Rheumatology Flashcards
which gender is more susceptible to RA?
women:men = 3:1 :(
the etiology of RA is unknown, but what are some possible contributing factors?
- genetics
- environmental factors
- certain cells might be involved (mast cells etc)
- autoimmune involvement (body attacks itself)
what is a pannus?
It is a layer of fibrovascular tissue that forms in the synovial membrane - it thickens the synovium and the body then releases tissue degrading enzymes and more synovial fluid into the joint space and degrades everything and makes it swell.
what are the three main physical results of RA?
joint degeneration
ligamentous laxity
joint deformities
what are some possible non-articular signs and symptoms of RA?
fatigue general malaise low grade fever aenemia depression weakness weight loss
- possibly hard fibrous tissue nodules (up to 50% ppl)
- vasculitis, Raynauds
- Sjögren’s Syndrome (eye and mouth dryness, scleritis and episcleritis)
- pulmonary fibrosis and pleurisy
- pericarditis and pericardial effusion
- carpal tunnel and cubital tunnel syndrome or other peripheral neuropathies
- GI, renal or hematological symptoms
what happens to the joints (signs and symptoms)?
- morning stiffness (After inactivity)
- symmetrical pain and swelling in certain joints (esp hands and feet)
- joint deformities
describe swan neck and boutonierre deformities
MCP - PIP - DIP
what are some other deformities that can happen with RA?
Swan neck = flex - ext - flex
Boutonierre = ext - flex - ext
zig-zag deformity (RD of wrist with UD of MCP) UD at MCP volar subluxation of MCP with swelling mallet toe (DIP flex) hammer toe (ext - flex - ext => like Boutonierre) claw toe (ext - flex - flex) hallux valgus genu valgus and varus C1-2 subluxation
what kind of lab tests can help indicate the presence of RA?
- serology (rheumatoid factor and antibodies)
- acute phase reactants (proteins associated with inflammation)
- hemoglobin levels (anemia)
what can bone scintigraphy (bone scan) tell?
- level of bone remodeling at joints
lupus affects which gender at a 5:1 ratio?
women
what do lupus and RA have in common?
both are systemic, chronic, inflammatory disorders with unknown etiologies but genetics plays a role, plus there is autoimmune involvement.
what systems can be affected by lupus?
skin: butterfly and other rashes, photosensitivity and ulcers.
muscles: myositis (resembles polymyositis).
joints: symmetric, inflammatory, non-erosive of distal > proximal capsule and supporting structures.
heart: pericarditis, myocarditis, accelerated atherosclerosis.
lungs: pleurisy, pleural effusion, pulmonary embolism or hypertension, interstitial lung disease.
kidneys: mild involvement but can have renal failure.
GI: nausea, vomiting, pain, diarrhea, peritonitis, colitis.
blood vessels: vasculitis, scin ulcers, GI bleeds, bowel infarction.
nervous system: stroke, seizure, headaches, peripheral or central neuropathies, depression, psychosis
what is usually present in the serum of those with lupus?
Antinuclear Antibodies (ANA)
what is pancytopenia? Is this associated with lupus?
low levels of WBCs, platelets, and RBCs
yes
does scleroderma affect women or men more? what is the most common presenting symptom?
women 3:1
Raynauds
what type of tissues does scleroderma affect? What does it do to these tissues?
affects connective tissue in skin and internal organs. Results in inflammation, vasculopathy and fibrosis.
what are the two types of scleroderma?
limited (CREST) or diffuse.
Limited has Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyly, Telangiectasia
usually distal to elbows/knees, less organ involvement, favourable prognosis.
Diffuse has involvement of trunk and proximal limbs, more organ involvement and permanent organ damage - less favourable prognosis. Can have “Mauskopf” facial changes
what systems can scleroderma affect?
skin - thickening
msk - erosive arthritis, myositis
GI - heartburn, atrophy of m so dysmotility, distension
lung - pulmonary fibrosis and hypertension
heart - myocardial fibrosis (can lead to sudden death)
kidney - renal hypertension, rapid failure
Describe the progression of Scleroderma in the hands
starts as sausage digits, progresses to sclerodactyly with bone resorption, contractures (MCP ext and PIP flex) and calcium deposits with open areas oozing chaulky material.
Does gout affect men or women more?
Men!
is gout chronic or acute?
acute
what causes gout? What do patients usually present with?
hyperuricemia (too much uric acid in blood - forms hard crystals that usually hit one MTP joint)
patients present with rapid redness and swelling of a joint accompanied by excruciating pain. Can have fever, chills, not able to weight bear or allow light touch, and will usually recover in 1-2 weeks.
Does AS affect women or men more commonly?
Men
The etiology of AS is unknown, but genetics are likely a factor. What other disease(s) are genetically linked with AS?
inflammatory bowel diseases (Chrons and ulcerative colitis)
which joints are most affected by AS?
axial skeleton, SI, sometimes large proximal appendicular joints
what are some other manifestations of AS other than inflammation of joints and subsequent bone formation (ankylosing the joints)
- inflammation of tendon/ligament attachments and fascia
- ocular inflammation
- cardiomyopathy
- chronic infiltrative changes in upper lung lobes
what would a patient with AS look like?
Early:
- night pain and morning stiffness (increase pain with immobility)
- long term pain and stiffness in mid/low back ( >3 months)
- loss of mobility of spine and loss of lumbar lordosis
- limited chest expansion
- low-grade fever, fatigue, anemia, loss of apetite, iritis
what are the three criteria for diagnosis of AS?
- history of inflammatory back pain
- loss of spinal mobility
- radiological evidence of sacroilitis
what would be expected on X-rays in early and late stages of AS?
- Sacroiliitus and squaring of vertebral bodies in early stages
- bamboo spine and fusion in late stages
are AS patients usually positive or negative for rheumatoid factor?
negative
What does DMARD stand for?
Disease Modifying Anti-Rheumatic Drug
what is usually given until DMARDS kick in?
NSAIDS or glucocorticosteroids
what is the most common DMARD prescribed?
methotrexate
the main downside of biologics is ____
cost ( > $20000 per year)
what type of drug is inflectra? what is it similar to?
biosimilar - similar to Remicade
how many points on the EULAR & ACR scale is needed to be diagnosed with RA? What are the 4 categories where one can have points?
6 points, from:
number of joints
RF factor present or not
acute phase reactants present or not
duration (+/- 6 weeks)
what are the 5 screening questions for AS?
- pain begin slowly?
- before 40?
- morning stiffness?
- exercise makes it better?
- been happening for more than 3 months?
what is a normal result of a modified schober’s test?
more than 4 cm longer compared to in neutral
