Rheumatology Flashcards
The following presentation is concerning for…
Symmetric polyarthritis
Pleuritic CP
Raynaud’s
Malar Rash/Discoid rash
SLE
Active SLE is indicated with what level of C3/C4?
low complement levels
What SLE specific dx labs would you order for a suspected case of SLE?
ANA
Anti-dsDNA Abs
Anti-Smith Abs
Anti-phospholipid Abs
Which ANA subtype typically remains positive even in SLE remission, and is detected in 10-50% of patients?
Anti-Sm
Which ANA subtype is specific for SLE, and levels fluctuate with activity of SLE…
Andi-dsDNA
A patient presenting with the following hx is concerning for…
aching
redness and swelling of hands, fingers, knees
2 hr morning stiffness
RA
A physical exam showing the following is concerning for…
Erythema/swelling of PIP and MCPs
Ulnar deviation at MCP
RA
With RA, ESR and CRP are…
elevated
What are two 1st line labs to get with RA?
RF, CBC
What Ab test is specific for RA?
Anti-CCP
A patient with the following presentation is concerning for…
- dry mouth/eyes
- diffuse joint and muscle pain
- increased dental cavities
Sjogren syndrome
What Ab tests should be ordred for suspected sjogren’s cases?
Anti-ro, anti-la Abs
A patient with the following presentation is concerning for…
- limited shoulder ROM bilaterally
- morning stiffness and on car rides
- recent onset UE/LBP/Hip/thigh pain
PMR
Elevated _______ is characteristic in PMR and is associated with what condition?
ESR
giant cell temporal arteritis
Is ESR/CRP specific for PMR?
no
What lab results would you expect for each of the following for fibromyalgia?
CBC ANA RF CRP ESR
all normal
A patient with the following is concerning for…
- LBP and progressive stiffness
- worse in AM
- LBP worse with inactivity
- Hx of plantar fascitis
ankylosing spondylitis
Bamboo spine and sacroiliitis on imaging is concerning for…
ankylosing spondylitis
What lab is strongly associated with ankylosing spondylitis?
HLA-b27
CREST syndrome is associated with…
Systemic sclerosis
CREST stands for…
calcinosis reynauds esophageal dysfunction sclerodactyly telangiectasia
ANA is _____ in 95% of systemic sclerosis patients…
positive ANA
Which antibody is associated with diffuse, cutaneous systemic sclerosis?
Anti-Scl-70
Anti-dsDNA Ab
SLE
Anti-Sm Ab
SKE
Anti-Ro/SSA
Sjogren
Anti-La/SSB
Sjogren
Anti-Scl-70
systemic sclerosis
Anticentromere (ACA)…
Crest/limited systemic sclerosis
Ab positive in RA…
ANA, RF, Anti-CCP
Chronic, symmetric polyarthritis
positive RF
positive anti-CCP
RA
polyarthritis, rash, nephritis, serositis
+ ANA
+ Anti-dsDNA
+ Anti-Sm
SLE
Acute onset proximal myalgia
morning stiffness
age > 55
High ESR
improvement w/ CS
Polymyalgia rheumatica
Tender points, non-restorative sleep/fatigue, normal labs…
fibromyalgia
Sicca Complex (dry glands)
+ Anti-Ro
+ Anti-La
Sjogren’s
CREST syndrome
+ Anti-SCL-70
+ ACA
Systemic Sclerosis
Back pain/stiffness
Bamboo spine
+ HLA-b27
ankylosing spondylitis
The below are 5 indications for…
new onset monoarthritis
crystal-induced arthritis
infx/septic arthritis
inflamm/non-inflamm arthritis
unexplained swelling
arthrocentesis/synovial fluid analysis
What is the most feared complication of arthrocentesis?
septic joint
What are three concerns for GC injection…
tendon rupture
nerve damage
osteonecrosis
What are 2 derm complications from joint aspiration/injection
skin atrophy
hypopicmentation
On gross inspection of synovial fluid, what should you look for?
Clarity
Color
Viscosity
On microscopic assessment of synovial fluid, what three things are normal?
high viscosity
clear
acellular
What are the 4 categories of joint effusions?
non-inflammatory
inflammatory
septic
hemorrhagic
3 causes of _______ joint effusion…
OA
Trauma
Avascular necrosis
noninflammatory
5 causes of ______ joint effusion…
septic arthritis RA/SLE spondy lyme disease crystals/gout
inflammatory
3 causes of septic joint effusion…
bacteria, fungi, mycobacteria
4 causes of _______ joint effusion…
hemophilia
trauma
tumor
anticoagulation
hemorrhagic
WBC > ________ is typically inflammatory…
2000
What type of effusion…
- yellow color
- high viscosity
- 0-2000 WBCs
- < 25% PMNs
Noninflammatory
What type of effusion…
- opaque/translucent
- yellow
- low viscosity
- PMNs 50+ %
inflammatory
What type of effusion…
- opaque
- yellow/green
- 20,000-100,000 WBCs
- PMNs 75% +
septic
WBCs > _______ should be considered septic until proven otherwise…
100k
PMNs 75+ considered…
septic
Can you have septic arthritis if WBC < 100k?
yes
Cx of joint fluid is positive in…
septic
A patient with the following hx is concerning for…
- swollen, painful, red joint
- hot to touch
- mild fever
septic arthritis
Joint fluid that is turbin, WBC 88k, 90% neutrophils, pos Cx.. this indicates…
septic arthritis
Patient presents with joint pain at base of 1st toe after eating prime rib, cocktails, dancing.
What type of crystals confirm dx of gout
MSU, negatively-birefringent needle shaped
A patient presents with…
- joint pain, swelling, redness
- no fever
- X-Ray shows chondrocalcinosis.
What type of crystals would indicate pseudogout?
Calcium pyrophosphate dihydrate (CPPD), positively birefringent, rhomboid shape
What is the gold standard for analyzing crystals…
polarized light microscopy
This measure is a material’s ability to refract light rays
birefringence
Which crystals appear yellow when parallel to the compensator of the microscope?
mono-sodium urate (MSU)
negative birefringent
Which crystals appear blue when parallel to the compensator?
CPPD
positive birefringent
