Rheumatology

Question 1

Sxs of SLE

Answer 1

Symmetric polyarthritis
Pleuritic chest pain
Malar rash
Raynauds

Question 2

ACR criteria to diagnose SLE

Answer 2

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+)

Question 3

General labs used in SLE

Answer 3

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

Question 4

What do low complement levels indicate with SLE?

Answer 4

Active lupus

Question 5

Cardinal feature of SLE

Answer 5

ANA (but not specific)

Question 6

How is ANA reported?

Answer 6

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

Question 7

Some other things to think about with +ANA

Answer 7

RA
Malignancy
Thyroid Probs

Question 8

ANA subtypes

Answer 8

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

Question 9

What is the anti-dsDNA antibody?

Answer 9

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

Question 10

What is the anti-smith antibody?

Answer 10

Detected in only about half of pts with SLE

Generally remains positive in the pts even with remission

Question 11

Subtypes of antiphospholipid antibodies

Answer 11

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

Question 12

What medical issues are associated with antiphospholipid syndrome?

Answer 12

Arterial or venous thromboembolic events

Recurrent fetal loss

Question 13

Sxs of rheumatoid arthritis

Answer 13

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

Question 14

What is rheumatoid factor?

Answer 14

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

Question 15

Rheumatic diseases associated with RF

Answer 15

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

Question 16

Nonrheumatic diseases associated with RF

Answer 16

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

Question 17

What is anti-CCP?

Answer 17

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

Question 18

Sxs of Sjogrens

Answer 18

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

Question 19

Antibodies in Sjogrens

Answer 19

Anti-Ro and Anti-La/SSB

Question 20

Sxs of polymyalgia rheumatica

Answer 20

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)

Question 21

Characteristic lab finding with PMR

Answer 21

Increased ESR and CRP (inflammatory markers)

Question 22

What is PMR associated with?

Answer 22

Giant cell temporal arteritis

use low dose corticosteroids for this

Question 23

Sxs of fibromyalgia

Answer 23

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

Question 24

What do you expect to see on labs fibromyalgia?

Answer 24

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

Question 25

Sxs of ankylosing spondylitis

Answer 25

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

Question 26

What lab test is associated with ankylosing spondylitis?

Answer 26

HLA-B27

Question 27

What might you also see HLA B27 with?

Answer 27

Reactive arthritis, psoriatic arthritis or IBD

Question 28

Sxs of systemic sclerosis

Answer 28

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

Question 29

What lab supports the diagnosis for limited systemic sclerosis?

Answer 29

Anticentromere antibodies (also have ANA)

Question 30

Lab associated with diffuse cutaneous systemic sclerosis

Answer 30

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

Question 31

What is diffuse cutaneous systemic sclerosis associated with?

Answer 31

Severe interstitial lung disease

Question 32

Normal joint fluid

Answer 32

Viscous, egg white consistency, acellular | Reduce friction b/w articular cartilage of synovial joints

Question 33

Use of arthrocentesis

Answer 33

When sign of effusion of inflammation in joint - For diagnosis - To relieve pressure - To give meds (glucocorticoid, anesthetic etc)

Question 34

Indications for arthrocentesis

Answer 34

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

Question 35

Common aspiration sites

Answer 35

Shoulder, elbow, hip, knee, wrist, ankle

Question 36

Most feared concerns related to arthrocentesis

Answer 36

Septic joint

Question 37

Concerns of glucocorticoid injection

Answer 37

Tendon rupture Nerve damage Osteonecrosis (rare)

Question 38

What else might happen after arthrocentesis?

Answer 38

Skin atrophy or hypopigmentation

Question 39

Categories of joint effusions

Answer 39

Noninflammatory Inflammatory Septic Hemorrhagic

Question 40

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

Answer 40

Inflammatory is >2000 WBCs | Noninflammatory is <2000

Question 41

What is 100,00 WBC until proven otherwise?

Answer 41

Septic

Question 42

Neutrophils (PMNs) in synovial fluid

Answer 42

<25% is noninflammatory | >75% is septic

Question 43

Diagnostic test for septic arthritis

Answer 43

ID of bacteria in synovial fluid

Question 44

Sxs of gout

Answer 44

Severe onset of pain (maybe big toe)

Question 45

What crystals are in gout?

Answer 45

``` Monosodium urate (MSU) Negatively birefringent and needle shaped ```

Question 46

Sxs of pseudogout

Answer 46

See pain in knww etc | Chondrocalcinosis on xray

Question 47

What crystals are in pseudogout?

Answer 47

Calcium pyrophosphate dihydrate (CPPD) | Positively birefringent, rhomboid shape

Question 48

What is birefringent

Answer 48

Material's ability to refract light rays