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CCFP > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are three comorbidities that usually are seen with fibromyalgia

A

1) Chronic fatigue syndrome
2) myofascial pain syndrome
3) Psychiatric illness

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2
Q

What are the signs of symptoms of fibromyalgia?

A
  • Pain (≥3 mo, intermittent then persistent)
  • Chronic fatigue - non-restorative sleep
  • Cognitive dysfunction: poor working memory, verbal
  • Somatic Symptoms: IBS, H/A, menstrual pain, TMJ
  • Mood disorder: anxiety/depression
  • Sexual dysfunction
  • PTSD
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3
Q

How is a diagnosis of fibromyalgia made?

A

history and normal investigations

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4
Q

When considering a diagnosis of fibromyalgia, what are other conditions that are on your differential diagnosis?

A
  • rheumatological disease (SLE, spondyloarthritis, PMR, RA)
  • hypothyroidism
  • Depression
  • Neurologic (MS, neuropathy, myopathy)
  • Infectious (Lyme disease, hep C, HIV)
  • Meds (statin, aromatase inhibitor, bisphosphonate)
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5
Q

What are some lifestyle modifications that can be done to treat fibromyalgia?

A
  • Education (disease is benign, non-deforming, non-progressing)
  • Exercise program (water aerobics, ta chi)
  • Support the back and neck
  • Cognitive-behavioral therapy
  • stress reduction
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6
Q

True or false, non-pharmacological management is more effective than pharmacologic management in treating fibromyalgia

A

TRUE

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7
Q

What are some pharmacological options for the treatment of fibromyalgia?

A
  • NSAID/acetaminophen
  • cyclobenzaprine 1-4mg
  • tramadol
  • nabilone
  • amitriptyline (evidence for sleep restoration)
  • SSRI + SNRI (less evidence than TCA)
  • gabapentin/pregabalin
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8
Q

What are some referrals you can make when you diagnose someone with fibromyalgia?

A
  • sleep study referral

- psychological consult

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9
Q

What are some investigations that you can obtain when the diagnosis for fibromyalgia is equivocal?

A
  • CBC
  • ESR/CRP, CK
  • TSH
  • ANA
  • Sleep Study
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10
Q

What is the primary etiology of Gout?

A

Serum urate level ≥ 6.8-7
Primary:
- idiopathic renal under excretion (90%)
- idiopathic overproduction
Secondary:
- Dietary Excess
- Under excretion –> renal failure, drugs

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11
Q

What are the risk factors for Gout?

A
  • DM
  • Male
  • Hyperuricemia
  • CKD
  • obesity
  • CAD
  • metabolic syndrome
  • dyslipidemia
  • Drugs: diuretics, cyclosporine, low dose ASA
  • Foods: meat, seafood, alcohol, high sugar soft drinks
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12
Q

What are the signs and symptoms of gout

A
  • often the 1st MTP joint
  • acute pain, swelling, erythema, w/ limited joint mobility
  • tophi (monosodium urate crystals)
  • renal - nephropathy, calculi, acidic urine
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13
Q

What other diagnoses are on your differential for someone who presents with symptoms suggestive of gout?

A
  • OA (inflammatory episodes)
  • psoriatic arthritis
  • Trauma
  • septic arthritis
  • RA
  • pseudogout
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14
Q

If septic arthritis is still on the differential, what investigation would you perform?

A
  • synovial fluid aspiration for crystals
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15
Q

What are some lifestyle modifications someone can make for the treatment of gout?

A
  • limit purine and high fructose intake
  • avoid alcohol
  • avoid meats, sardines, shellfish, beans, peas
  • consider a diet of <1600kcal /day
  • weight loss
  • avoid thiazides, consider losartan instea
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16
Q

What are the treatment options for an acute gout attack?

A
  • Ice
  • NSAIDs
  • colchicine
  • corticosteroids (usually if NSAID and colchicine is contraindicated)
17
Q

What can be given to patients with gout for prophylaxsis?

A

allopurinol (indefinitely)

18
Q

When is prophylactic medication for gout indicated?

A
  • ≥1 tophi
  • radiographic damage from gout
  • ≥ 2 flares/year
  • > 1 lifetime flare but <2/year
  • first flare, and CKD stage ≥3, SU >535, or urolithiasis
19
Q

What are some findings on xray of someone who has osteoarthritis

A

joint narrowing
subchondral sclerosis
subchondral cyst formation
ostephytes

20
Q

What are risk factors for OA

A
  • family history
  • inactivity
  • obesity
  • muscle weakness
  • heavy physical activity
  • previous trauma
  • reduced proprioception
21
Q

What are signs and symptoms

A
  • insidious onset
  • morning stiffness <30 min, and stiffness after inactivity
  • pain alleviated with rest and inactivity
  • pain around joints after weight-bearing exercise
  • crepitus with motion
  • bony enlargement
  • limited ROM
22
Q

What are other diagnosis (ddx) to consider in someone who you think has OA?

A
  • infection
  • RA
  • malignancy
  • fracture
  • gout/pseudogout
  • bursitis (trochanteric, pes anserine)
  • referred pain
23
Q

What are some red flags in someone with joint pain?

A
  • acute severe pain
  • constitutional symptoms (fatigue, night sweats, wt loss)
  • Neurogenic pain
  • Trauma (?fracture)
  • focal/diffuse muscle weakness
  • claudication
  • night pain
  • hot and swollen joint
24
Q

What are some lifestyle modifications for someone with OA?

A
  • exercise rx
  • joint protection
  • muscle strengthening
  • physiotherapy/rehab
  • supportive footwear - shock-absorbing, well fitted, orthotics
  • assistive devices - cane, brace, home adaptors
25
Q

What are the treatments for OA other than lifestyle modifications?

A
  • NSAIDs
  • Topical capsaicin, NSAIDs
  • acetaminophen
  • corticosteroid joint injections
  • surgery
26
Q

When do you refer someone with OA to a specialist?

A
  • inadequate pain control
  • presence of night pain
  • functional restriction (impaired ADLs, unable to walk w/o pain, threat to pts work/life)
27
Q

What are some findings on lab investigation of PMR?

A
  • low hgb
  • elevated platelets
  • increased ESR, CRP
  • normal CK
28
Q

What are the inclusion criteria for PMR?

A
  • age > 50
  • duration >2 wks
  • abrupt onset
  • morning stiffness >45
  • bilateral shoulder +/- pelvic girdle pain
  • elevated ESR/CRP
29
Q

How do you treat PMR?

A

with steroids (prednisone)

30
Q

15% of patients with PMR develop _____

A

Giant cell arteritis

CCFP (7 decks)

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