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MSK Exam 2 Spring 2015 > Rheumatology - Told > Flashcards

Rheumatology - Told Flashcards

1
Q

osteoarthritis

A

not inflammatory

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2
Q

pain

A

dalor

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3
Q

heat

A

calor

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4
Q

rubor

A

redness

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5
Q

swelling

A

tumor

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6
Q

cardinal features of inflammation

A

dalor, calor, rubor, tumor

also - tenderness, stiffness, crepitation

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7
Q

single joint

A

monoarthritis

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8
Q

2-4 joints

A

oligoarthritis

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9
Q

<5 joints

A

pauci

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10
Q

5 or 6 joints

A

extended pauci

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11
Q

> 6 joints

A

poly arthritis

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12
Q

insertion of tendon

A

enthesis

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13
Q

ESR

A

non protein acute phase reactant - effects plasma viscosity as fibrinogen is consumed

more inflammation - less viscous plasma - more cells fall out of suspension

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14
Q

time course of rheumatoid arthritis

A

10 years from initial immune stirring to disease onset

initial immune stirring - RF, anti-CCP, and elevated CRP

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15
Q

rheumatoid factor

A

auto-Abs - usually IgM

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16
Q

complement consumption

A

in RA joint

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17
Q

immunopathology of RA

A

rheumatoid factor produced by synovium

  • RF fixes complement
  • complement consumed
  • recruit and activates PMNs
  • localized immune complex disease

TNF and MAC destroy joint

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18
Q

pro-inflammatory

A

TNF-a and IL-1

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19
Q

anti-inflammatory

A

soluble TNF receptor

IL-1 antagonist

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20
Q

epidemiology of RA

A

more in women
1-2% of population

peak age 25-45yo

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21
Q

improves during pregnancy

A

rheumatoid arthritis

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22
Q

associated with RA

A 
infection
renal disease
GI disease
heart disease - recently has gone down
malignancfy
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23
Q

diagnosis of RA

A

4 criteria met

1 - morning stiffness >1 hour*
2 - swelling 3 or more joint areas*
3 - swelling in hand joints*
4 - symmetric joint swelling*
5 - rheumatoid nodules
6 - rheumatoid factor
7 - erosion or osteopenia on hand x-ray
8 - must be present >6 weeks
*longer than 6 months
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24
Q

PIP

A

rheumatoid arthritis

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25
Q

DIP

A

osteoarthritis

26
Q

pannus

A

infiltrating lymphocytes - seen in rheumatoid arthritis

27
Q

ulnar deviation

A

rheumatoid arthritis

28
Q

U/S vs. RA

A

inflammation better seen with ultrasound**

29
Q

imaging in RA

A

X-ray insensitive

MRI - occult erosions, synovial enhancement, synovial thickening

30
Q

boutonniere deformity

A

in hand with RA

enthesitis and rupture

31
Q

swan neck deformity

A

in hand with RA

enthesitis and rupture

32
Q

enthesitis

A

inflammation where tendon/ligament insert into bone

33
Q

rheumatic nodules

A

almost pathognomonic of RA

-always RF positive

34
Q

additional mainfestations of RA

A 
rheumatoid nodules
sjogrens
feltys
vasculitis
rheumatoid lung
cardiac
neuromyopathy
inflammatory eye disease**
osteoporosis
lymphadenopathy
hyperviscosity - DVT
cryoglobulinemia
dermatologic
amyloidosis
35
Q

myelopathy in RA

A

spinal cord damage
-no HVLA**

neck pain radiates to occiput
dysesthesia of fingers and feet
marble sensation - limbs and trunk
jumping leg
disturbed bladder function
36
Q

scleritis and scleromalacia

A

seen with RA

-inflammatory eye disease

37
Q

sicca symptoms

A

dry eyes, dry mouth, vaginal dryness, tracheo-bronchial dryness

sjogrens - can occur with rheumatoid arthritis

38
Q

SS-A

A

Ro

39
Q

SS-B

A

La

40
Q

SS-A and SS-B

A

Ro and La

associatd with primary sjogrens

41
Q 
Rh +
anti-CCP +
ANA +
ESR/CRP elevated
anemia
thrombocytosis
hyperglobulinemia
leukopenia/granulocytopenia
glucose in body fluids - very low
A

seen in RA

42
Q

diagnosis of RA based on auto-Abs

A

RF alone - needs to be very high for diagnosis - not that specific

with anti-CCP - increased specificity

43
Q

CCP

A

cyclic cirtullinated protein

44
Q

good predictor of erosiveness

A

RF

45
Q

anti-CCP alone

A

96% specific

46
Q

anti-CCP and RF

A

98% specific

47
Q

goal of therapy in RA

A

alleviate pain
slow rate of joint damage

only things we can do unfortunately

48
Q

pharmacotherapy for RA

A 
NSAIDs - toxicity assocation
corticosteroids - chronic use - bad
DMARD - delayed onset of action
biologic - infection and \$\$$
analgesic - long last opiod - control pain and improve function
49
Q

DMARDs

A

methotrexate
leflunomide

also hydroxychloroquine, sulfasalazin, gold compounds, azathioprine, cyclosporine

50
Q

category X in pregnancy

A

leflunomide and methotrexate

51
Q

IL-1 receptor antagonist

A

anakinra

52
Q

soluble TNF receptor

A

etanercept

53
Q

anti TNF-a Abs

A

adalimumab

infliximab

54
Q

once a week dosing

A

methotrexate

55
Q

early onset of action

A

leflunomide

56
Q

rapid exretion with cholestyramine

A

leflunomide

57
Q

goal of tx with RA

A

AM stiffness 5 criteria must be met >2 consecutive months

58
Q

co-morbid disease in RA

A

lung and eyes

59
Q

low dose steroids

A

for flares of RA

60
Q

biologic agent

A

only if non-biologics fail

MSK Exam 2 Spring 2015 (10 decks)

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