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rheum and ortho packrat > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

NSAID MOA and effects? (Hint: 3)

A

Inhibit cyclooxygenase and prostalglandin. Anti-pyretic, anti-pain, anti-inflammatory

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2
Q

Steroid MOA?

A

Upregulate expression of anti-inflammatory proteins and downregulate expression of proinflammatory poroteins

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3
Q

Sulfa class and MOA?

A

DMARD/Non-biologic.

MOA not well understood. Slows down or stops joint damage.

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4
Q

Antimalarial class and MOA?

A

DMARD/Non-biologic.

Reduces activation fo dendritic cells and the inflammatory process

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5
Q

Alkylating Agents class and MOA?

A

DMARD/Non-biologic. Chemotherapy agents.

Interferes with DNA replication.

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6
Q

Antimetabolite class and MOA?

A

DMARD/Non-biologic.

Interfere with nucleic acid synthesis

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7
Q

Methotrexate which type of drug?

A

Antimetabolites

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8
Q

Immunosppressant class and MOA?

A

DMARD/Non-biologic.

Suppress B and T cells (big roles in inflammation)

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9
Q

Tacrolimus which type of drug?

A

Immunosuppressant

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10
Q

What are DMARD/Biologic drugs?

A

Genetically engineered proteins originally from human genes. Target specific parts of immune system which fuel inflammation.

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11
Q

TNF-Alpha-Neutralizer class and MOA?

A

DMARD/Biologic.

Blocks tumor necrosis factor, messenger which drives inflammation.

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12
Q

IL-6-Inhibitor class and MOA?

A

DMARD/Biologic.

Blocks protein IL-6 from attaching to cells stoking inflammation.

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13
Q

Tocilizumab (Actrema) drug class?

A

DMARD/Biologic. IL-6-Inhibitor.

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14
Q

B-Cell Biologic class and MOA?

A

DMARD/Biologic.

Wipes out B-cells involved in inflammation.

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15
Q

T-Cell Biologic class and MOA?

A

Attaches to surface of T-Cells blocking communication between them

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16
Q

Novel Class class and MOA?

A

Inhibits Janus Kinase enzymes of inflammation. Targets RA cells from inside, single target.

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17
Q

What cells and where do the Novel Class target?

A

RA cells from inside.

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18
Q

Is the etiology of Rheumatoid Arthritis known?

A

Unknown eti

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19
Q

Rheumatoid Arthritis affects joints with what sort of lining?

A

Synovial lining

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20
Q

Which cell mediates Rheumatoid Arthritis?

A

T-Cells

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21
Q

Hallmark sx of Rheumatoid Arthritis?

A

Symmetrical Synovitis

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22
Q

What parts of body most affected by Rheumatoid Arthritis?

A

Hands and feet

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23
Q

How many joints swollen for how long to make dx for Rheumatoid Arthritis?

A

2+ swollen joints for 6+ weeks

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24
Q

Which 2 antibodies in Rheumatoid Arthritis?

A

RF or ACPA Antibodies

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25
Q

Tx for Rheumatoid Arthritis?

A

Early DMARD is TOC

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26
Q

Etiology of Reactive Arthritis?

A

Arthritis due infection in other part of body

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27
Q

Which bacteria and what site most common in men with Reactive Arthritis?

A

Camphylobacter in enteric

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28
Q

Triad in Reactive Arthritis?

A

Urethritis, Arthritis, Conjunctivitis

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29
Q

Symmetric or Asymmetric arthritis in Reactive Arthritis?

A

Asymmetric

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30
Q

When do sx appear in Reactive Arthritis?

A

2-4 weeks post GI or GU infection

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31
Q

Other than joint pain what sx in Reactive Arthritis?

A

Malaise, fever, fatigue

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32
Q

Can infection be cultures from joints in Reactive Arthritis?

A

Nope

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33
Q

What is Dx based on in Reactive Arthritis?

A

History and Physical. No labs.

