Rheumatology

Question 1

Treatment for Ankylosing Spondylitis

Answer 1

1. NSAIDs
2. TNF-a (humira)
3. MTX, hydrocholoroquine sulfasalazine

• Ca/Vit D for all patients
• Bisphos for Osteopenia, and Osteoporosis

Question 2

Treatment for RA

Answer 2

1. MTX
2. Add leflunamide, sulfazalazine, Hydroxoxychloroquine
3. Add Biologic
   - – TNF-alpha (etanercept)
   - – Monoclonal antibody (humira, inflixamab)

Hydroxychloroquine and sulfasalazine can be used in pregnancy

Question 3

Etanercept SE

Answer 3

Demyelinating syndromes
Pancytopenia
+ ANA lupus like syndrome

Question 4

Treatment of Sjorgrens Syndrome

Answer 4

Symptomatic treatment

immunosuppression only when symptoms are severe

Question 5

Treatment of psoriatic Arthritis

Answer 5

1. NSAIDS
2. MTX for peripheral joint disease not responding to NSAIDs
3. Add TNF-alpha for sx not responding to MTX

Question 6

Reactive Arthritis Treatment

Answer 6

Usually self limiting in the absence of ongoing infection/secondary cause
Tx NSAIDs, steroid injections

Question 7

Sclerosis Treatment

Answer 7

Treat symptomatically

GERD treat with PPI
Renal Crisis treat with Ace inhibitor
Bacterial overgrowth due to dysmotility- treat with Rifaximin
Alveolitis/ILD: cyclophosphamide
PAH (CREST) - treat with PAH meds
ILD (Diffuse)- Treat with cyclophosphamide

Question 8

MCTD treatment

Answer 8

Steroids, azapthiprine, and mTX

Question 9

PMR

Answer 9

Low dose steroids (15MG)

Question 10

Polymyositis/Dermatomyositis

Answer 10

Treat with Steroids initially
MTX or azathioprine if refractory
IVIG in refractory

Question 11

Adult onset Still Disease Diagnosis

Answer 11

Major

• Spiking fevers
• Arthalgias
• Salmon colored rash- maculopapular
• leukocytosis

Minor:

• Negative ANA
• Positive RF
• Elevated AST
• Sore throat
• Splenomegaly

*** elevated ferritin >2500 highly specific

> 5 total criteria with 2 major

Question 12

Adult Onset Still Disease Treatment

Answer 12

1. NSAIDS
2. Steroids if refractory
3. MTX, TNF-ALPHA

Question 13

FMF Diagnosis

Answer 13

Recurrent fevers, self limiting
Serositis
Arthalgias
Rashes that last 3-4 days

Elevated ESR, Positive AA protein, Protienuria, and Meditterean fever geven

descendant of ashkenazi jewish

Question 14

FMF treatment

Answer 14

Colchicine

Question 15

Mixed Connective Tissue Disease Criteria

Answer 15

Anti-RNP + 
>/= three of the following 
1. swelling of the hands/joints
2. synovitis
3. sclerodactyl 
4. Raynauds 
5. myositis

Question 16

Treatment of mixed connective tissue

Answer 16

Prednisone
Methotrexate
Aziothoprine

Question 17

Antibodies to test for APL

Answer 17

Anti-cardiolupin
lupus anticoagulant
beta-2 glycoprotein