Rheumatology Flashcards
What is feltys syndrome
Rheumatoid arthritis + neutropenia + splenomegaly
**if you see any of these look for the third**
How is the diagnosis of RA made?
- Clinical criteria should lead to lab testing,
- Nobody Should Have Rheumatoid Symptoms 3 times
- Noduels
- Symmetric
- Hands
- RF or CCP
- Stiffness
- 3 or more joints
- X-ray findings of erosions
- Nobody Should Have Rheumatoid Symptoms 3 times
- Serology
- Rheumatoid factor or Anti CCP can be used
What is the treatment algorhythm for RA?
NSAIDs (Sxs) + DMARDS (everyone) + Biologics (severe) —- Steroids (flares)
- DMARDs
- Methotrexate (1st line)
- Leflunomide (2nd line)
- Hydroxychloroquine (pregnancy)
- Sulfasalazine (additive)
- Anti TNF
- Etanercept
- Infliximab
- Rituximab
- NSAIDs
- NEVER A MONOTHERAPY
Spinal symptom distinction of Ank spond or RA
RA affects C1 and C2 while ank spond involves the lower back
What is the main pathology of scleroderma?
- COllagen replacing smooth musle
- Widespread deposition of extraneous collagen
What are the symtoms of CREST? How is each treated?
- Calcinosis
- Raynauds - Non DHP CCBs
- Esophageal dysmotility - PPIs
- Sclerodatyly - Penicilamine
- Telangiectasia
What is the difference between systemic sclerosis and CREST?
Systemic sclerosis has all the CREST symptos with the addition of visceral involvement (Renal and heart)
What are the antibodies for CREST and Systemic sclerosis respectively?
CREST: Anti - Centromere and PAH
Systemic sclerosis: anti Scl-70 and ILD
Sjogren’s syndrome symptoms
- Dry eyes
- Bilateral parotid enlargement
- Dry mouth
How is Sjogrens diagnosed? Treated?
- Clinical but assisted by antibodies
- Anti Ro and La antibodies
- Tx: Not anything, but symptom control
What is the underlying pathology of the myositis disorders?
Inflammatory disease caused by T cell (polymyositis), Immune complex (dermatomyositis), and T cells (inclusion body myositis)
Symptoms of the myositis disorders?
- Painful proximal muscle weakness (difficulty rising out of a chair but intact grip strength)
- Dermatologic signs:
- Erythematous rash on sun exposed areas
- Heliotrope rash
- Grottons papules
How is myositis disorders diagnosed? Treated?
- First test is to EMG to determine if its a nerve conduction issue versus muscular damage
- Next to confirm, do a muscle biopsy and separate the diseases from each other
- Check for occult malignancy and treat with high dose steroids
What is the underlying gene of the spondyloarthropathies?
B27, but this isnt the end all be all of diagnosis. Theyre seronegative: No RF, CCP, ANA reactive antibodies
What are the symptoms of ank spond?
Low back pain with morning stiffness that improves with use.
What are the diagnostic steps of ank spond? Treat?
Bamboo spine on xrray and calcification of the achilles tendon; Treated with NSAIDs and escalate to methotrexate and if all else fails moves to monoclonal antibodies like etanercept
What is the presentation of reactive arthritis?
Non-gonococcal urethritis and asymmetric bilateral arthritis of the lower back and hands as well as conjunctivitis
What is the treatment of reactive arthritis?
Treat underlying infection to prevent acute from becoming chronic. Treat the chlamydia with doxycycline and arthritis with NSAIDs
What is Reiters syndrome
Urethritis, arthritis, uveitis
What is the presentation of psoriatic arthritis
- Symmetric and PIP and DIP arhtritis with erosive pitting of the nails.
- Plaques that are silvery and scaley
What is the treatment for psoriatic arthritis?
