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Rheumatology II Flashcards

1
Q

RA genetic loci?

A

DR4

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2
Q

RA inciting factors?

A

Maybe EBV, parvo, human herpesvirus 6, mycoplasma

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3
Q

Types of automimmune reaction in RA?

A

Type III

Type IV → CD4+ cells release inflammatory cytokines
• TNF is important cytokine from macrophages

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4
Q

What cells in RA probably produce RF?

A

Inflamed synovial cells express an antigen that triggers B cells to produce rheumatoid factor (RF).

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5
Q

Where do the immune complexes in RA come from?

A

RF and IgG join to form immunocomplexes

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6
Q

What likely causes inflammatory cells to enter the joint space in RA?

A

Once ICs deposit, they activate complement system.

C5a release acts as chemotactic agent for neutrophils and other leukocytes.

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7
Q

What is a pannus in RA?

A

Granulation tissue in the synovial tissue formed by fibroblasts and inflammatory cells.

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8
Q

Hand joints most commonly affected by RA?

A

Symmetric MCP, PIP joints

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9
Q

What is swan neck deformity?

A
  • Flexion of DIP

* Extension of PIP

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10
Q

What is Boutonniere deformity?

A
  • Extension of DIP

* Flexion of PIP

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11
Q

What non-hand joints are commonly affected by RA?

A
  • Knees
  • C-spine
  • Hips
  • Shoulders
  • Elbows
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12
Q

Lung manifestations of RA?

A
  • Chronic pleuritis with effusions

* Interstitial fibrosis

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13
Q

What are the hematological manifestations of RA?

A
  1. Chronic anemia
  2. Hemolytic anemia (autoimmune)
  3. Felty syndrome
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14
Q

What is Felty’s syndrome?

A

Autoimmune neutropenia and splenomegaly

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15
Q

What neuropathy is common in RA?

A

Carpal tunnel syndrome

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16
Q

What is common c-spine manifestation in RA?

A

Possible subluxation of atlantoaxial joint
• Possible cord compression → paralysis
• Possible vertebral artery occlusion → stroke

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17
Q

Where are rheumatoid nodules found?

A
  • Extensor surface of forearms

* Lungs

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18
Q

What are rheumatoid nodules typically correlated to?

A

High RF titers

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19
Q

What are common cardiac manifestations of RA?

A
  1. Fibrinous pericarditis
  2. Aortitis
  3. Immunocomplex small vessel vasculitis (usually around the ankles)
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20
Q

Popliteal cysts are common with what AI disorder?

A

RA

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21
Q

Serology of RA?

A
  • ANA (30%)
  • RF (70-90%)
  • Anti-CCP
  • Increased y-globulin
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22
Q

Initial RA treatment?

A
  • Exercise
  • NSAIDs
  • Disease modifying drugs
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23
Q

What is Sjogrens syndrome?

A

Autoimmune destruction of minor salivary and lacrimal glands

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24
Q

Which gender does Sjogrens typically affect?

