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Rheumatology > Rheumatology Lab Evaluation > Flashcards

Rheumatology Lab Evaluation Flashcards

1
Q
  • pain that is worse with inactivity, worse in AM and often awaken the patient from sleep
  • pain is better with light activity (RA, Ankylosing spondylitis)
A

inflammatory pain

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2
Q

pain is better with rest and worse with activity (osteoarthritis, tendonitis)

A

Non-inflammatory

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3
Q
  • inflammation of one joint
  • hyper-acute: gout, infection
  • subacute: inflammatory arthritis, pseudogout, infection
A

monoarthritis

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4
Q

is inflammation of multiple joints

A

Polyarthritis

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5
Q

associated with pain and limitation of BOTH passive and active ROM

A

articular process

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6
Q

like tendonitis and bursitis: associated with pain and limitation of active, but not much passive ROM

A

Extra articular process

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7
Q

pain in one area

A

regional pain

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8
Q

pain in both sides, above and below the diaphragm

A

diffuse pain

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9
Q

four major disease processes in rheumatology?

A
  • mechanical processes: tendonitis, bursitis, mechanical low back pain
  • inflammatory processes: like rheumatoid arthritis
  • autoimmune processes like SLE
  • diffuse pain syndrome (fibromyalgia)
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10
Q
  • Rate (mm/hr) at which red blood cells settle in a test tube
  • Elevation results from: Infection (most common), malignancy, autoimmune/inflammatory conditions
  • levels slow to change (in contrast to c-reactive protein)
  • used for disease monitoring in rheumatoid arthritis, polymyalgia rhematica, systemic vasculitis, and lupus
A

Erythroscyte sedimentation rate (ESR)

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11
Q

what falsely elevates ESR?

A
  • end stage renal disease
  • nephrotic syndrome
  • anemia
  • obesity; it is an inflammatory process
  • oral contraception/pregnancy
  • age
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12
Q

what decreases ESR?

A
  • Low fibrinogen (i.e DIC)
  • polycythenia vera
  • sickle cell
  • spherocytosis
  • CHF
  • cachexia
  • severe leucocytosis
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13
Q

Small molecule that binds dying cells and or pathogens

  • rapid rise within hours of tissue injury
  • synthesized in liver
  • plays a role in the innate immunity

normal is less than 0.3mg/dl

A

C-reactive protein

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14
Q

variables that affect C-reactive protein?

A
  • Age
  • sex
  • race
  • obesity
  • smoking
  • HTN
  • alcohol
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15
Q

what should you think of with a very high CRP?

A

Bacterial infection

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16
Q

If there is a discrepancy between ESR and CRP what could that look like?

A

High ESR, Low CRP

  • Falsely elevated ESR
  • liver disease (not able to synthesize CRP)
  • lupus, not fuly understood (related to high interferons) but active lupus tends to have a “muted” CRP response

Low ESR, high CRP

  • early infection, procalcitonin could be helpful
17
Q
  • autoantibody that binds to Fc region of human IgG
  • rheumatoid arthritis
  • False positive-c hronic infections- (hepatitis C, bacterial endocarditis), sjrogens syndrome, primary biliary cirrhosis, multiple myeloma, healthy population
  • High titers suggest more severe/aggressive disease and increased rate of extra-articular disease
A

Rheumatoid factor

18
Q
  • autoantibody against the posttranslational modification of arginine
  • rare false positives: need to monitor patient for RA development, rarely psoriatic arthritis, autoimmune hepatitis
  • associated with erosive damage and severe disease in general
  • Do not need to follow RF or CCP titers for longitudinal monitoring of disease
A

Anti-cyclic citrullinated peptide antibody (CCP)

19
Q

broad umbrella term for many different autoantibodies that react to antigens in the nucleus of cell

A

Antinuclear antigen antibodies (ANA)

20
Q

what patterns of ANA are there? what diseases are associated?

A

Homogenous/diffuse

  • systemic lupus
  • drug induced lupus
  • scleroderma

Speckled

  • systemic lupus
  • mixed connective tissue disease
  • sjogrens
  • myositis

nucleolar

  • scleroderma

Centromere

  • limited scleroderma
21
Q

what are specific autoantibodies and their associated disease?

A
  • double stranded DNA: systemic lupus
  • SSA (RO): sjogrens systemic lub
  • SSB (LA): Sjogrens
  • RNP: mixed connective tissue disease
  • smith: systemic lupus
  • scl-70 scleroderma
  • Jo-1: inflammatory myopathy
22
Q

when should you not check ANA?

A
  • isolated fatigue
  • myalgia (unless objective weakness on exam or elevated CK)
  • joint pains without inflammatory features or joint swelling
  • back pain
23
Q
  • Positive ANA tests will often prompt testing for C3 and C4 components of the complement cascade
  • levels tend to trend downward with increased lupus activity
  • other nonrheumatic causes include: congenital deficiency, proliferative glomerulonephritis, endocarditis, hepatitis B &C
A

Complement

24
Q
  • fifth disease
  • viral infection of childhood
  • often asymptomatic in adults and red facial rash rare in children
  • acute parvo infection often results in inflammatory polyarthritis similar to rheumatoid arthritis. Resolves completely
  • Positive anti B-19 IgG of little significance as 50% of adults will test positive for previous exposure
  • positive anti-b19 igM suggests recent infection
A

Parovirus

25
Q
  • weak acid and exists mostly in the ionized form
  • at concentrations above 6.8 urate can begin to deposit as cystals in the body
  • overproduction: inherited enzyme defects, myeloproliferative disorders, purine rich diet, alcohol
  • underexcretion: renal failure, metabolic syndrome/obesity, diuretics
A

Uric acid

majority of people with high uric acid never develop gout

25
Q

when to check uric acid level?

A
  • should only be checked between gout flares to monitor uric acid levels when using urate lowering therapy (i.e, allopurinol)
  • diagnosis of gout is based on joint or tophi aspiration and cystal exam
26
Q

Often present as a “pulmonary renal syndrome”
* hemoptysis, respiratory distress with identified lung nodules or pulmonary infiltrates
* rapidly progressive glomerulonephritis

Other manifestations

  • upper airway disease (sinus, ears, trachea)
  • inflammatory eye disease
  • arthritis
  • rash
  • bowel ischemia
  • mononeuritis
A

Antineutrophil cytoplasmic antibodies (ANCA)

27
Q

What can cause a false positve ANCA?

A
  • Autoimmune hepatitis
  • systemic lupus
  • inflammatory bowel disease
  • cocaine
  • some medications

Rheumatology (10 decks)

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