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PANCE > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Fibromyalgia

- pathophys

A

increased pain perception, increased substance P

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2
Q

Fibromyalgia

- Dx

A
  • diffuse pain
  • 11+/18 trigger points for > 3 months
  • Msk bx: “moth-eaten”
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3
Q

Fibromyalgia

- mgmt

A
  • exercise (swimming best)
  • TCAs (amytriptiline)
  • SSRIs, SNRIs
  • pregabalin
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4
Q

Gout

- medical causes

A
  • thiazide and loop diuretics
  • ACEi
  • Arbs (except losartan)
  • pyrazinamide
  • ethambutol
  • ASA
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5
Q

Gout

- MC joint

A

1st MTP joint “podagra”

knees, feet, ankles also common

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6
Q

Gout

- Dx

A
  • arthrocentesis: negatively birefringent needle-shaped urate crystals
  • xray: mouse/rat “punched-out” erosions, +/- tophi
  • Lab: elevated ESR, WBC in acute attacks
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7
Q

Gout

- Tx

A

Acute
- NSAIDs (indomethacin, naprosyn)
- Colchicine 2nd line
Prophylaxis
- allopurinol: inhibits xanthin oxidase which increases uric acid excretion
- colchicine (only drug given both prophylactically and in acute attacks)

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8
Q

Pseudogout

- pathophys

A
  • calcium pyrophosphate dihydrate deposition
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9
Q

Pseudogout

- Dx

A
  • Arthrocentesis: rhomboid-shaped crystals

- Xray: chondrocalcinosis

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10
Q

Pseudogout

- mgmt

A
  • 1st line: intra-articular steroids (differentiate from gout)
  • NSAIDs
  • Colchicine
    Chronic: NSAIDs, +/- colchicine
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11
Q

Juvenile idiopathic/rheumatoid arthritis

- describe

A
  • Autoimmune mono- or poly arthritis
  • Children <16
  • often resolves by puberty
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12
Q

Juvenile idiopathic/rheumatoid arthritis

- Three types

A
  • Pauci-articular (oligoarticular)
  • Systemic/acute febrile (still’s disease)
  • Polyarticular
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13
Q

Juvenile idiopathic/rheumatoid arthritis

- Pauci-articular

A
  • <5 joints involved
  • MC large joints
  • Associated with iridocyclitis (anterior uveitis)
  • Inc risk ankylosing spondylitis
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14
Q

Juvenile idiopathic/rheumatoid arthritis

- Systemic/acute febrile

A
  • daily arthritis with diurnal fever

- salmon/pink migratory rash

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15
Q

Juvenile idiopathic/rheumatoid arthritis

- Polyarticular

A
  • > 5 small joints
  • most similar form to adult RA
  • increased risk of iridocyclitis (anterior uveitis)
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16
Q

Juvenile idiopathic/rheumatoid arthritis

- dx

A

Clinical

  • inc ESR, CRP
  • pauci-articular: +ANA
  • RF only 15%
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17
Q

Juvenile idiopathic/rheumatoid arthritis

- Mgmt

A
  • NSAIDs +/- steroids
  • methotrexate or leflunomide
  • Frequent eye exams to screen for iridocyclitis
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18
Q

Osteoporosis

- pathophys

A
  • decreased bone density

- loss of both bone mineral and matrix

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19
Q

Osteoporosis

- kinds

A
  • primary: postmenopausal/senile
    RF: caucasian/asian, thin, smoker, steroids, renal dz, etoh, reduced ca/vitD, physical inactivity
  • secondary: chronic disease/meds
    RF: drugs, high cortisol state seen in prolonged steroid use or cushing dz
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20
Q

Osteoporosis

- clinical

A

1st sx usu pathological fracture, back pain, deformity

- spine fracture MC in lumbar and thoracic spine

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21
Q

Osteoporosis

- Dx

A
  • Labs: usu nl
  • possible reduced Vit D
  • DEXA scan: shows demineralization (normal ≥ -1.0, osteopenia -1.0 to -2.5, osteoporosis ≤ -2.5)
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22
Q

Osteoporosis

- Mgmt

A 
- Exercise: weight bearing
Drugs
- bisphosphonates 1st line
- Ergocalciferol: reduce progression 
- Selective estrogen receptor modulators: raloxifine (no inc risk 
- Estrogen: postmenopausal women only
- PTH: teriperiwtide
- calcitonin: last line
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23
Q

Bisphosphonate MOA

A

slow down bone loss by inhibiting osteoclast bone resorption

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24
Q

Polyarteritis Nodosa

  • overview
  • associated with what other dz
A
  • systemic vasculitis if the small/medium arteries

