Rheumatology Flashcards
1
Q
What is osteoarthritis?
A
degenerative condition involving wear and tear of the cartilage and osseous hypertrophy at the articular margins
2
Q
What are the clinical manifestations of osteoarthritis?
A
- asymmetrical and/or monoarticular
- deep, dull ache that is relieved with rest and worsened with activity
- insidious onset, with progression taking years to present
- morning stiffness < 30 minutes
- osteophytes
- carpometacarpal joint squaring of thumb
3
Q
How do you diagnosis osteoarthritis?
A
- joint space narrowing
- osteophytes
- sclerosis of subchondral bony end plates adjacent to diseased cartilage
- subchondral cysts
4
Q
What is Rheumatoid Arthritis?
A
chronic inflammatory autoimmune disease involving the synovium of joints
-inflammatory polyarthritis
5
Q
What is the usual age to present with rheumatoid arthritis?
A
20 - 40 years
women > men (3:1)
6
Q
Is genetic predisposition necessary for rheumatoid arthritis?
A
yes
7
Q
What joints are most commonly involved with rheumatoid arthritis?
A
hands (MCP, PIP) and wrists
8
Q
Characteristic Hand Deformities
A
- ulnar deviation of the MCP joints
- boutonniere deformities
- swan-neck deformities
9
Q
Buotonniere deformities
A
PIP flexed, DIP hyerextended
10
Q
Swan-neck contractures
A
MCP flexed, PIP hyperextended, DIP flexed
11
Q
What are the clinical manifestations of rheumatoid arthritis?
A
morning stiffness (present in all patients) - lasting hours
12
Q
Cervical Spine involvement - Rheumatoid Arthritis
A
- atlantoaxial subluxation and instability (C1/C2)
- all RA patients should have C-spine x-rays before any surgery
13
Q
Caplan syndrome - RA
A
multiple rheumatoid nodules with possible cavitation
-occurs in RA patients with exposure to silica dust, asbestos fibers, or other pneumonconses
14
Q
Other Systemic Manifestations with Rheumatoid Arthritis
A
subcutaneous rheumatoid arthritis
-pathognomonic for RA
15
Q
Felty Syndrome
A
- triad of long-standing seropositive RA, neutropenia, and splenomegaly
- usually occurs fairly late in disease process (>10 years)
16
Q
Diagnosis of Rheumatoid Arthritis
A
- Rheumatoid factor
- Anti-cyclic citrullinated peptide/protein antibodies (ACPA/Anti-CCP)
17
Q
Ankylosing Spondylitis
A
- strong association with HLA-B27
- bilateral sacroilitis is pathognomonic
- characterized by “fusion” of spine in ascending manner
18
Q
What are the clinical manifestations of ankylosing spondylitis?
A
enthesitis: inflammation at insertion point of tendons to bone
Extra-articular manifestations
-eye involvement (MC) - acute anterior uveitis
19
Q
What needed for a diagnosis of ankylosing spondylitis?
A
- sacroillitis - sclerotic changes of sacroiliac area
- “bamboo spine”
20
Q
Psoriactic arthritis
A
dactylitis (“sausage fingers”)
21
Q
What is needed for a diagnosing psoriatic arthritis?
A
- x-ray of the fingers and/or toes demonstrates “pencil in a cup”
- HLA-B27 positive
22
Q
Reactive arthritis
A
inflammatory arthritis that occurs after certain infections involving the GI (campylobacter) and GU (chlamydia) tracts
-onset of symptoms usually about 1-4 weeks after initial infection
23
Q
What are the clinical manifestations of reactive arthritis?
A
- enthesitis: inflammation of sites of tendon attachment to bone
- dactylitis: “sausage digit”
- urethritis or cervicitis
- ocular inflammation
- keratoderma blennorrhagicum: waxy paular rash on the palms and solde
24
Q
What is are the diagnostics of reactive arthritis?
A
- synovial fluid: cloudy, viscous, non-hemorrhagic
- X-ray findings are fluffy periostitis = proliferative changes along the shaft of the bone
25
What is the most common cause of Septic arthritis?
Staphylococcus aureus
26
Gout
inflammatory monoarticular arthritis resulting from crystallization of monosodium rate within the joints
-hyperuricemia is the hallmark of the disease
27
What is the pathophysiology of gout?
- increase in production of uric acid
| - decreased excretion of uric acid
28
Stage 1 - Asymptomatic hyperuricemia
- increased serum uric acid level with no clinical findings of gout
- may be present without symptoms for 10-20 years or longer
- should not be treated
29
Stage 2 - Acute gouty arthritis
- peak age of onset 40-60 years of age in men
- initial attack typically associated with sudden onset of exquisite pain
- most often attacks the big toes at the first MTP joint (podagra)
- painful, cellulitic changes
30
Stage 3 - Intercritical gout
- asymptomatic period after initial attack
- may not have another flare up for years
- attacks tend to become polyarticular with increased severity over time
31
Stage 4 - Chronic tophaceous gout
- usually noted in poorly controlled gout for more than 10-20 years
- Tophi: conglomerations or urate crystals surrounded by giant cells in an inflammatory reaction
- cause deformity and destruction of hard and soft tissues
32
What is needed to diagnosis gout?
