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503 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

When is the peak incidence of rheumatoid arthritis and is it more common in males or females?

A

Within fourth and fifth decades

2.5 times more common in females than males

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2
Q

How long must symptoms be present to diagnose RA?

A

At least 6 weeks

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3
Q

Key features of RA?

A

Inflammatory synovitis
Symmetrical and polyarticular
Nodules

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4
Q

This is palpable/touchable synovial swelling and morning stiffness over an hour with fatigue.

A

Inflammatory synovitis

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5
Q

RA typically affects what joints?

A

Wrists, MCP, and PIP joints

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6
Q

What joints does RA typically spare?

A

DIPs, thoracolumbar spine, and IPs of the toes

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7
Q

These are subcutaneous or periosteal at pressure points (especially along where people lean on their arms)

A

Nodules

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8
Q

What serological markers are sent for RA?

A

Rheumatoid factor

Anti-cyclic citrullinated peptide antibody (anti-CCP)

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9
Q

What serological marker is more specific for RA?

A

Anti-CCP

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10
Q

If both RF and anti-CCP are positive then:

A

There is a higher correlation with erosive disease in RA.

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11
Q

What in x-ray is also a positive sign of RA?

A

Marginal erosions and joint space narrowing

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12
Q

Pathogenesis of RA?

A

Synovial fluid is overproduced and can cause pain/inflammation (like oil in a car).

Pannus: old, thickened synovial fluid that eats away at cartilage.

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13
Q

Early erosion in RA leads to:

A

More advanced disease

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14
Q

Possible systemic manifestations of RA?

A

Fatigue
Raynaud’s phenomenon (cold hands due to thinning blood vessels)
Dry eyes, dry mouth ( secondary Sjögren’s syndrome to RA)
Interstitial lung disease
Pleuritis or pericarditis
Vasculitis

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15
Q

RA treatment principles:

A

Diagnose and refer to rheumatology ASAP
When damage begins early- start aggressive treatment early
Monitor for adverse effects at least every 2 months

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16
Q

What medication is the gold standard in RA treatment?

A

Methotrexate

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17
Q

Main concerns with methotrexate?

A

Hepatotoxic it and marrow suppression

-checkup at least every 8 weeks, but every 2 to 3 weeks at first

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18
Q

Tumor necrosis factor inhibitors are used in RA for patients:

A

With inadequate response to methotrexate.

Before starting this try plaquenil, azathioprine, or sulfasalazine in combo with methotrexate.

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19
Q

If patient has bone erosion in RA what medication is needed?

A

TNF inhibitors due to significant reduction in radiographic progression compared to placebo/methotrexate.

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20
Q

Psoriatic arthritis clinical presentation:

A 
Sausage digits and tenosynovitis 
Asymmetric oligoarthritis, especially DIPs 
Symmetric poly arthritis 
Spondylitis 
Arthritis mutilans 
Seronegative 
15-30 percent of psoriasis 
Associated with nail pitting and extensive skin disease
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21
Q

Pharm management in psoriatic arthritis:

A

NSAIDs, steroid injections
Methotrexate (helps skin and joints)
Anti-TNF agents

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22
Q

Polymyalgia rheumatica clinical features:

A

Age at least 50 usually over 70
Acute onset of pain lasting weeks in two or more axial areas including neck, shoulders, and pelvic girdle
Morning stiffness for an hour or more
Rapid response to low dose corticosteroids
Absence of another explanation of symptoms
ESR of 40 mm/hr or higher

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23
Q

PMR is associated with what condition?

A

Giant cell arteritis

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24
Q

This can cause visual changes, jaw pain, and scalp tenderness and is considered an emergency. Immediate high-dose steroids are required to prevent blindness.

A

Giant cell arteritis

25
Q

PMR management:

A

Low-dose prednisone tapered to lowest dose for at least a year.

Example:
Begin with 20mg for 2 months
Decrease by 5 mg every month until patient reaches 5 mg/day and then continue with 5 mg/day for remainder of a full year.
Then decrease by 1mg every month until complete

26
Q

When to use methotrexate with PMR?

A

Use if patient fails 2 attempts to taper prednisone.

Increase prednisone to the lowest effective dose and then add methotrexate.

27
Q

This is a multi system disease that affects many organs. It has a constellation of diverse signs and symptoms that change over time.

A

Systemic lupus erythematous (SLE)

28
Q

Constitutional symptoms of SLE:

A

Fatigue, fever, and weight loss

29
Q

Demographic characteristics of SLE?

A

Overwhelming female predominance
Typical onset during reproductive years
Strong minority representation

30
Q

SLE triggers?

