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MOHD4: Exam 3 > Rheumatology, Spondyloarthritis, & SLE (Stafford) > Flashcards

Rheumatology, Spondyloarthritis, & SLE (Stafford) Flashcards

1
Q

in actue arthritis, joints are often excruciatingly tender to touch and movement, are red, warm and swollen. This is typically seen with what subtypes of arthritis? what type of cell are the primary components?

A

Infectious and crystal; neutrophils!

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2
Q

Which of these is not a characteristic or type of chronic arthritis?

A. Swelling

B. Redness

C. Rheumatoid

D. Osteo

E. Lymphocytes

A

B

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3
Q

patient’s complaint of joint pain is ______. objective evidence of joint swellling is ________.

A

arthralgia; arthritis

swelling can be from bone, soft tissue (synovitis), or fluid.

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4
Q

which inflammatory condition presents with erosive arthritis, ie, joint inflammation resulting in destruction of cortical bone (shown below)?

A

rheumatoid arthritis

*in contrast, SLE is a form of nonerosive arthritis

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5
Q

an interrelated group of disorders characterized by combinations of inflammatory axial/spinal pain, peripheral arthritis, and enthesitis

A

spondyloarthritis

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6
Q

pain that is worse after rest, typically in the morning, and is associated with morning stiffness that lasts longer than an hour is inflammatory or non-inflammatory?

A

inflammatory

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7
Q

pain that is worse after activity, typically later in the day, and is associated with morning stiffness that lasts less than 30 minutes is inflammatory or non-inflammatory​?

A

non-inflammatory

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8
Q

this type of test should always be obtained for acute arthritis, and sometimes for chronic arthritis

A

synovial fluid analysis

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9
Q

Which of the following is NOT a test that is routinely ordered to assess musculoskeletal complaints?

A. CBC

B. BUN

C. Creatinine

D. LFTs

E. ANA

A

E

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10
Q

All of the following are normal characteristics of synovial fluid except which?

A. High viscosity

B. Transluscent color

C. < 200 WBC

D. < 25 PMNs

E. volume < 3.5 ml

A

B. The normal clarity of synovial fluid is transparent, meaning you can see through it. Translucent fluid only allows you to see light, and is indicative of inflammation.

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11
Q

Polmyalgia rheumatica presents in patients > age 50 and is characterized by:

  • pain that is hard to localize
  • aching and stiffness that is worse with immobility
  • essentially normal phys exam with possible pain upon active shoulder/hip mobility

What systemic condition is it often associated with?

A

giant cell arteritis

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12
Q

Which of the following characterizes non-inflammatory pain?

A. Worse after rest

B. Improves with rest

C. Improves with activity

D. Worse first thing in the morning

A

B

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13
Q

Which of the following is not a feature of SLE?

A. Can affect virtually any organ system

B. Affects women 7-15X more than men

C. Sun exposure, drugs, and smoking are risk factors

D. It affects Caucasians more than Asians

E. Relatively benign, indolent, minimally active to rapidly progressive and fulminant course

A

D.

Blacks > Asians > Caucasians

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14
Q

The ratio of women to men is reduced in prepubertal and postmenopausal SLE, indicating that ____ promotes immune responsiveness and increases risk of lupus while _____ are immunosuppressive and decrease risk.

A

estrogen; androgens

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15
Q

Which of the following cutaneous manifestations is NOT part of the diagnostic criteria of SLE?

A. Alopecia

B. Mucosal ulcers

C. Discoid rash

D. Photosensitivity rash

E. Malar (butterfly) rash

A

A.

Alopecia is a common feature but is not part of the diagnostic criteria. Also not included in diagnostic criteria: constitutional symptoms (ie, fever, chills, fatigue, weight loss)

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16
Q

Which of the following manifestations is part of the diagnostic criteria of SLE?

A. Arthralgia

B. Alopecia

C. Arthritis

D. Lymphadenopathy

E. Raynaud’s phenomenon

A

C

Though all of these may be important features, only Arthritis is actually in the diagnostic criteria.

17
Q

Which of the following manifestations of the cardiac, pulmonary and neurologic systems is NOT included in the diagnostic criteria for SLE?

A. Pleurisy

B. Pericarditis/pericardial effusion

C. Abnormal chest x-ray

D. Cognitive dysfunction

E. Unexplained seizures & psychosis

A

D.

Cognitive dysfunction is seen in as many as 40-80% of SLE cases, but is not part of the diagnostic criteria because it may not all be from SLE; may instead be secondary to sleep disturbance, depression, metabolic abnormalities or medications.

18
Q

Hematologic manifestations that are specifically indicative of SLE include all of the following EXCEPT:

A. Normocytic anemia

B. Autoimmune (Coombs +) hemolytic anemia

C. Leukopenia

D. Lymphopenia

E. Thrombocytopenia

A

A.