- NSAIDs: Mild arthritis and no/meh skin findings
- Methotrexate: Severe arthritis and real skin findings
- TNF-a: Nonresponsive to methotrexate
What are the symptoms of enteropathic/IBD associated arthritis? What are the treatment?
- Non-deforming, migratory, symmetric bilateral arthritis in a patient with IBD
- Tx: IBD with ASA compounds (mesalamine)
What are the symptoms of giant cell artheritis?
- Temporal artereitis
- Tender swollen temporal artery
- Unilateral temporal headache
- Systemic symptoms
- ESR
- Weight loss
- Low grade fever
- Malaise
What are the treatment modalities of giant cell arteritis?
- STEROIDS FIRST
- Definitive diagnosis can then be made by biopsy
What are the symptoms of Kawasaki Disease?
- Asian childhood disease
- Strawberry tongue,
- Truncal rash
- Palmar and plantar erythema
- Vascultis of coronary arteries
What is the treatment method for Kawasaki?
IVIG and Aspirin
What are the symptoms of polyarteritis Nodosa?
- Vasculitis in multiple organs at the same time without a common vascular distribution
- Purpura and painful nodules
- Kidney glomerulonephritis vasculitis
- Mesenteric vasculitis (ischemia)
- Asymmetric painful and sensory neuropathy (mononeuritis multiplex)
- Aneyrysms and stenosis in medium sized vessels
What is the association with polyarteritis nodosa?
Hepatitis B
What is the treatment or PAN?
High dose steroids and cyclophosphamide
What are the symptoms of takayasu arteritis?
Age undr 40, impacts the vessels of the aorta and its major branches
- Absent pulses in large vessels
- Systemic inflammation (ESR and weight loss)
What is the diagnosis and treatent for takayasu arteritis?
- Angiogram will make diagnosis - showing claudication
- Tx: High dose prednisone
What is the symptoms of wegners?
- WeCner’s
- Hematuria and hemoptysis but also with nasl involvement
- Renal + lung + nasal
- c-ANCA positive
Cryoglobulinemia symptoms
- Palpable purpura and Hepatitis C
Cryoglobulinemia diagnosis and treatment
- Dx: Assess for cryoglobulins in serum
- Possible positive RF, elevated ESR, decreased compliment
- Tx: Steroids, cyclophosphamide, rituximab, plasmapheresis
What are the symptoms of HSP?
Palpable purpura and abdominal pain or abdominal bleeding
How is the diagnosis of HSP made? How is it treated?
- Dx: Biopsying the effected tissue to reveal leukocytoclastic vasaculitis
- Tx: steroids
*
What do you do if you see a red hot swollen joint?
Arthrocentesis
What is the appearance of a septic joint?
Full of pus: white, opaque, lot of cells, over 50,000 polys
Joint cultures for septic arthritis show what organisms? What happens if you dont see any organisms?
Presence of staph. If septic and no organisms then its likely gonorrhea and you should get a NAAT and chocolate agar culture
Antibody for lupus?
ANA
Antibody for drug induced lupus
Histone
Antibody for lupus + renal involvement
ds-DNA
Autoimmune hepatitis antibodies
Smooth muscle
Primary biliary cirrhosis antibody
Mitochondrial
Scleroderma antibody
Anticerntromere
Sjogren’s antibody
RO + LA
Rheumatoid arthritis antibody
CCP and RF
Polymyositis antibody
Anti-Jo
Treatment for gout
- Allopurinol for XO inhibition and maintenance
- Probenicid for uricosurics and maintance
- Colchicine and NSAIDs for flares and prophylaxis
Some things that can cause a gout flare? How can this be prevented?
- Tumor lysis syndrome - leukemia or lymphoma patients
- Prevent with vigorous rehdration and pretreatment with allopurinol
- Rasburicase
Arhtorscentesis of gout?
Negatively birefringen needle shaped crystals
How do you treat a septic arthritis with negative gram stain?
Ceftriaxone and vancomycin