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34
Q

Gene associated with 30-50% of Reactive Arthritis?

A

HLA-B27

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35
Q

Tx for Reactive Arthritis?

A

NSAIDs, intraarticular glucocorticoid injectin, systemic glucocorticoids, non-bio DMARDs (sulfa, methro), bio DMARDs (TNF-I)

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36
Q

Eti of Juvenille Rheumatoid Arthritis?

A

Unknown

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37
Q

Age of onset in Juvenille Rheumatoid Arthritis?

A

<16 y/o

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38
Q

Most common rheumatoid disease in kids?

A

Juvenille Rheumatoid Arthritis

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39
Q

Oligo/Pauci Articular JRA what percent of cases?

A

50%

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40
Q

How any joints affected in Oligo/Pauci JRA? Which?

A

≤5 joints. Weight-bearing joints.

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41
Q

What ophthamological complication in Oligo/Pauci Articular JRA?

A

Anterior Uveitis

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42
Q

How to Oligo/Pauci JRA kids appear?

A

Appear well

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43
Q

Polyarticular JRA what percent?

A

30-40%

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44
Q

Polyarticular JRA number of joints and what types?

A

≥6 joints, any size

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45
Q

Which joints stiff in Polyarticular JRA?

A

TMJ and cervical joints

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46
Q

Small joints involvement in Polyarticular JRA- symmetrical or asymmetric?

A

Symmetric small joint involvement

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47
Q

Systemic JRA what percent of cases?

A

10%

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48
Q

Systemic JRA appear? Fever?

A

Fever 103+ once or twice a day around same time. Appear ill, chest pain, friction rub.

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49
Q

Rash in Systemic JRA? Where on body?

A

Evanescent rash, no itch. On trunk and extremities

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50
Q

If JRA dx and tx before 7 y/o vs after 7?

A

Before 7=good chance of remission

After 7=might spread and stick around

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51
Q

Tx for JRA?

A

NSAIDS and corticosteroids to reduce joint dmg and prevent loss of function, induce remission and reduce flares.

Intraarticular triancinolone. Methotrex or Lefuomide.

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52
Q

Polymyositis etiology? Who gets most?

A

Idiopathic inflammatory myopathy. W>M.

>Black population

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53
Q

What happens to muscles in Polymyositis?

A

CD8 T-cells and macrophages surround and invade healthy muscle fibers and destroy them

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54
Q

Polymyositis develops over how long?

A

Develops over 3-6 months

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55
Q

Location of muscles affected by Polymyositis? Symmetrical or asymmetrical?

A

Symmetrical proximal muscle

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56
Q

Two major risks in Polymyositis?

A

Dysphagia and aspiration

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57
Q

Difficult movements in Polymyositis?

A

Difficulty kneeling, climbing stairs, get up from chair, hold head up

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58
Q

Two muscles sparred in Polymyositis?

A

Ocular and facial muscles normal

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59
Q

Any pain or sensation in Polymyositis?

A

No pain, normal sensation

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60
Q

CPK in Polymyositis?

A

5-50x elevated

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61
Q

LAD in Polymyositis means what?

A

Muscle damage

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62
Q

AntiJo-1 and EMG in Polymyositis?

A

Positive for AntiJo-1. Abnormal EMG in 90%

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63
Q

Test of choice in Polymyositis?

A

Muscle biopsy. Show focal CD8 T-lymph infiltration.

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64
Q

1st line tx in Polymyositis? If no improvement in 4 weeks? Refractory?

A

1st line=Prednisone
4 weeks=Immunomodulators
Refractory=Tacrolimus

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65
Q

Polymylalgia Rheumatics (PMR) etiology? Who gets?

A

Unknown. Effect eldery 72+, mostly women.

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66
Q

What activated in PMR?

A

Systemic macrophage and T-cell activation

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67
Q

Location of myalgia in PMR? When most stiff?

A

Proximal myalgia of shoulders and hip girdle. Morning stiff for 1+ hr.

