Rheumatology Flashcards
CBC in RA patients may show
anemia with normal MCV
Which finger joints are affected in RA?
MCP and PIP
Also:
Boutonnier deformity, Swan neck deformity
Baker’s cysts
C1/C2 subluxation (check before intubation!)
The single most accurate test for RA is
anti-cyclic citrulinated peptide (anti-CCP)
Felty’s syndrome consists of what three features?
RA
Splenomegaly
Neutropenia
The lowest glucose level on pleural effusion would be in cases of
RA
Standard of care for RA is
NSAIDs + DMARDs (Methotrexate is the best initial one)
If methotrexate fails in RA, add
Anti-TNF agents like infliximab
Test for Hep B and TB before starting
Patients with mild RA on hydroxychloroquine should get an annual __ exam
eye; checking for retinopathy
Alternate DMARDs like anakinra (___ receptor antagonist) and rituximab (___antibody) can be used for RA
Anakinra is an IL-1 receptor antagonist
Rituximab is an Anti CD-20 antibody (B-cells!)
___ are a bridge to DMARD therapy for RA
Steroids. They do not change progression of disease but help in acutely ill patient with severe inflammation
The seronegative spondyloarthropathies are associated with
HLA-B27
- ankylosing spondylitis
- reactive arthritis
- psoriatic arthritis
- JRA
Young man with back pain that is worse at night and is relieved by leaning forward =
ankylosing spondylitis
The most sensitive test for ankylosing spondylitis is
Sacroiliac joint MRI (years before x-ray)
Do steroids work for ankylosing spondylitis?
NO, that’s the most common wrong answer for AS.
Treat AS with
NSAIDs
Biological agents
Sulfasalazine
Secukinumab, an IL-17 antagonist
Do not use steroids.
Asymmetric arthritis, urethritis, GI infxn history, genital lesions, conjunctivitis (KNEE, PEE, SEE)=
reactive arthritis, a/w chlamydia, shigella, salmonella, yersinia, or campylobacter
Treat reactive arthritis with
NSAIDs
Key features of psoriatric arthritis include
Nail pitting DIP involvement (unlike RA) Sausage-shaped digits (dactylitis) Enthesitis (inflammation of tendon insertion sites) Psoriasis
Treatments for psoriatic arthritis include
NSAIDs Methotrexate Infliximab Secukinumale Ustekinumab
Fever, salmon-colored rash, polyarthritis, lymphadenopathy, myalgias =
JRA
Additional criteria include HSM and elevated LFTs
Biopsy of bowel in Whipple disease shows
PAS-positive organisms on PCR
Treat with bactrim (curative!)
The most common presentation of Whipple disease is
joint pain
Also diarrhea, fat malabsorption, weight loss
OA affects the ___ joints
Distal interphalangeal joints (unlike RA)
For CCS, all of the following tests should be ordered for osteoarthritis diagnosis:
ANA
ESR
Rheumatoid factor
Anti-CCP
OA does not affect the ___ joint
metacarpophalangeal!
Rash + Joint Pain + Fatigue =
Lupus
The best initial test for SLE is ___
The most specific test for SLE is __ or __
ANA is best initial
Anti-DS DNA or Anti-Smith are most specific
___ levels drop in an SLE flare up and ___ levels rise in a flare up
Complement levels drop, Anti-DS DNA rises
A baby of a mom who has anti-Ro (SSA) antibody is at risk for
heart block
Drug-induced Lupus is caused by __, __, and ___
hydralazine, procainamide, and isoniazid
What antibodies are found in drug-induced lupus?
Anti-histone antibodies
Drug-induced lupus never affects the __ or __
kidneys or CNS
Complement levels and anti-DS DNA are also normal
Most accurate test for Sjogren’s Syndrome is
Lip biopsy
What is the Schirmer test?
Decreased wetting of paper held up to eye to Dx Sjogren’s
What are the specific tests for Sjogren’s?
Anti-Ro/SSA, Anti-La/SSB
Treat Sjogren’s with
pilocarpine and cevimeline to increase acetylcholine and thus oral/ocular secretions
Tight skin + Heartburn + Raynauds =
Scleroderma
There is no specific diagnostic test!
The leading causes of death in scleroderma are
Lung fibrosis and pulmonary hypertension
Renal involvement in scleroderma can lead to
malignant hypertension
The interstitial lung disease caused by scleroderma can be treated with
cyclophosphamide
CREST syndrome stands for
Calcinosis of the fingers Raynaud's Esophageal dysmotility Sclerodactyly Telangiectasia
Does CREST present with joint pain, PPH, herat lung or kidney involvement?
NO
Anticentromere antibodies =
CREST syndrome
Marked eosinophilia + orange peel skin =
Eosinophilic Fasciitis
Treat w/ steroids
The main difference between polymyositis and dermatomyositis is
skin involvement in DM
Proximal muscle weakness is indicative of
PM and DM
Do muscle biopsy
Electromyogram will be abnormal
The most serious threat associated with PM/DM is
Malignancy of cervix, lungs, pancreas, breasts, or ovaries
Age >50 + proximal muscle pain + elevated ESR =
polymyalgia rheumatica
Stiffness worse in morning
Great response to steroids
Polyarteritis nodosa affects ___ but does not affect the ___
PAN causes abdominal pain, renal/ testicular probs, pericarditis, and HTN
It does not involve the lungs
30% of patients with PAN have
Hepatitis B surface antigen
Upper and lower respiratory findings + c-ANCA =
Granulomatosis with Polyangiitis
Vasculitis + Eosinophilia + Asthma =
Allergic Angiitis
used to be churg-strauss syndrome
Temporal arteritis is associated with ___ and is a type of ___
polymyalgia rheumatica; a type of giant cell arteritis
If temporal arteritis is suspected, __ is most important first step
treat with steroids!
Elevated ESR, headache, jaw claudication, visual probs
Diagnose Takayasu’s arteritis with
aortic arteriography or MRA, NOT biopsy!
Cryoglobulinemia is associated with ___ while Polyarteritis Nodosa is a/w __
Hepatitis C and renal involvement
PAN is a/w Hep B!
Behcet Disease is more likely in patients of Middle Eastern or Asian ancestry and features __
oral and genital ulcers
ocular involvement that can lead to blindness
skin lesions (needle sticks are super painful)
CNS disease
Which joints are affected in pseudogoug?
Knee and wrist, not toes!
Best initial test for Paget’s Disease of Bone is an elevated
Alkaline phosphatase
Calcium and phosphate will be normal