- negatively birefringent, needle-shaped crystals
| - radiography: punched out erosions with overhanging rim of cortical bone in advanced disease
33
Pseudogout
- calcium pyrophosphate crystal deposition in joint spaces
- typically affects larger joints
- classically monoartcular
34
What are the risk factors for pseudogout?
- common in elderly patients with degenerative joint disease
- hemochromatosis
- hyperparathyroidism
35
What is needed to diagnosis psudogout?
- weakly positively birefringent, rod-shaped and rhomboidal crystals in synovial fluid
- radiography: chonrocalcinosis
36
Indications for Arthrocentesis
- painful joint effusion
- monoarticular inflammation of the joint
- suspicion of systemic rheumatoid disorder of unknown etiology
- articular inflammation of unknown cause
37
Contraindications for Arthocentesis
- after total joint arthroplasty
| - relatively contraindicated for patients on anticoagulant therapy
38
Complications for Arthocentesis
- introduction of infection
- bleeding
- allergy to local anesthetic
- pain
39
Who is SLE most commonly seen in?
Women of childbearing age and AA
40
What is the pathophysiology of SLE?
Environmental exposure triggers genetically predisposed pts:
- smoking
- exposure to UV lights
- EBV
41
What are the 2 forms of SLE?
- Spontaneous: systemic sxs
| - Cutaneous: dermatologic sxs
42
What labs are done for SLE?
- ANA
- Anti-dsDNA
- Anti-smith
- Antiphospholipid antibody
43
What are the S/Sxs of SLE?
- Malar butterfly rash
- Photosensitivity
- Discoid lesions
- Oral ulcers
- Alopecia
- Reynaud phenomenon
44
What are the clinical manifestations of SLE?
- Arthralgias (MC 1st sx) of wrist and fingers
- Jaccoud arthropathy (reversible ulnar deviation of MCP joints
- Cardiac: libman-sacks edocarditis
- Pulmonary: pleuritis
- Hem: hemolytic anemia
- Renal: Proteinuria (>0.5g/day)
45
Does drug induced lupus affect the CNS and Kidneys?
NO
46
What are S/Sx of drug induced lupus?
- Malar rash
- Alopecia
- NO ulcers.
47
What labs are used to diagnose drug induced lupus?
Anti-histone antibodies (always present)
48
What are some drugs that cause drug induced lupus?
- Procainamide
- Hydralazine
- Isoniazid
- Quinidine
- Carbamazepine
- Phenytoin
49
Sjögren syndrome is MC'ly seen in who?
Women ages 40-50
50
What is the pathology of Sjögren syndrome?
Lymphocyte infiltrate and destruction of lacrimal and salivary glands
51
What are risks of Sjögren syndrome?
- NHL
| - MC COD is malignancy
52
What are the 2 types of Sjögren syndrome?
- Primary: dry eyes and mouth (SICCA sxs)
| - Secondary: dry eye and mouth w/ connective tissue disease
53
What are the clinical manifestations of Sjögren syndrome?
- SICCA syndrome:
- Dry eye (xerophthalmia): burning, redness, blurred vision, keratoconjunctivitis.
- Dry mouth (xerostomia): tooth decay and depapillation of the tongue.
- Chronic fatigue (MC non-sicca sx)
54
What labs are used to diagnose Sjögren syndrome?
Ro (SS-A) and La (SS-B)
55
What are the diagnostic tests for Sjögren syndrome?
- Schirmer test: filter paper placed into eye to measure lacrimal gland output.
- Salivary gland bx: most accurate.
56
What is the OTC management for Sjögren syndrome?
Biotene and lemon drops
57
What is another name for systemic sclerosis?
Scleroderma (hardening/thickening of the skin)
58
What is the epidemiology of systemic sclerosis?
- W>M (2-3x)
| - 35-50 yoa
59
What is the pathology of systemic sclerosis?
Chronic connective tissue disorder that leads to widespread fibrosis
60
What are the 2 types of systemic sclerosis?
- Diffuse
| - Limited (CREST)
61
What lab is done for diffuse systemic sclerosis?
Anti- topoisomerase antibody
62
What lab is done for limited systemic sclerosis?
Anti-centromere antibody
63
What does CREST stand for?
- C: calcinosis cutis
- R: reynaud's phenomenon
- E: esophageal dysmotility
- S: sclerodactyly (claw like appearance of hands)
- T: telangiectasias
64
What are triggers for Reynaud's phenomenon?
Cold temp and stress causes:
- blanching then,
- Cyanotic then,
- Reactive hyperemia
65
What is the MC cause of death from systemic sclerosis?
Pulmonary involvement
66
What is the epidemiology of Idiopathic inflammatory myopathies?
W>M and AA
67
What are the clinical manifestations of Idiopathic inflammatory myopathies?
- Symmetrical proximal muscle weakness
- Earliest and most severely affected muscle groups:
- The neck flexors
- Shoulder girdle
- Pelvic girdle musculature
68
What are the two types of Idiopathic inflammatory myopathies?