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68
Q

Shoulder pain unilateral or bilateral in PMR?

A

Initially unilateral then bilateral

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69
Q

Difficulty doing what in PMR?

A

Difficult woverhead activities and getting out of bed

70
Q

ESR in PMR?

A

> 40

71
Q

Pain and morning stiff in PMR?

A

Pain >1 month

Stiff 1+hr

72
Q

1st line Tx in PMR?

A

Prednisone and NSAIDs when tapering

73
Q

Vasculitis divided into what three main types?

A
  1. Large vessel
  2. Medium vessel
  3. Small vessel
74
Q

Giant Cell Arteritis has major crossover with what other rheumatological condition?

A

Polymylagia Rheumatics

75
Q

Takaayshu Arteritis can result in what syndrome?

A

Subclavian Steel Syndrome

76
Q

Subclavian Steel Syndrome cause?

A

Stenotic lesion of vetebral artery causing retrograde blood flow

77
Q

Subclavian Steel Syndrome manifestation?

A

Decreased BP in arms, asymmetrical decreased pulses in arms and legs

78
Q

Who mostly develops Takayasu Arteritis?

A

Female asian 40+

79
Q

What major artery does Takayasu Arteritis affect?

A

Aortic body and branches

80
Q

Tx of Giant Cell Arteritis if vision preserved?

A

PO Prednisone 40-60mg

81
Q

Tx of Giant Cell Arteritis if vision not preserved?

A

IV Methylprednisolone 1g x3 days

82
Q

Medium Vessel Vasculitis affects which 4 arteries?

A
  1. Splenic
  2. Renal
  3. Hepatic
  4. Mesenteric
83
Q

Polyarteritis Nodosa (PAN) spares which organ but always affects what?

A

Spared lungs, kidneys always affected

84
Q

Polyarteritis Nodosa (PAN) GI manifestations?

A

Bleesing, pain, NV

85
Q

Polyarteritis Nodosa (PAN) and skin manifestations?

A

Skin molting, purpura, ulcers, nodules

86
Q

Polyarteritis Nodosa (PAN) and kidneys?

A

Glomerular ischemia + HTN

87
Q

Polyarteritis Nodosa (PAN) tx? Mild, moderate, severe?

A

Mild=PO Prednisone
Moderate=Cyclophosphamide
Severe=Methylprednisolone IV

88
Q

Kawasaki Dz primarily affects who?

A

Infants and young children

89
Q

Kawasaki Dz fever lasts for how long?

A

5 days!

90
Q

Kawasaki Dz and tongue?

A

Strawberry tongue

91
Q

Kawasaki Dz involves what major organ?

A

Heart! Can affect coronary arteries!

92
Q

Kawasaki Dz hands and feet? Skin?

A

Red palms and soles. Polymorphous rash.

93
Q

How often EKG with Kawasaki Dz?

A

2 and 6 weeks

94
Q

Kawasaki Dz tx?

A

IVIG 2g/kg over 8-12h and ASA 30-50mg/kg q8h. Observe for 12-24h until fever gone.

95
Q

Small Vessel Vasculitis affects which vessels?

A

Small intraparynchymal arteries, arterioles, capillaries, venules

96
Q

Micropolyangitis most common syndrome?

A

Pulmonary-Renal Syndrome most common in small to med vessels

97
Q

Micropolyangitis most common in?

A

4-5th decade. Men=Women

98
Q

Micropolyangitis clinical manifestation? (Hint: lungs)

A

Purpura, pulmonary hemmorhage, splinter hemmorhage, interstitial lungs fibrosis, ulcers

99
Q

Micropolyangitis dx?

A

Elevated acute phase reactants

+ANCA, +Hema/Proteinuria, +RBC Casts

100
Q

Granulomatosis with polyangiitis classic triad? What else affect?

A

Triad=Upper resp dz, lower resp dz, glomerulonephritis

Other=proptosis, ptosis, ophaloplegia, slcerosis

101
Q

Granulomatosis with polyangiitis sx develop over how long?

