Rheumatology Flashcards
Treatment of dermatomyocytis
1st line treatment is prednisone, if no response can use azathioprine or methotrexate in addition, last line is immunoglobulin
Modifiable risk factor for RA
Smoking increases the risk of RA
Lofgren syndrome
Sarcoid presenting as: fever, erythema nodosum, polyarthralgia and hilar lymphadenopathy. Do not need tissue diagnosis
Heerfordt syndrome
Sarciod presenting as: uveitis, parotid enlargement, and fever. Do not need tissue diagnosis
Gout or infected joint?
They can occur at the same time. Suspect infection if the synovial leukocyte count is >50,000
Treatment of RA, 2nd agent
If patient fails methotrexate start combination therapy by adding a TNF-alpha inhibitor.
Treatment of ankylosing spondylitis
First line treatment is routine use of NSAIDs. If not tolerated then TNF-alpha inhibitors. Nonbiologic DMARDs are NOT effective in axial disease
Inclusion body myositis
Most common form of myositis >60, men
Proximal and distal muscle weakness
CK is modestly elevated
No extramusclar manifestations
Polymyositis
Younger patients, women
Proximal muscle weakness
Extramuscular manifestations are common
Tend to have positive auto-antibodies (80% +ANA)
Type I cryoglobulinemic vasculitis
Monoclonal immunoglobin, paraprotein Seen in patients with Sjogrens, Waldenstrom and multiple myeloma Palpable purpura Mononeuritis multiplex Immune complex glomerulonephritis low C3 and C4
Type II cryoglobulin vasculitis
Most commonly occurs in active hep C infection
Palpable purpura
Mononeuritis multiplex
Immune complex glomerulonephritis
RA developing SLE symptoms?
Drug induced lupus can occur with the TNF-alpha inhibitors (etnercept)
Mangement of SLE in pregnancy
Okay to use hydroxchloroquine. If have severe disease okay to have azathioprine if necessary. Prednisone for flare
Treatment of systemic sclerosis
MSK features are best treated with MTX
Alveolitis with cyclophosphamide
Management of arthritis associated with IBD
Start with sulfasalazine if NSAIDs worsen bowel symptoms.
Anti-UI ribonucleoprotein antibodies (RNP)
mixed connective tissue disease
Antiproteinase-3 antibodies
produce cANCA pattern and associated with granulomatosis with polyangiitis
HSP
Small vessel vasculitis, palpable purupura, arthritis, abdominal pain and hematuria. Leukocytoclastic vasculitis with IgA deposits
Microscopic polyangiitis
Small vessel vasculitis, +p-ANCA and antimyeloperoxidase antibodies , pulmonary involvement, glomuerulonephritis and purpuric skin lesions
Polyarteritis nodosa
Medium vessel vasculitis, Mononeuritis multiplex, HTN, testicular, abdominal pain, look for hep B
Granulomatosis with polyangiitis
Small vessel vasculitis, AKA Wegener, upper airway, mononeurititis multiplex, + c-ANCA (antiprotenase-3 antibody), pulmonary, ocular and renal disease
Testing in myasthenia
most patients are acetylcholine receptor antibody +, some are MuSK +, get a chest CT to look for thymic hyperplasia or thymoma
Reactive arthritis
Inflammatory arthritis that starts within 2 months of bacterial gastroenteritis or non-gonococcal urethritis/cervicitis. Can also have conjunctivitis. NSAIDS and steroids are the go to. If not effective try sulfasalazine
Paroxysmal nocturnal hemoglobinuria
Unprovoked venous clots. Hemolytic anemia. Mild to moderate pancytopenia. Diagnose by flow cytometry showing that erythrocytes and lymphocytes do not have CD55 and CD59