- Polymyositis: no derm findings
| - Dermatomyositis: skin rash
69
What are some characteristics of Polymyositis?
- Gradual increasing multiple myalgia
| - W>M
70
What lab is used to diagnose Polymyositis?
Anti-Jo-1 antibodies
71
What are the clinical manifestations of Dermatomyositis?
- Heliotrope rash: around eyes
- Gottron papules: purplish, papular, erythematous, scaly lesion over the knuckles
- V sign: rash on face, neck and anterior chest
- Shawl sign: rash on shoulder, upper back, elbows and knees.
72
There is an increase incidence of what with adults with Dermatomyositis?
Malignancy
73
What is the epidemiology of Polymyalgia rheumatica?
- 65-70 yo
| - W>M
74
Polymyalgia rheumatica has a strong correlation of what?
Temporal Arteritis
75
What is the clinical manifestations of Polymyalgia rheumatica?
Stiffness and subjective weakness of shoulder and hip region (bilateral) after a period of inactivity/rest.
76
What lab is elevated with Polymyalgia rheumatica?
- ESR >50
77
What is the epidemiology of Fibromyalgia?
Adult women
78
What is the pathology of Fibromyalgia?
Chronic non-progressive course w/ waxing and waning intensity
79
What is the etiology of Fibromyalgia?
Unknown
80
What is the key to diagnose Fibromyalgia?
Multiple trigger points
81
What are the S/Sxs of Fibromyalgia?
- Stiffness and body aches (myalgia/arthralgia)
- Fatigue
- Pain is constant and aching
- Aggravated by weather changes and stress
- Sleep deprivation
- GI issues
- Anxiety
- Depression
- "fibro fog"
- pain worse in the AM, alleviates w/rest, warmth, and mild exercise and meds
82
What is the management of Fibromyalgia?
Stay active and engage in low intensity exercise (yoga and swimming)
- narcotics can worsen sxs.
83
Is Takayasu arteritis large medium or small vasculitis?
Large
84
Is Polyarteritis nodosa large medium or small vasculitis?
Medium
85
Is Behçet disease large medium or small vasculitis?
Medium
86
Is Granulomatosis with polyangiitis large medium or small vasculitis?
Small
87
Is Eosinophilic granulomatosis with polyangiitis large medium or small vasculitis?
Small
88
What is the epidemiology of Takayasu arteritis?
- Young Asian women
| - 10-20 yoa.
89
What is the pathology of Takayasu arteritis?
Granulomatous vasculitis of the aortic arch and its major branches
90
What are the S/Sx of Takayasu arteritis?
- Decreased or absent peripheral pules
- Discrepancies in blood pressure (arms vs legs)
- Arterial bruits
- Visual disturbances (hemorrhage of retinal arteries)
91
What body systems are involved with Polyarteritis nodosa?
Nervous system and GI tract
92
What is associated with Polyarteritis nodosa?
- HBV
- HIV
- Drug rxns
93
What is the pathophysiology of Polyarteritis nodosa?
Necrosis is segmented "rosary sign" as a result of aneurysms
94
What is the clinical manifestations of Polyarteritis nodosa?
- Livedo reticular
- Gangrene
- Ulcers
- Subcutaneous nodules
- Wrist drop
- NO pulmonary involvement
95
What is the diagnostic test for Polyarteritis nodosa?
Biopsy
96
What is Behçet disease?
Autoimmune, multisystem vasculitis disease, unknown etiology
97
What is the epidemiology of Behçet disease?
Middle eastern decent
98
What is the clinical manifestations of Behçet disease?
- Painful, sterile oral and genital ulcerations (pathergy)
- Relapsing uveitis
MC: oral ulcers
99
What are the diagnostic test for Behçet disease?
- Bx of involved tissue
| - Make sure to r/o herpes and lichen planus
100
Granulomatosis with polyangiitis involves what?
Predominantly involving the kidneys and upper/lower respiratory tract
101
What is the MC cause of death of Granulomatosis with polyangiitis?
Renal disease- most die within 1 yr following diagnosis
102
What are clinical manifestation of Granulomatosis with polyangiitis?
Upper respiratory:
- Purulent or bloody nasal discharge
- Painful oral ulcers
- Cough
- Hemoptysis
- Dyspnea
- Tracheal stenosis
- Saddle nose
103
What labs are use to diagnose Granulomatosis with polyangiitis?
c-ANCA (anti-neutrophil cytoplasm)
104
What is the diagnostic test to confirm Granulomatosis with polyangiitis?
Open lung bx
105
Eosinophilic granulomatosis with polyangiitis involves what?
- Cardiac
- Respiratory
- Skin
- GI
- Renal
- Neurologic
106
What are the clinical manifestations of Eosinophilic granulomatosis with polyangiitis?
- Subcutaneous nodules
- Palpable purpura
- Asthma
- Dyspnea
- Eosinophilia
107
What are the diagnostics used for Eosinophilic granulomatosis with polyangiitis?
Eosinophils on skin or lung tissue bx
108
What is the prognosis of Eosinophilic granulomatosis with polyangiitis?
Death usually related to cardiac or pulmonary complications.
- 5 yr survival w/o tx
- 10 yr survival w/treatment
