Rheumatology

Question 1

JRA

Answer 1

synovial inflammation leading to bone/ joint erosion, morning stiffness, limp or falling often, easily fatigued, joint swelling but NEVER red or exquisitely tender, alteration of activities/loss of function

Question 2

JRA: ACR classification criteria

Answer 2

MUST 1. age

Question 3

subgroup of JRA named after 6 months

Answer 3

systemic: arthritis w/ fever
pauciarticular: 4 or fewer joints
polyarticular: 5 or more joints

Question 4

Oligoarticular JRA

Answer 4

• 4 or fewer joints involving large joints like knees, ankles, wrists- NOT hip
• serology: POSITIVE ANA, negative RF
• main morbidity- ASYMPTOMATIC ANTERIOR UVEITIS (associated w/ positive ANA) can lead to blindness

Question 5

Poly JRA

Answer 5

• 5 or more joints involved- small and large joints like PIP, MCP, wrist
• rheumatoid nodules
• ANA may be positive
• RF may be positive or negative- if positive- worse prognosis

Question 6

systemic JRA

Answer 6

• males = females
• quotidian fever (goes up and down at certain times of the day over many days)
• rash- salmon colored “fleeting salmon colored rash” macular or wheal- like, not pruritic, may coalesce with fever
• ANA and RF negative
• leukocytosis
• visceral involvement- HSM, LAD, serositis

Question 7

JRA tx

Answer 7

• NSAIDS, naproxen
• DMARDS- methotrexate, anti- TNF agents, abatacept
• low dose steroids as bridging agents

Question 8

with JRA r/o what?

Answer 8

lupus i.e. SLE

Question 9

SLE criteria

Answer 9

• need at least 4 out of 11 criteria
• 4 skin- malar rash, discoid rash, photosensitivity, oral ulcers
• 2 immunologic- ANA, dsDNA, anti- Smith, antiphospholipid antibodies
• 5 organ systems- CNS (sz, psychosis), serositis, kidney (proteinuria), arthritis (non erosive), hematologic (lymphopenia

Question 10

malar rash

Answer 10

butterfly rash on face

Question 11

neonatal lupus

Answer 11

• maternal tx of antibodies

- complications- rash, HEART BLOCK (usually 3rd degree), hepatitis, neutropenia/thrombocytopenia, hydrops fetalis

Question 12

tx for neonatal lupus

Answer 12

supportive- may need cardiac pacing for heart block

Question 13

Henoch- Schonlein Purpura (HSP): clinical manifestations

Answer 13

• rash- palpable purpura, (usually in lower extremities), angioedema
• abdomen- colicky pain that may precede rash, intussusception w/ currant jelly stool
• arthritis- large joints like knees, ankles, wrists, periarticular therefore no damage to joint
• renal- hematuria, proteinuria- need 24 hr urine

Question 14

HSP labs

Answer 14

normal platelets
mild/ mod increase in WBC's
urinalysis, 24 hr urine- ranges from normal to nephritic picture
increased ESR
ANA/ RF negative
C3, C4 normal
ANCA negative

Question 15

HSP clinical course

Answer 15

usually self limiting dx in childhood, resolution in 6- 8 wks, recurrence in 33% within first few months, prognosis dependent on renal involvement, massive GI hemorrhage in 2% of patients, moderate to sever glomerulonephritis, renal insufficiency in 1%