A

4 months and slowly

102
Q

Granulomatosis with polyangiitis and nose?

A

Crusting/ulcerating/bleeding nasal septum

103
Q

Granulomatosis with polyangiitis dx?

A

Chest CT, UA, elevated ESR and CRP

104
Q

Tx for Granulomatosis with polyangiitis and Micropolyangitis?

A

Cyclophosphamide PO + Prednisone, Rituximab PO + Prednisone, continue Cylo x3-6 months

105
Q

Who gets IgA Vasculitis?

A

5-7 y/o, Fall/Winter/spring

106
Q

IgA Vasculitis deposits?

A

IgA1-dominant immune deposits

107
Q

IgA Vasculitis and purpura?

A

Palpable purpura

108
Q

IgA Vasculitis classic tetrad?

A

Palpable purpura, arthralgia/arthritis of LE large joints, abd pain, renal dz

109
Q

IgA Vasculitis dx?

A

H+P. If doubt then biospy.

110
Q

IgA Vasculitis tx?

A

PO Hydration, rest, NSAIDS.

Severe abd pain and can’t PO=Prednisone

111
Q

Variable Vessel Vasculitis Behcet Dz gene risk?

A

HLA-B51 increases risk

112
Q

Variable Vessel Vasculitis Behcet Dz triad?

A

Aphthous ulcers, genical lesions, recurrent eye inflammation

113
Q

Variable Vessel Vasculitis Behcet Dz leading cause of blindness where?

A

Japan

114
Q

Giant Cell Arteritis dx gold standard?

A

Biopsy

115
Q

Giant Cell Arteritis ESR?

A

Always above 70, often above 100

116
Q

Wegner’s aka

A

Granulomatis w/polyangiitis

117
Q

What causes gout?

A

Overproduction or underexcretion of uric acid crystals which building up in joints, tissues (tophi), and fluids

118
Q

What is cause of 90% of gout?

A

Underexcretion of urate

119
Q

What is #1 arthopathy in US?

A

Gout

120
Q

What do Thiazides (HCZT) and low-dose ASA do in gout patient?

A

Increase uric acid levels

121
Q

Define Podagra in gout patient

A

Severe pain, redness, and tender joints.

122
Q

What do joints look like in gout patient?

A

Warm, tense, dusky red

123
Q

Where to 50% of initial gout attack occur?

A

MPT of great toe

124
Q

Where does gout usually occur? (Hint: Three places)

A

Feet, angles, knees

125
Q

What are tophi?

A

Happens in chronic gout. Bone destruction and erosion d/t urate crystals. Causes gross deformity and functional loss.

126
Q

Dx of gout?

A

Arthrocentesis. Shows intracellular uric acid crystals.

127
Q

What will 24h urine test show in gout patients?

A

Underexcretors=normal

Overproducers=high

128
Q

Dietary tx for gout?

A

Avoid red and organ meat, beans, peas, EtOH, fat milk

129
Q

1st line tx in Acute Gout?

A

NSAIDS within 24 h. Naproxen, Ibuprofen, Diclofenac, Indomethicin

130
Q

2st line tx in Acute Gout?

A

Colchicine

131
Q

3st line tx in Acute Gout?

A

Corticosteroids. Intraarticular and systemic.

132
Q

4st line tx in Acute Gout?

A

IL-1-Beta-inhibitor (Anakinra)

133
Q

Chronic Gout urate goal?

A

<5

134
Q

Chronic Gout indications?

A

Urate >6.5, tophi, multiple attacks

135
Q

Chronic Gout 1st line tx? CI?

A

Xanthine oxidase inhibitors (Allopurinol). C/I in moderate to severe renal failure.

136
Q

Chronic Gout 2nd line tx?

A

Uricosurics. Probenecid (1st line if Allopurinol C/I’d)

137
Q

Gout underexcretor prophylaxis?

A

Uricosuric (probenecic, Sulfindyrazone)

138
Q

Gout flare tx?

