Rheumatology Flashcards by Emily W

7 types of JIA

SUP POPE

Systemic arthritis
Undifferentiated arthritis
Polyarthritis (RF negative) 5+ joints in 6 months need RF tested two occasions at least 3m apart
Polyarthritis (RF positive)
Oligoarthritis (1-4 involved, often ANA positive, most common)
Psoriatic arthritis
Enthesis-related arthritis

ALL have eye exam (uveitis in 20-30%)

How well did you know this?

Not at all

Perfectly

Felty syndrome (3)

RA, Neutropenia and splenomegaly

How well did you know this?

Not at all

Perfectly

Enthesitis related arthritis

HLA B27 80%
Male over 6y
Anterior uveitis
Ank spend
IBD
Dactylitis (also with sickle cell and psoriatic arthritis)

How well did you know this?

Not at all

Perfectly

therapy for SLE

Hydroxychloroquine (standard)
Steroids
Azathioprine
Mycophenolate mofetil
Cyclophosphamide 
Rituximab

How well did you know this?

Not at all

Perfectly

SLE most deaths related to..

Infection

How well did you know this?

Not at all

Perfectly

Drugs that cause drug induced lupus

Minocycline
Anticonvulsants
Hydralazime
TNF agents

How well did you know this?

Not at all

Perfectly

Granulomatosis with polyangitis triad

Small vessel

Upper and lower respiratory tract inflammation and renal disease

ANCA positive

How well did you know this?

Not at all

Perfectly

HSP other name

IgA vasculitis

How well did you know this?

Not at all

Perfectly

HSP recurrence rat

and end stage renal disease rate

Recurrence in 1/3rd

ESRF in 1-3%

How well did you know this?

Not at all

Perfectly

Behcet criteria and mx

Recurrent mouth ulcers (exhibit pathergy)
Recurrent genital ulcers
Eye lesions
Skin lesions
Pathergy

Mx steroid, colchicine etc

How well did you know this?

Not at all

Perfectly

Juvenile dermatomyositis criteria

Symmetric proximal muscle weakness
Skin changes - gottron papules knuckles and eyelid rash (50% have photosensitivity and can have malar rash)
Elevated CK, AST, LDH, Aldolase
Abnormal EMG and muscle biopsy
Positive anti jo and Ro indicate high risk early death

How well did you know this?

Not at all

Perfectly

Limited systemic sclerosis 5 features

CREST previous name
Calcinosis
Raynaud
Eosophageal dysmotiliy
Sclerodactyly
Telangiectasia

How well did you know this?

Not at all

Perfectly

Raynauds Tx

Nifedipine

Nitroglycerin 2% ointment for digital ulcers

How well did you know this?

Not at all

Perfectly

Tx for chorea

Carbamazepine
Phenobarbital
Haloperidol
Chlorpromazine

How well did you know this?

Not at all

Perfectly

Macrophage activation syndrome

Cytokines storm with 10-30% mortality
Pancytopenia
Fever
Splenomegaly
High TG, High ferritin, high ddimer 
Decreased fibrinogen (DIC)
Deranged LFTs

Haemophagocytosis of bone marrow
Persistent high CRP but decreasing ESR (consumption of fibrinogen - DIC)

How well did you know this?

Not at all

Perfectly

Anti-glomerular basement membrane antibodies seen in

Goodpasture syndrome (IgG deposits BM with crescenteric changes))

How well did you know this?

Not at all

Perfectly

B cell depletion agent

Rituximab

How well did you know this?

Not at all

Perfectly

IL-1 inhibitors

Anakinra
Canakinumab (very impressive SJIA)
Rilonacept

How well did you know this?

Not at all

Perfectly

How much normal population HLA B27 positive

10%

How well did you know this?

Not at all

Perfectly

Criteria for SLE

Rash on maids

Renal
Arthritis
Serotitis
Haematological 
Oral uk era
Neurological 
Malar rash
ANA (most sensitive)
Immunological
Discoid rash 
Sunlight sensitivity

How well did you know this?

Not at all

Perfectly

Periodic fevers (PFAPA vs FMF)

PFAPA well in between and self resolves, 0% risk amyloidosis and FmF 40-75% risks amyloidosis

How well did you know this?

