Rheumatology Review Flashcards
fill out this flow chart
lab factors that make you think it’s RA
rf factor and Anti-CCP
for RA:
• Swelling and tenderness in ___ joints of
___ and __ are most common
presentation
• Symptoms present for > ___weeks with > ___joints and prolonged ___ stiffness
should make you consider RA
• Swelling and tenderness in small joints of
hands and feet are most common
presentation • Symptoms present for > 6 weeks with > 3
joints and prolonged morning stiffness
should make you consider RA
what part of this picture would. make you think it’s RA rather that OA
small joint swelling appearnace is common in both, but OA also has large joint involvement. OA is also less symmetrical, where as in RA, both hands are likely to b affected at the same time.
which diseases are causing each pattern of arthritis?
- RA= symmetric, affecting small joints and the knees
- Psoriatic: very asymmetric
- ankylosing spondylitis: spondilitis/axial involvement and large peripheral joints in an asymmetrical fashion.
- Osteoarthritis: affected some small joints in the hands but LARGE ones too like knees, hip, big toe (compared to MCP)
out of RA, psoriatic arthritis, AS and OA, which one has a more symmetrical presentation?
RA. the rest have fewer joints being affected at once (usually) and are often asymmetrical.
which one is more likely to be OA vs RA
left = OA = bony prominence– it’s hard
right = synovial swelling = RA. Inflammation is soft.
• 3 swollen joints
- MTP/MCP involvement
- Positive squeeze test
• Morning stiffness> 30 mins
most likely diagnosis
rheuamtoid arthritis
how would these lab values look in someone with RA?
Bouchard nodes affect ___ joints in OA, and heberdens nodes affect ____ joints in OA
treat OA with acetaminophen and nsaid pain relief
- Bouchard = pip
- heberden = dip
management of OA
weight managmenet
light exercise (activity may increase the pain but certain activities might help strengthen areas)
T/F ANA is good for lupus detection screenign
false. • The ANA test is not specific to a single disease. It should NOT be used as a
screening test
• A strongly positive ANA test means that it is more likely that a person may have an autoimmune disease. However, positive test results do not tell what type of autoimmune disease it is.
if you suspect lupus, check an ENA profile and anti-smith or anti-dsDNA
note:
what types of arthritis comprise seronegative classifications
AS
psoriatic arthritis
reactive arthritis
IBD related or enteropathic arthritis
what part of the body does spondyloarthritis (rF negative) affect?
spine
what is spondyloarthritis?
• Group of diseases with chronic inflammatory arthritis predominantly affecting the _____
- variable peripheral joint disease that is often ___, involving oligoarthritis of ___ joints and associated with extra articular manifestations such as (___, ___ and ___)
- usually ____ and _____ antibody negative.
- assocaited with the ____ gene
what is spondyloarthritis?
• Group of diseases with chronic inflammatory arthritis predominantly affecting the spine
- variable peripheral joint disease that is often asymmetrical, involving oligoarthritis of large joints and associated with extra articular manifestations such as ibd, psoriasis, and iritis
- usually rf and anti-ccp antibody negative.
- assocaited with the hla-b27 gene
what type of arthritis does this person have
psoriatic arthritis. it’s an inflammatory seronegative arthritis associated with psoriasis. 30% of people with psoriasis have arthritis
associated features and comorbidies of psoriatic arthritis
associated features; dactylitis, asymmetric joints affected involving the spine, plaque psoriasis, enthesitis, uveitis and IBD
comorbidites: CVD, diabetes, NAFLD, depression
Patients with ____ disease more likely to develop PsA
Patients with nail disease more likely to develop PsA4
usual sites of enthesitis
dactylitis is associated with which types of arthritis?
