Rheumatology Flashcards
Ankylosing Spondylitis
Chronic inflammation of axial skeleton and sacroiliac joints w/ progressive stiffness
MC M 15-30yo
Sxs
- Chronic LBP - morning stiffness w/ decr ROM
- back stiffness decr w/ exercise and activity
Dx
- HLA-B27
- Incr ESR
- Bamboo spine on Xray - loss of normal curvature
Tx
- NSAIDs, rest, PT = 1st line
- Glucocorticoid
- Non-bio DMARD - sulfasalazine, methotrexate
- TNF-a inhibitor (infliximab) => steroids
Fibromyalgia
Chronic widespread muscular pain, sleep disruption, mood changes
11 out of 18 sites documented
Non destructive, non progressive
normal labs
Tx
- EXERCISE
- SSRI, TCAs
- Pregabalin
- Duloxetine
Giant Cell (Temporal) Arteritis
>55yo, F>M
Sxs:
- Tender inflammed, cordlike temporal arteries w/o pulse
- HA
- Acute vision loss vs diplopia
- Tinnitus
- Comorbid polymyalgia rheumatica
Dx:
- Ele ESR , always >70, usu >100
- Bx to confirm - multinucleated giant cells
Tx:
- High dose prednisone (60-120mg) slow taper
- 6-12 mos
- Thoracic aneurysms - more common
Gout
altered purine metabolism = uric acid accumulation in soft tissues and bones
>30yo &M>W (9:1) until menopause (1:1)
Sxs:
- Podagra attack (great toe)
- pain, swelling, redness, exiquisite tenderness
- tophi in chronic gout
Dx
- Arthrocentesis & joint fluid analysis
- Negative, bifrigent needle shaped crystals
- Serum Uric acid > 8 - dont measure during accute attack
Tx:
- LSMs - less purine foods
- NSAIDs - Indomethacin for acute attack
- Management with colchicine or allopurinol
Juvenile Rheumatoid Arthritis
Begin before or at 16yo.
Sxs - arthritis, fever, rash, adenopathy, splenomegaly, iridocyclitis
Three types
-
Oligoarticular JIA - MC, young girls
- = 4 joints during first 6 mos of dz
- persistent vs extended (more than 5 joints after first 6 mos)
-
Polyarticular JIA -2nd MC
- >/= 5 joints at onset
- RF neg vs RF pos - arthritis is symmetric and involves small joints
- RF pos - adolescent girls, more like adult RA
-
Systemic JIA - Still Disease
- Fever and systemic manifestations, rash
- joint pain and stiffness worse in AM
Dx
- clinical
- anti-CCP, can have ANA
Tx
- NSAIDs, intraarticular CS
- Methotrexate
Polyarteritis Nodosa
Systemic Vasculitis of medium and small arteries => necrotizing inflammatory lesions
Men in 40-50s, a/w Hep B
Sxs:
- Renal - HTN 2/2 incr renin production
- Constitutional - fever, myalgias, arthritis, no lungs involv
- CNS - neuropathy, amaurosis fugax, periph neuropathy, mononeuritis multiplex
- Derm - livedo reticularis, purpura, ulcers, gangrene
Dx
- Ele ESR
- P-ANCA negative (20% can be positive)
- Renal or mesenteric angiography - microaneurysm + abrupt cut off of small arteries
Tx
- Corticosteroids; cyclophosphamide if refractory
- Plasmaphersis if +HBV
Polymyalgia Rheumatica
Pain and stiffness in shoulder, neck, pelvic girdle - older patients
Sxs:
- fever, malaise, wt loss, fatigue
- no weakness*
- a/w Giant cell Arteritis
Dx:
- High ESR, CRP
Tx:
- low dose Corticosteroids - 10-20 mg/d
- NSAIDs
- exercise
Polymyositis
Idiopathic inflammatory muscle disease of proximal limbs, neck, pharynx
Sxs
- Progressive symmetrical proximal muscle weakness
- have distal strength
- painless
Dx
- Incr muscle enzymes (aldolase, CK)
- Muscle biopsy
- anti-Jo1 Ab = myositis specific ab –> mechanical hands
- anti-SRP ab = specific to PM
- anti-Mi-2 ab = specific for dermatomyositis
Tx - high dose CS, +/- methotrexate, azathioprine, IV Immunoglobulin
Reactive Arthritis
Can’t see, cant pee, cant climb a tree
Sxs
- Conjunctivitis, urethritis, arthritis
- Keratoderma blennorrhagicum = hyperkeratotic lesions on palms/soles
Dx
- HLA-B27
- aseptic synovial fluid
Tx
- NSAIDs, if no response, Methotrexate => sulfasalazine, steroids
- abx for current infx
Rheumatoid Arthritis
Chronic systemic inflammatory dz
F>Ml 40-60yo
Sxs:
- Arthralgias, morning stiffness, and fatigue
- gets better with movement, worse with rest
- Wrists, MCP, PIP joints - ulnar deviation
- Spares DIP
- Swan neck/boutoniere deformity
Dx:
- Xray - erosions
- anti-CCP (more sensitive)
- + RF
Tx:
- Initial tx - NSAIDs, CS for pain control
- DMARDs
- Methotrexate** 1st = reduces permanent damage
- Azathioprine
-
TNF-i/biologics
- can reactive latent TB and cause lymphoma
Scleroderma
Systemic Sclerosis
Thickness/fibrosis of skin d/t excess collagen
Sxs
- diffuse thickening of skin
- dysphagia/hypomotility - hard to swallow
- Raynaud’s
Dx - ANA, Anti-Centromere
Tx
- PPI for GI
- ACE for renal
- CCB for raynauds
- Immunosuppression for Pulm HTN
Sjorgen’s Syndrome
Lymphocytic invasion of lacrimal and salivary gland; linked to lymphoma
Sxs:
- dry eyes, mouth
- a/o SLE or RA
Dx:
- +ANA
- SS-A (Ro) and SS-B (La)
- Schrimer’s test
Tx
- Immunosuppression tx
- Moisturizers for eyes/mouth
Systemic Erythematous Lupus
dx, tx
Dx: 4 or more of following
- Malar rash
- discoid lesions
- photosensitivty
- Oral ulcers
- arthritis
- serositis - pericarditis, pleuritis
- Renal dz - proteinuria
- +ANA
- anti DNA
- anemia, leukopenia, thrombocytopenia
Tx:
- NSAID, exercise
- Sun protection
- CS prednisone - mainstain
- Hydroxychloroquine - check retina freq
Systemic Lupus Erythematous
eti, sxs
90% young women, more commonly AA, inherited
Sxs:
- Malar rash, Discoid rash
- Serositis - pericarditis
- Oral ulcers
- Arthritis
- Photosensitivty
- Blood disorder
- Renal disease
- ANA+