- assoc with HBV

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25
Q

Polyarteritis Nodosa

- pathophysiology

A
  • Leads to necrotizing inflammatory lesions
  • Micro aneurysms rupture
  • Hemorrhage, thrombosis
  • Organ ischemia and infarction
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26
Q

Polyarteritis Nodosa

- Clinical

A
  • renal: HTN (inc renin), renal failure
  • constitutional: fever, myalgias, arthritis
  • lung usually spared
  • CNS: neuropathy, mononeuritis multiplex
  • Derm: livedo reicularis, purpura, ulcers
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27
Q

Polyarteritis Nodosa

- dx

A
  • inc ESR
  • usually ANCA negative
  • biopsy: necrotizing lesions
  • renal/mesenteric angiography: microaneuryisms with small artery cut-off
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28
Q

Polyarteritis Nodosa

- mgmt

A
  • steroids

- plasmapheresis if HBV pos

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29
Q

Polymyalgia rheumatica

- overview

A
  • idiopathic inflammation which leads to synovitis, bursts, tenosynovitis
  • pain and stiffness of proximal joints
  • Usu >50 yo
  • closely related to giant cell arteritis
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30
Q

Polymyalgia rheumatica

- Clinical

A
  • bilateral, proximal joint aches/stiffness
  • Worse in the morning
  • No severe muscle weakness
31
Q

Polymyalgia rheumatica

- dx

A
  • clinical
  • Inc ESR
  • normochromic normocytic anemia
32
Q

Polymyalgia rheumatica

- mgmt

A
  • low dose steroids

- NSAIDs

33
Q

Polymyositis

- overview

A
  • idiopathic inflammatory muscle disease of proximal limbs, neck, pharynx
  • may affect heart, lung, GI
34
Q

Polymyositis

- Clinical

A
  • progressive, symmetrical proximal muscle weakness

- usu painless

35
Q

Polymyositis

- dx

A
  • Lab: inc aldolase*, CK, ESR
  • Positive muscle biopsy
  • abnl EMG
    • anti-Jo
  • mechanics hands
  • interstitial lung fibrosis
36
Q

Polymyositis and dermatomyositis

- Antibodies

A 
Polymyositis
- Anti-SRP
- Anti-Jo
Dermatomyositis
- Anti-mi-2
37
Q

Polymyositis

- mgmt

A
  • high dose steroids
38
Q

Dermatomyositis

- clinical

A
  • heliotrope upper eyelide discoloration
  • Gottron’s papules (raised violacious scaly eruptions on knuckles)
  • Malar rash which includes nasolabial folds
  • Photosensitive “shawl” sign
  • Diffuse alopecia
39
Q

Dermatomyositis

- dx

A
  • increased aldolase, CK, ESR
40
Q

Reactive arthritis

- overview

A
  • autoimmune response to infection elsewhere in the body

- MC 20-40 yo male

41
Q

Reactive arthritis

- clinical

A
  • arthritis: asymmetric
  • conjunctivitis/uveitis
  • urethritis
42
Q

Reactive arthritis

  • associated dzs
  • time frame
A
  • MC chlamydia
  • gonnorhea
  • GI infections
  • usu 1-4 weeks post infection
43
Q

Reactive arthritis

- dx

A
  • HLA-B27
  • WBC: 10-20k
  • IgG
  • synovial fluid WBC 1-8K, aseptic
44
Q

Reactive arthritis

- mgmt

A
  • NSAIDs

- no response > methotrexate, sulfasalazine, steroids

45
Q

Scleroderma

- overview

A
  • systemic connective tissue disorder

- thickened skin

46
Q

Scleroderma

- clinical

A
  • tight, shiny, thick skin
47
Q

Scleroderma

- 2 types

A
  • limited cutaneous systemic sclerosis (CREST)

- Diffuse cutaneous systemic sclerosis

48
Q

Scleroderma

- Limited cutaneous systemic sclerosis

A
  • calcinosis cutis
  • Raynauds
  • esophageal motility disorders
  • sclerodactyly
  • telangeictasias
49
Q

Scleroderma

- Diffuse cutaneous systemic sclerosis

A

trunk and proximal extremities effected

50
Q

Scleroderma

- dx

A
  • Pos anti-centromere Ab (More associated with CREST, better prognosis)
  • Pos anti-scl-70
51
Q