A
  • Pegloticase IV q2w
  • Colchicine
  • NSAIDs
139
Q

3rd line Chronic Gout tx?

A

Colchicine

140
Q

Only drug used in both acute and chronic gout?

A

Colchicine

141
Q

Negatively birefringent need-shaped urate cryststals in Gout or Pseudogout?

A

Gout

142
Q

Positively birefringent rhomboid shaped CPP crystals in Gout or Pseudogout?

A

Pseudogout

143
Q

Calcium Pyrophosphate Dihydrate deposite in kidneys and joints are consistent with which disease?

A

Pseudogout

144
Q

Pseudogout most common in which two joints?

A

Knee or wrist

145
Q

Pseudogout joint looks like?

A

Red, swollen, tender

146
Q

Pseudogout arthocentesis shows what?

A

Positively Birefrincence Rhomboid Crystals

147
Q

Pseudogout crystals in parallel are what color? Perpendicular?

A

Parallel=Blue

Perpendicular=Yellow

148
Q

X-ray joint space in Pseudogout shows what?

A

Chondrocalcinosis

149
Q

Which test is diagnostic for Pseudogout?

A

X-ray joint space showing chondrocalcinosis

150
Q

1st line tx for Pseudogout?

A

Colchicine

151
Q

2nd line tx for Pseudogout

A

NSAIDS

152
Q

Who gets Fibromyalgia?

A

W>M. 20-50 y/o.

153
Q

What sort of sensitization in Fibromyalgia?

A

Central Sensitization

154
Q

What is Central Sensitization in Fibromyalgia mean?

A

Abnormal biochemical and endocrine findings

155
Q

Psychological steps in Fibromyalgia leading to sensitization? (Hint: 3)

A

Psych trauma->psych distress->sensitization of pain system

156
Q

Define Fibromyalgia

A

Persistent widespread pain and abnormal tenderness, fatigue, sleep, and autonomic disturbances

157
Q

What sort of Sx in Fibromyalgia?

A

GI, GU, chronic HA, poor concentration, memory disturbances

158
Q

Tenderness and Fibromyalgia? Swelling and erythema?

A

11 of 18 points and 3+ months.

No swelling, no erythema.

159
Q

What sort of diagnosis if Fibromyalgia?

A

Dx of exclusion. Must rule out everything else.

160
Q

Tests for Fibromyalgia?

A

Labs to r/o known causes, sleep study, imaging for OA/DJD, cerebral flow MRI

161
Q

Non-pharm tx for Fibromyalgia?

A

CBT, exercise, weight loss, acupuncture, chiropractic

162
Q

1st line tx for Fibromyalgia?

A

Tylenol, Tramadol, or mix (Ultracet)

163
Q

2nd line tx for Fibromyalgia

A

TCA (strongest evidence of working!)

164
Q

3rd line TXs for Fibromyalgia?

A

SNRI, SSRI, Milacipran, antepileptics

165
Q

Raynaud’s Phenomema types?

A

Primary and Secondary

166
Q

Primary Raynaud’s Phenomema age and associated dz?

A

<30, no associated dz

167
Q

Secondary Raynaud’s Phenomema age and associated dz?

A

> 30, has associates dz (CREST syndrome, etc)

168
Q

Raynaud’s Phenomona clin manifestiation?

A

Abrupt onset of well-demarcated pallor of digits progressing to cyanosis w/pain and often numbess followed by reactive hyperemia on rewarming.

169
Q

Raynaud’s Phenomona vasospasm/vasoconstriction due to?

A

Cold or stress

170
Q

Gangrene in Raynaud’s Phenomona?

A

Happens in Secondary Raynaud’s Phenomona

171
Q

Primary Raynaud’s Phenomona bilateral?

A

Yes

172
Q

Tx of choice for Raynaud’s Phenomona

A

Dihydropyradine CCBs (Amlodipine, Nifedipine)

rheum and ortho packrat (2 decks)

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