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X Clin Lab Med > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Sxs of SLE

A

Symmetric polyarthritis
Pleuritic chest pain
Malar rash
Raynauds

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2
Q

ACR criteria to diagnose SLE

A 
Malar rash
Photosensitvity
Polyarthritis
Renal disorders (proteinuria, casts)
Heme disorders (anemia etc)
Anti-DNA, Anti-sm, anti-phospholipid ab
Discoid rash
Mucosal ulcers
Serositis (pleuritis or pericarditis)
Neuro sxs
\+ ANA
(usually need 4+)
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3
Q

General labs used in SLE

A 
CBC
Creatinine
U/A
LFTs
ESR/CRP
C3 and C4
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4
Q

What do low complement levels indicate with SLE?

A

Active lupus

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5
Q

Cardinal feature of SLE

A

ANA (but not specific)

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6
Q

How is ANA reported?

A 
Titer of antibodies with serial dilution (1:40)
Staining pattern (homogenous, speckled, nucleolar or centromere-loosely associated with underlying autoimmune disease)
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7
Q

Some other things to think about with +ANA

A

RA
Malignancy
Thyroid Probs

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8
Q

ANA subtypes

A

Anti-dsDNA
Anti-Sm
Anti-phospholipid
Only do these if index of suspicion is higher for the diagnosis

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9
Q

What is the anti-dsDNA antibody?

A

Useful to distinguish SLE cause it is rarely seen in other disorders
Often fluctuates with disease activity

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10
Q

What is the anti-smith antibody?

A

Detected in only about half of pts with SLE

Generally remains positive in the pts even with remission

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11
Q

Subtypes of antiphospholipid antibodies

A

Anticardiolipin Ab, beta 2 glycoprotein, lupus anticoagulant
Present in pts with antiphospholipid syndrome
Primary condition or in setting of underlying disease (SLE)

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12
Q

What medical issues are associated with antiphospholipid syndrome?

A

Arterial or venous thromboembolic events

Recurrent fetal loss

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13
Q

Sxs of rheumatoid arthritis

A

Morning stiffness longer than 30 min (inflammatory)- hands, fingers, knees
Redness and swelling of PIP and MCPs (DIPs spared)
Ulnar deviation at MCPs

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14
Q

What is rheumatoid factor?

A

Moderate specificity for RA
But associated with several autoimmune/rheum and nonrheumatic disease
Should also order anti-CCP with it

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15
Q

Rheumatic diseases associated with RF

A

RA, Sjogrens, Mixed connective tissue disease, SLE, polymyositis

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16
Q

Nonrheumatic diseases associated with RF

A

Bacterial endocarditis, hep B/C, TB, sarcoidosis, malignancy, primary biliary cholangitis

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17
Q

What is anti-CCP?

A

Antibodies to citrullinated peptides (ACPA) used when suspicious for RA–antibodies against them are most commonly used b/c specificity is high

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18
Q

Sxs of Sjogrens

A 
Fatigue
Dry mouth and dry eyes (sicca complex)
Cavities
Diffuse joint aches
\+ Schermers
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19
Q

Antibodies in Sjogrens

A

Anti-Ro and Anti-La/SSB

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20
Q

Sxs of polymyalgia rheumatica

A

Aching pain in arms, low back, hips and thighs
Acute onset of morning stiffness and stiff with long car rides
Gel phenomenon
Shoulder ROM decreased
(Proximal aching and stiffness)

21
Q

Characteristic lab finding with PMR

A

Increased ESR and CRP (inflammatory markers)

22
Q

What is PMR associated with?

A

Giant cell temporal arteritis

use low dose corticosteroids for this

23
Q

Sxs of fibromyalgia

A

Myalgias and arthralgias
Mind feels foggy
Always tired
May have multiple tender points

24
Q

What do you expect to see on labs fibromyalgia?

A

All normal (CBC, ANA, RF, CRP, ESR)

25
Q

Sxs of ankylosing spondylitis

A

Low back pain and progressive stiffness (worse in morning)
Better with exercise and worse with rest
Hx of plantar fasciitis (enthesitis)
Bamboo spine, sacroiliitis

26
Q

What lab test is associated with ankylosing spondylitis?

A

HLA-B27

27
Q

What might you also see HLA B27 with?

A

Reactive arthritis, psoriatic arthritis or IBD

28
Q

Sxs of systemic sclerosis

A 
CREST
Calcinosis
Raynauds
Esophageal involvement
Sclerodactyly (tightening of skin on hands and face)
Telangiectasias
29
Q

What lab supports the diagnosis for limited systemic sclerosis?

A

Anticentromere antibodies (also have ANA)

30
Q

Lab associated with diffuse cutaneous systemic sclerosis

A

Anti-scl-70 antibody/antitopoisomerase I (scleroderma)- 70x worse b/c this one is worse

31
Q

What is diffuse cutaneous systemic sclerosis associated with?

A

Severe interstitial lung disease

32
Q

Normal joint fluid

A

Viscous, egg white consistency, acellular

Reduce friction b/w articular cartilage of synovial joints

33
Q

Use of arthrocentesis

A

When sign of effusion of inflammation in joint

  • For diagnosis
  • To relieve pressure
  • To give meds (glucocorticoid, anesthetic etc)
34
Q

Indications for arthrocentesis

A

New onset acute monoarthritis
Suspected crystal induced arthritis
Suspected infection/septic arthritis
Inflammatory vs noninflammatory arthritides
Unexplained joint, bursa or tendon sheath swelling

35
Q

Common aspiration sites

A

Shoulder, elbow, hip, knee, wrist, ankle

36
Q

Most feared concerns related to arthrocentesis

A

Septic joint

37
Q

Concerns of glucocorticoid injection

A

Tendon rupture
Nerve damage
Osteonecrosis (rare)

38
Q

What else might happen after arthrocentesis?

A

Skin atrophy or hypopigmentation

39
Q

Categories of joint effusions

A

Noninflammatory
Inflammatory
Septic
Hemorrhagic

40
Q

Difference in classification of synoial fluid b/w inflammatory and noninflammatory

A

Inflammatory is >2000 WBCs

Noninflammatory is <2000

41
Q

What is 100,00 WBC until proven otherwise?

A

Septic

42
Q

Neutrophils (PMNs) in synovial fluid

A

<25% is noninflammatory

>75% is septic

43
Q

Diagnostic test for septic arthritis

A

ID of bacteria in synovial fluid

44
Q

Sxs of gout

A

Severe onset of pain (maybe big toe)

45
Q

What crystals are in gout?

A 
Monosodium urate (MSU)
Negatively birefringent and needle shaped
46
Q

Sxs of pseudogout

A

See pain in knww etc

Chondrocalcinosis on xray

47
Q

What crystals are in pseudogout?

A

Calcium pyrophosphate dihydrate (CPPD)

Positively birefringent, rhomboid shape

48
Q

What is birefringent

A

Material’s ability to refract light rays

X Clin Lab Med (4 decks)

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