Rheumatology/Musculoskeletal Flashcards
What is Felty syndrome?
- Rare complication (<1%) of rheumatoid arthritis:
- High titer rheumatoid factor
- Splenomegaly
- Neutropenia (<1500, <1000→↑risk of clinically significant infection)
Treatment for Felty syndrome
- Gold
- MTX (second-line Tx for RA)
- G-CSF for severe neutropenia or unresponsive to Tx for RA, and when splenectomy is contraindicated or not possible
Cardiac manifestation of ankylosing spondylitis
Chronic aortic regurgitation (complication)➡Heart failure▶⬇exercise capacity, shortness of breath
*Chronic inflammation of the aortic root and valve cusps▶retraction of valve cusps, impaired valve closure
Which risk of neoplasia do patients with Paget disease of bone have?
⬆Bone remodeling and overgrowth➡osteogenic sarcomatous transformation (⬆several thousand times than the general population)
Diseases associated with erythema nodosum
- Streptococcal infection
- Sarcoidosis
- Tuberculosis
- Endemic fungal disease (Histoplasmosis)
- Inflammatory Bowel Disease
- Behcet Disease
Primary mechanism underlying the most common cytopenias in SLE
Autoantibodies➡Immune-mediated peripheral destruction (in all 3 cell lines)
Which conditions you must study in a patient with pseudogout?
- Hyperparathyroidism
- Hypothyroidism
- Hemochromatosis
Sudden posterior knee and calf pain with “crescent sign” most probably may suggest.
Ruptured popliteal Baker cyst
*But rule out deep venous thrombosis as well with ultrasound
What should you think in a patient with Rheumatoid arthritis history and worsening of weakness and painless sensation of 4 extremities after intubation?
Worsening subluxation of the atlantoaxial joint➡cord compression➡cervical myelopathy
*Atlantoaxial instability due RA
What treatment you should add to treat hypercalcemia from sarcoidosis or any granulomatous disease?
Prednisone
Greatest risk factors for curve progression in adolescent idiopathic scoliosis
- Female
- Age <12 years
- Early pubertal status (premenarchal)
- Skeletal immaturity
- Severe curvature (Cobb angle ≥25 degrees)
Use of extremities arteriogram in a patient with Raynaud phenomenon
Diagnose Thromboangiitis obliterans (Buerger disease)
Drugs for chronic treatment of gout to control the high uric acid levels
- Allopurinol: ❌Xanthine oxidase; purine analogue➡inhibit other enzymes▶⬇production of uric acid (safe with renal injury)
- Febuxostat: ❌XO; not purine analogue➡only inhibit XO (if allopurinol is contraindicated)
- Pegloticase: dissolves uric acid
- Probenecid and sulfinpyrazone (uricosuric): ⬆excretion of uric acid in the kidney (contraindicated in renal insufficiency)
- Lesinurad: ❌reabsorption of uric acid in the proximal tubule
General recommendations to manage chronic gout and prevent attacks recurrences
- Diet: ⬇alcohol, lose weight, ⬇high-purine foods (meat, seafood)
- Stop thiazides, aspirin, and niacin
- Colchicine: prevent attacks because of sudden fluctuations in uric acid levels
- Drugs to control uric acid levels
Risk factors for calcium pyrophosphate deposition disease (CPDD) or pseudogout
- Hemochromatosis, Hyperparathyroidism (chronic hypercalcemia)
- Diabetes, hypothyroidism, Wilson disease
Most accurate test for pseudogout, and which is the finding?
Arthrocentesis➡positively birefringent rhomboid-shaped crystals
Best initial treatment for fibromyalgia
- Aerobic exercise
- Tricyclic antidepressant
Drugs options for fibromyalgia treatment
- Amitriptyline
- Duloxetine or venlafaxine (dual reuptake inhibitors)➡who do not respond to tricyclics
- Milnacipran (serotonin and norepinephrine reuptake inhibitor approved specifically for fibromyalgia)
- Pregabalin
Best initial test for antiphospholipid syndrome
Mixing study➡patient’s plasma is mixed with an equal amount of normal plasma:
- PTT will come down to normal▶⬆PTT is from clotting factor deficiency
- Remain ⬆PTT▶APL syndrome antibody is present in plasma
Most specific test for the lupus anticoagulant
Russell viper venom test (RVVT)➡prolonged with APL antibodies and does not correct on mixing with normal plasma
Coagulation tests results on antiphospholipid syndrome
⬆PTT, normal PT and INR➡only thrombophilia with abnormality in the PTT
*lupus anticoagulant is more often associated with ⬆PTT
Most specific antibody for Systemic sclerosis and CREST
- Systemic sclerosis: Anti-Scl-70 (anti-topoisomerase 1)
- CREST: Anti-centromere
Best initial test for inflammatory myopathies with proximal muscle weakness
CPK, Aldolase
Most accurate test for polymyositis and dermatomyositis
Muscle Biopsy