Not at all

Perfectly

Livedo reticularis indicates..

Mottled purple skin can be from:
Anti phospholipid 
Systemic lupus erythematosus
Dermatomyositis
Rheumatoid arthritis
Polyarteritis nodosa
Granulomatosis with polyangiitis
Sjogren syndrome

How well did you know this?

Not at all

Perfectly

C-ANCA in

Wegeners
Reacts against proteinase 3

(P-ANCA in microscopic polyangitis against myeloperoxidase)

How well did you know this?

Not at all

Perfectly

Churg-Strauss

Atopic/asthma and multi system vasculitis

P ANCA positive

Large vasculitis Medium vasculitis Small vasculitis

Large vasculitis - GCA, takayasu Medium vasculitis - PAN, Kawasaki Small vasculitis -Chung-Strauss, HSP, wegners, microscopic polyangitis

JIA arthritis for how long at least

Intra articulate steroid lasts for at least

4 months | Triamcinolone hexacetonide

Joints most effected by psoriatic arthritis

Polyarticular arthritis involving DIP joints

Radiologic changes diagnostic of ank spond

Sclerosis of sacroiliac joint margins on X-ray

Most specific marker SLE

Anti smith | DsDNA

Pemphigus biopsy

Is a rare autoimmune skin disease causing blisters skin and mucous membranes Biopsy shows intraepidermal blister with IgG deposits

SJS biopsy

Full thickness epidermal necrosis

Can eight loss improve cutaneous psoriasis

Yes

Psoriasis treatment

``` Calcipotriol (vitamin d analogue) Steroids topically Dithranol Coal tar UVB MTX Biological agents ```

SLE percent ANA positive

ANA- 97% positive

What does aspirin do in Kawasaki

Aspirin protects from coronary events but not development of aneurysms

Biological big risk

Infection (deactivation TB)

Anti CCP antibody positive in most with...

JIA

Nikolskys sign is and reflects what

Elicit by applying pressure to affected skin and there is extension of blister or removal of epidermis where touched Positive in pemphigus Vulgaris and negative in bullies pemphigoid Reflects autoimmune disease

Heliotrope in what? Blue violet discolouration of eyelids

Dermatomyositis

RF positive in

Sjogren (also anti ro and la) and JIA

Raynauds, tight thick skin, ulcers Salt and pepper skin Positive anticentromere

``` Systemic sclerosis (scleroderma) Rare in children ```

AntiJo antibodies in dermstomyositis relates to

Risk of interstitial lung disease

Rash of systemic JIA

Salmon colour evanescent discrete borders best den with fever migratory

Hunchback child called

Sheuermanns disease

Back pain and fever in preschool child with narrowing of vertebral disc on X-ray consistent with

Discitis

Percent with arthritis in IBD

15%

Reiters/reactive arthritis occurs 1-4 weeks following what infections

Salmonella, shigella, campylobacter TB Yersinia Chlamydia

Calcinosis in

Inherited CT diseases Hypercalcaemia Connective tissue disease (dermatomyositis, systemic sclerosis, cutaneous lupus erythematosus)

10 year old with 1-3 day fever episodes wth serositis, knee arthritis with rash over joint

Familial Mediterranean fever | Colchine

Painful rash migrates distally with exercise in 3 year old 2-6 times per year

TRAPS AD Gene TNFRSF1A 25% get amyloidosis

Fever every 21-28 days and ulcers adenitis syndrome

PFAPA Periodic fever, aphthous ulcer, stomatitis, pharyngitis, adenitis Prednisone Adenotonsillectomy

(cutaneous hypersensitivity to superficial trauma).

Koebner phenomenom

Dermatomyositis facial rash

Facial erythema crossing nasolabial folds (malar rash in SLE does not involve nasolabial folds).

FMF and PFAPA treatment

FMF colchicine and amyloid | PFAPA p for prednisone

Keppra/ leveteracitam SE

Tiredness | Aggression/behaviour change

DIP joints and Nails may show pitting, yellowing, transverse ridges or destruction (onycholysis)

Psoriatic arthritis

Three causes of photosensitivity

SLE Dermatomyositis Psoriasis