A 
Recent sun exposure 
Emotional stress 
Infection 
Certain drugs (sulfonamides, hydralazine) 
Surgery
31
Q

SLE criteria?

A

Must meet 4:
Mucocutaneous- Malar rash, discoid lesions, photosensitivity, oral ulcers
Symptomatic organs: arthritis, serositis, neuropsychiatric, renal
Labs: ANA, hematologic (lymphopenia, leukopenia, hemolytic anemia, thrombocytopenia), immunologic (anti-ds-DNA, anti-smith, antiphospholipid antibodies), nephrtitis (RBC casts, proteinuria)

32
Q

What system is most commonly affected in SLE?

A

Cutaneous system

33
Q

3 most common types of skin lesions in SLE?

A

Acute
Subacute
Discoid (chronic)

34
Q

These types of lesions with SLE present as a butterfly rash, are erythematous and edematous, and are seen on chin and forehead, not nasolabial folds.

A

Acute lesions

35
Q

Which type of lesions are strongly associated with active systemic lupus?

A

Acute

36
Q

These types of lesions in SLE primarily affect Caucasian females and are symmetric, widespread, superficial, non scarring, and typically seen on sun exposed skin.

A

Subacute lesions

37
Q

These types of lesions of SLE are seen typically on face, scalp, pinnae, behind the ears, and neck. They are seen in non-sun-exposed areas, can be exist as part of systemic disease or in isolation, and present with central atrophic scarring with active indurated erythema at periphery.

A

Discoid (chronic)

38
Q

Mucocutaneous manifestations of lupus?

A

Alopecia, mucosal lesions, and vasculitis.

39
Q

Important areas to inspect with SLE?

A 
Scalp
Pinnae 
Behind ears
Palate
Finger tips
Palms
40
Q

Musculoskeletal symptoms of SLE?

A

Painful joints with synovitis, erythema, or decreased ROM. Is generally symmetrical unlike RA can be brief or persistent.

41
Q

What organ is the signature organ affected by SLE?

A

Kidneys

42
Q

Lupus nephritis has been shown to:

A

Lead to a bad outcome

43
Q

What lead to a diagnosis of renal disease in SLE?

A

Proteinuria

*urinalysis is key

44
Q

Nervous system symptoms of SLE?

A

Psychiatric- mood disorders, anxiety, psychosis
Cognitive- attention deficit, lack of concentration, impaired memory
Neurological- acute confusional state, seizures, headaches
Neuro deficits- visual defects, ptosis, nystagmus, vertigo, and peripheral neuropathy

45
Q

What is the most frequent cardiac complication of SLE?

A

Pericarditis- substernal or pericardial pain aggravated by inspiration, coughing, swallowing lasting hours to days

46
Q

Pulmonary complications of SLE?

A

Pneumonitis, pulmonary hemorrhage, pulmonary HTN, shrinking lung syndrome.

Acute lupus pneumonitis- pleuritic chest pain, cough with hemoptysis and dyspnea

47
Q

SLE treatment:

A 
Sunblock 
NSAIDs 
Plaquenil- used for skin and joint manifestations 
Corticosteroids 
Immunosuppressants
48
Q

What is the first fda approved treatment for lupus in 50 years?

A

Benlysta (benlimumad)- B-lymphocyte stimulator inhibitor

49
Q

Presence of this antibody almost always indicates lupus?

A

Antibody to SM

50
Q

What are complements?

A

Proteins that fortify immune system.

51
Q

Inflammation from lupus severely ___ the amount of complements.

A

Reduces

52
Q

Lupus may be active if C3 and C4 numbers are ___?

A

Low

53
Q

Unlike RA, OA is:

A

Generally not considered an inflammatory disease and it affects individual joints without systemic effects.

54
Q

What is the most common form of arthritis?

A

OA

55
Q

Risk factors of OA?

A 
Age (75 % of people over 75 have OA)
Female 
Obesity 
Hereditary 
Trauma 
Neuromuscular dysfunction 
Metabolic disorders
56
Q

Symptoms and signs of OA?

A 
Pain related to use 
Pain worsens throughout the day 
Minimal morning stiffness 
Decreased ROM 
Joint instability
Bony enlargement 
Restricted movement 
Crepitus 
Variable swelling and/or instability
57
Q

Joints commonly affected by OA?

A 
Hands 
Feet
Hips
Knees 
Spine
58
Q

Treatment of OA:

A 
Routine exercise (essential) 
Patient education (essential) 
Weight loss 
PT
Tylenol- 1st line up to 3g/day
NSAIDs if no liver issues 
Intra-articular steroid injections 
Hyaluronate injection- viscous solution that helps relieve knee pain in some 
Surgical procedures- is all conventional therapies have been utilized

503 (6 decks)

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