A

Female

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25
What are the main three clinical finds of Sjogrens?
1. Rheumatoid arthritis 2. Keratoconjunctivitis secca (sand in my eyes) 3. Xerostomia
26
Serology of Sjogrens?
1. ANA (almost always) 2. RF (90%) 3. SS-A, SS-B
27
How do you confirm Sjogrens?
Lip biopsy shows lymphoid destruction of minor salivary glands
28
How do you treat Sjogrens?
1. Artificial tears 2. Pilocarpine or cyclosporine eye drops 3. Civemaline (cholinergic for dry mouth)
29
What is the definition of SLE?
Chronic multisystem autoimmune disease that primarily involves skin, joints, serosal membranes, blood cells, nervous system, and kidneys.
30
What genetic loci is associated with SLE?
DR3
31
How can complement affect how likely a PT is to get SLE?
Certain complement deficiencies (C2 for example) can increase risk
32
What are four environmental factors that might precipate SLE?
1. Infection (EBV) 2. Ultraviolet light 3. Estrogen 4. Medications
33
What types of autoimmunity is involved with SLE?
``` Type III • Skin • Glomeruli/tubules • Joints • Small vessels Type IV • Blood components ```
34
What is a very common arthritic finding with SLE?
Morning stiffness in the hands
35
What are the common hemotalogic findings with SLE?
* Hemolytic anemia * Thrombocytopenia * Leukopenia
36
What joints are most often affected with SLE?
* PIP, MCP | * Symmetric, nonerosive, not deforming
37
Skin findings in SLE?
* Malar rash on the face | * Rash worsened by UV light
38
Renal findings in SLE?
* Diffuse proliferative glomerulonephritis * Can present with nephrotic syndrome * CHRONIC RENAL FAILURE IS THE MOST COMMON CAUSE OF DEATH
39
Cardiovascular findings with SLE?
* Fibrinous pericarditis with or without effusions | * Libman-Sacks endocarditis (sterile vegetation on valve)
40
Respiratory findings with SLE?
* Pleuritic chest pain with or without effusions | * Interstitial fibrosis may occur leading to restrictive lung disease
41
CNS findings with SLE?
* Headache, psychosis, Seizures, stroke | * Vessel thrombosis causing stroke is most often associated with ANTI-PHOSPHOLIPID SYNDROME
42
Pregnancy complications related to SLE?
* Complete heart block can occur if IgG SS-A crosses | * Spontaneous abortion can occur (thrombosis from anti-phospholipid A)
43
What two drugs are most often the cause of drug-induced SLE?
Procainamide and hydralazine
44
Serology for SLE would show what?
* ANA (100%) -- for screening, 80% sensitive * Anti dsDNA -- confirmation 99% specific * Anti-Smith -- confirmation 100% specific
45
Complement levels in SLE?
Usually decreased because of complement activation from ICs
46
Immunofluorescent testing in SLE?
Band test -- Shows ICs at dermal-epidermal border
47
What structural component causes the symptoms of scleroderma?
Excessive collagen deposition in skin, GI tract, lungs, kidneys
48
Who does scleroderma most often affect?
Women of child bearing age
49
What is the pathogenesis of scleroderma?
1. Small-vessel endothelial cell damage produces blood vessel fibrosis and ischemic injury 2. T-cells release cytokines → excessive collagen synthesis 3. Stimulatory autoantibodies against platelet-derived growth factor
50
Hand findings in scleroderma?
1. Raynaud's phenomenon | 2. Tapered fingers with digital infarcts
51
Skin findings in scleroderma
1. Skin atrophy and tightening that starts distally 2. Parchment-like appearance 3. Extensive dystrophic calcification in subQ 4. Tightened facial features
52
GI findings in scleroderma?
1. Esophageal dysmotility 2. Reflux due to loss of lower esophageal sphincter 3. Loss of villi in small bowel 4. Dysmotility and cramping
53
Respiratory findings in scleroderma?
1. Interstitial fibrosis | 2. RESPIRATORY FAILURE IS MOST COMMON CAUSE OF DEATH
54
Renal findings in scleroderma?
1. Vasculitis involving arterioles | 2. Infarcts → malignant HTN
55
Common lab findings in scleroderma?
* ANA (79-90%) | * Anti-topoisomerase (30%)
56
What is CREST syndrome?
``` C-calcification & centromere antibody R-Raynaud's E-Esophageal dysmotility S-Sclerodactyly T-Telangiectasias ```
57
What malignant neoplasm are DM and PM associated with
Lung cancer
58
Mechanism of dermatomyositis damage
Antibody-mediated damage
59
Mechanism of polymyositis damage
T cell-mediated damage
60
Most common area for DM and PM pain
Shoulders
61
Skin findings with dermatomyositis?
1. Heliotrope rash around eyes | 2. Purple pustules on knuckles GOTTRON'S PATCHES
62
Laboratory findings with DM and PM
* ANA (30%) * Increased creatine kinase * Muscle biopsy shows lymphocytic infiltrate
63
Treatments for FM?
* Have PT stay active * AVOID NARCOTICS * SSRI's and TCAs might be beneficial
64
Which gender does juvenille RA affect more?
Girls
65
What occurs in 20% of JRA cases?
Still's disease
66
What is Still's disease?
* Commonly presents as an "infectious disease" * Fever, rash, polyarthritis * Generalized lymphadenopathy * Neutrophilic leukocytosis
67
What is polyarticular JRA?
* 40% of cases are this type | * Disabling arthritis of the joints dominates
68
What is pauciarticular JRA?
* 40% are this type * Arthritis is limited to a few joints * UVEITIS with potential for blindness can occur
69
Seronegative SA involves which joints?
Axial joints
70
Which genetic loci are associated with seronegative SA?
B27
71
What is ankylosing spondylitis?
Targets SI joints in young men
72
What disease causes bamboo spine?
Ankylosing spondylitis (causes forward curvature kyphosis)
73
What result on a Schober's test
Less than 5 cm
74
What non-spine problems are associated with ankylosing spondylitis?
* Prostatitis (80%) * Aortitis with regurgitation * Anterior uveitis
75
What are treatment options for ankylosing spondylitis?
1. NSAIDs 2. Disease modifying drugs 3. TNF-a inhibitors can slow down the progression of the disease drastically
76
Hand findings in psoriatic arthritis?
1. Sausage shaped DIP joints 2. Pencil-in-cup deformity 3. Extensive nail pitting
77
What are late manifestations of Lyme disease?
* Disabling arthritis * Bilateral Bell's palsy * Myocarditis and pericarditis
78
What might be seen on the penis of a patient with Reiter's syndrome?
Circinate balanitis
79
What type of damage might occur in osteoarthritis on a molecular level?
Particular cytokines which are released activate metalloproteinases and cause destruction of proteoglycans and collagen
80
What is reactive bone formation of joint margins in osteoarthritis called?
Osteophyte
81
What commonly protrudes into the bone in OA?
Subchondral cysts
82
What are joint mice/
Fragments of articular cartilage that breaks free into a joint space from OA

ICM II (10 decks)

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