopsy, anti jo
How to treat myositis
Steroids or find the cancer.
