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)