psoriatic arthritis and reactive arthritis
nail matrix vs nail bed disease
nail matrix: pitting, leuconychia, crumbling red sponts in the lunula
nail bed disease: onycolysis, subungual hyperkeratosis, oil drop change, splinter hemorrhages
what radiographic findings would you see in PsA
pencil in cup change in severe disease
sacroilitis
syndesmophytes; may look like ankylosing spondylitis
treatment of PSA
NSAIDS
methotrexate (is 3 joints or more)
biologics
may use glucocorticoids for flares or as bridging therapy
clinicical criteria for AS
- low back pain and stiffness for more than 3 months that improves with exercise
- limitation of motion of the lumbar spine in both the sagittal and frontal planes
- limitation of chest expansion relative to normal values correlated for age and sex
two tests to look for AS
schober test and occipt to wall test
usual presenting symptoms for AS
back pain
enthesitis
stiffness
peripheral joint pain
decreased spinal mobility
back questionmark formate
fatiguw
weightloss
iritis, IBD, symptoms of assocaited diseases.
outline the typical CBC, creatining, nsaid use, CRP/ESR and HLAB27 findings of AS
baboo spine – longstanding untreated AS– fused SI joints
T/F We should perform a whole body bone scan if we suspect AS
false. also, don’t order an HLA-B27 unless spondyloarthritis is suspected based on specific signs or symptoms.
T/F DMARDS can be prescribed forAS
false. DMARDS usually don’t work on inflammatory spinal disease. We try to treat AS with NSAIDS and biologics
Enteropathic arthritis is often indistinguishable from ______, usually follows onset of ___ ___, and has ___ correlation between bowel and joint flares
• 65 year old male with Crohn’s disease on
Vedolizumab.
• Seronegative rheumatoid arthritis
currently on sulfasalazine 1000 mg bid.
• Awaiting Left TKR secondary to OA
• Asked for follow-up with rheumatology
pre-operatively regarding medications.
• Anesthesia did not order a C-spine in their
recommendations.
IS THIS RA?
IBD red flag, seronegative makes RA less likely.
Schober test is 15 cm usually, this guy’s did not change. He has a stooped posture. AS
note
skin characteristics of dermatomyositis
heliotrope rash– muscle weakness, normal EMG but elevated ESR
gottrons rash on PIPs
Shawl sign
therapy for dermatomyositis
sjogrens syndrome symptoms
it’s a disease Characterized by lymphocytic infiltrates of salivary and tear glands leading to oral/ocular dryness and by antibody secretion arthritis
dry mucosa
arthritis
fever/fatigue
lung inbolbement
kidney involvement
raynauds
symptoms of limited scleroderma vs diffuse cutaneous systemic sclerosis
• Limited cutaneous systemic sclerosis – Skin sclerosis is typically distal to the elbows and knees, and, to a lesser extent, the face and neck, while the trunk is spared.
Many patients with limited cutaneous SSc (lcSSc) have manifestations of
the CREST syndrome (Calcinosis cutis, Raynaud phenomenon, Esophageal
dysmotility, Sclerodactyly, and Telangiectasia).
• Diffuse cutaneous systemic sclerosis – Skin thickening extends proximally to the upper arms, thighs, and/or trunk.
Analysis of a large patient cohort indicates that many patients with SSc cannot readily be classified into lcSSc or diffuse cutaneous SSc (dcSSc), and multiple distinct
additional disease subsets with shared features may exist
scleroderma antibodies that should be screened when suspecting scleroderma
remember; clinical features are broad
• Skin Manifestations – universal
• Raynaud’s phenomenon
• Arthritis, tendonitis, tendon friction rubs • GI involvement: dysphagia, diarrhea,
reflux
• Pulmonary involvement: Interstitial lung
disease, pulmonary arterial hypertension
• Cardiac involvement • Renal involvement • Neuromuscular involvement • Genitourinary involvement • Cancer risk
classification of vasculitis
when to expect vasculitis
- chronic and recurrent headches
- muscle weakness, ischemia, claudication of jaw or extremities
- palpable purpura
- mononeuritis multiplex
- TIA/stroke/neurological symptoms-wrist drop
- kidney dysfunction- glomerular nephritis, hematuria, proteinuria
- lung problems– pleuritis, alveolar hemorrage
- cardiac issues/aortic aneurysm/angina
lab investigations for GPA
note for GPA vasculitis
immunologic criteria for lupus
low complement
firect coombs test
ana
anti-DNA
Anti-Sm