Scleroderma

- mgmt

A
  • DMARDs
  • Steroids
  • Raynauds: CCB, prostacyclin
52
Q

Sjogren’s Syndrome

- overview

A

Autoimmune reaction vs. exocrine glands

** aggregation of lympocytes

53
Q

Sjogren’s Syndrome

- clinical

A
  • Xerostomia
  • Dry eyes
  • parotid enlargement
  • commonly seen with thyroid disfunction
54
Q

Sjogren’s Syndrome

- Dx

A
  • pos ANA
  • Pos Antiss-A (Ro)
  • Pos Antiss-B (La)
  • Pos RF
  • Pos Shirmer test (reduced tear production)
55
Q

SLE

- overview

A

chronic, systemic, multi-organ autoimmune disease of connective tissue

56
Q

SLE

- RF

A
  • genetic
  • environmentla
  • sun exposure
    MC young, AA/hispanic/native american females
57
Q

SLE

- drug causes

A
  • procainamide
  • hydralazine
  • INH
  • Quinidine
58
Q

SLE

- clinical

A
  1. Triad: joint pain, fever, malar rash (spares nasolabial fold)
  2. Serositis - pleurites and pericarditis
  3. Discoid: annular, red patches on face and scalp, heal with a scar
  4. Systemic: CNS, cardiovascular, glomerulonephritis, retinitis, oral ulcers, alopecia
59
Q

SLE

- Dx

A
  • Pos ANA (best initial test)
  • Pos anti-double stranded DNA
  • Pos anti-Smith (100% specific)
  • CBC: +/- anemia, leukopenia, lymphopenia, thrombocytopenia
60
Q

SLE

- Mgmt

A
  • Sun protection
  • hydroxychloroquine
  • NSAIDs
  • +/- pulse steroids
  • methotrexate
  • cyclophosphamide
61
Q

Antiphospholipid ab syndrome

- causes risk of what

A
  • increased risk of arterial and venous thrombosis
62
Q

Antiphospholipid ab syndrome

- Dx

A
  • Anticardiolipin Ab (*assoc with false positive for VDRL/RPR)
  • Lupus anticoag
  • Increased risk of miscarriages
63
Q

Rheumatoid Arthritis

- overview

A

symmetric polyarthritis, bone erosion, cartilage destruction, and joint structure loss (via pannus destruction)

64
Q

Rheumatoid Arthritis

- autoimmune response

A

T-cell related

65
Q

Rheumatoid Arthritis

- Clinical

A
  • prodrome: systemic sx
  • small joint stiffness (MCP, PIP, wrist, etc), worse with rest
  • symmetric arthritis - swollen, tender, erythematous, “boggy” joint
  • Boutonnierre and swan neck deformities
  • MCP unlar deviation
66
Q

Rheumatoid Arthritis

- dx

A
  • RF positive (best initial test)
  • Pos anti-cyclic citrullinated peptide Ab (most specific to RA)
  • arthritis in ≥ 3 joints ≥ 6 weeks
  • anemia of chronic dz
  • XR: narrowed joint space
67
Q

Rheumatoid Arthritis

- Mgmt

A
  • prompt start DMARDS to reduce joint damage
  • methotrexate first line
  • +/- NSAIDs and steroids
68
Q

DMARDS

- Nonbiologic (list 4)

A
  • methotrexate
  • leflunomide
  • hydroxychloroquine (plaque nil)
  • sulfasalazine
69
Q

Methotrexate

  • MOA
  • SE
A
  • reduces lymphocyte proliferation, immunosuppresant

- Hepatotoxicity, stomatitis, leukopenia, bone marrow suppression

70
Q

Leflunomide

- MOA

A

reduces T cell activation, prevents new joint erosion

- use as an alternative to methotrexate

71
Q

Hydroxychloroquine

  • MOA
  • when to use
  • SE
A
  • Reduces RF and active phase reactants
  • use in mild disease
  • Retinal toxicity- fundoscope q6-12 months
72
Q

Sulfasalazine

- MOA

A

Anti-inflammatory

- use in mild cases, less effective than methotrexate or leflunomide

73
Q

DMARDS

- list 5 biologics used

A
  • Etanercept (Enbrel): usually first line drug
  • Infliximab (Remicade): usually added to methotrexate, not usu mono therapy
  • Adalimumab (Humira): usually added to methotrexate, not usu mono therapy
  • Anakinra
  • Rituximab
74
Q
  • What tests must be done prior to starting any biologic DMARDS?
  • When to avoid TNF inhibitors
A
  • PPD to screen for tuberculosis
  • Also screen for HBV and HCV
  • Avoid TNF inhibitors if active or chronic infection

PANCE (14 decks)

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