Although normocytic anemia is the most common hematologic manifestation, it is very non-specific and can be seen in many other autoimmune or inflammatory diseases.

19
Q

What are the 2 most essential renal tests for diagnosing and following disease activity in SLE?

A
  1. urinalysis - be concerned specifically about proteinuria and cellular casts
  2. creatinine ( >1.5 ) or significant increase from baseline
20
Q

what is the most common histologic finding on renal biopsy from patients with SLE?

A

glomerulonephritis

*endocapillary proliferation, crescents, necrosis (see below):

21
Q

what percentage of patients with SLE have a + ANA? what percentage of those with a + ANA have SLE?

A

99% of those with SLE have a + ANA (high sensitivity!)

5% of those with + ANA have SLE (poor specificity)

22
Q

These 3 serologic tests have lower sensitivity but are highly specific for SLE and are included in the diagnositc criteria

A
  1. anti-dsDNA antibodies
  2. anti-smith (sm) antibodies
  3. ANA
23
Q

Non-pharmacologic treatments for patients with SLE include sun avoidance, balanced diet and exercise, smoking cessation and immunizations. What is the primary pharmacologic treatment for ALL patients to prevent flares?

A

Antimalarials (hydoxychloroquine) for ALL patients to prevent flares

NSAIDs are used to treat pain and inflammation.

Glucocorticoids for SOME manifestations but toxic.

Immunosuppressives (azathioprine, methotrex, mycophenolate mofetil) for major organ manifestations.

24
Q

What is the pneumonic for remembering the SLE criteria?

A

SOAP BRAIN MD: Serositis (inflammation of serous tissues), Oral ulcers, Arthritis, Photosensitivity, Blood (leukopenia, Coombs+ anemia, etc), Renal, ANA, Immunologic (anti-dsDNA, anti-sm), Neurologic, Malar rash, Discoid rash

25
Q

Infections, smoking, and UV light may all lead to SLE flares. What two photosensitizing drugs also may lead to light-induced drug rashes and disease flares?

A

Sulfa drugs and tetracyclines

26
Q

interrelated group of disorders that includes IBD arthritis, reactive arthritis, and psoriatic arthritis and is characterized by inflammatory back pain and enthesitis with new bone formation

A

spondyloarthritis

27
Q

prevalence of this genotype is highly indicated in spinal inflammation

A

HLA-B27

28
Q

Which of the following is NOT a hallmark of spondyloarthritis?

A. Axial joint involvement

B. Enthesitis

C. Peripheral joint involvement (ie, sausage digits)

D. Symmetric oligoarthritis

E. Extraarticular features (affecting organ systems)

A

D.

Tendency in SpA is toward asymmetric, lower extremity oligoarthritis (2-4 joints) and the DIP joints of toes and fingers

*these findings are NOT seen in RA which is symmetrical and almost never involves the distal joints

29
Q

Which of the following features distinguishes spondyloarthritis from rheumatoid arthritis?

A. Peripheral joint involvement

B. Enthesitis

C. Cervical spine involvement

D. Absence of rheumatoid factor

A

B

30
Q

What is the most characteristic feature of spondyloarthritis?

A. Bone erosion

B. Presence of chronic inflammatory cells

C. Presence of proinflammatory cytokines

D. New bone formation

E. Back pain

A

D

This particularly occurs at the enthesis

31
Q

a person with tenderness to direct palpation and percussion, and decreased mobility of the spine, and iritis should be susepcted to have what condition? what signs on radiography will confirm this suspicion?

A

Ankylosing spondylitis (AS);

x-ray would show:

  • symmetric sacroilitis - bony bridging or narrowing of joint, depending on the advancement of disease
  • vertebral squaring - due to bone erosion and new bone formation
  • syndesmophytes - new bone formation that fuses vertebral disks together (see below)
32
Q

This type of SpA most commonly affects females before age 40 and affects large joints closest to the axial skeleton; improves with exercise

A

ankylosing spondylitis (AS)

33
Q

the symmetric sacroilitis and inflammatory back pain seen in AS is also characteristic of this disease, which tends to occur in episodes

A

IBD Arthritis

34
Q

the pattern of arthritis in this condition is chronic inflammatory, asymmetric oligoarthritis affecting large and small joints (“sausage digits”) and is usually preceded by a GI/GU infection 2-4 weeks prior

A

reactive arthritis (Reiter’s syndrome)

*can’t see, can’t pee, can’t climb a tree

*also can have red scaly rash

35
Q

this condition displays multiple patterns of peripheral arthritis, both asymmetric and symmetric, and radiographic findings show “pencil-in-cup” erosion of the DIP joints of fingers:

A

psoriatic arthritis

36
Q

1st line therapy for sponyloarthritis disorders?

A

NSAIDs (followed by Anti-TNF therapy, if NSAIDs don’t work)

*daily exercise is important but adjunctive - not effective alone

MOHD4: Exam 3 (11 decks)

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