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239B > Rheumotology > Flashcards

Rheumotology Flashcards

1
Q

Auto Immune syndromes

A

Lupus, Rheum Arthritis, Hashimotos Thyroiditis, IBS, interstitial lung disease, MS

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2
Q

auto immune arthritis- 4 chronic groups

A

rheum arthritis, systemic lupus erythmatosus, seronegative spondloarthopathy, infection

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3
Q

seronegative spondyloarthropathy

A

ankylosing spondytitis
IBS
psoriatic arthritis
reactive arthritis

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4
Q

biologic MARD

A 
•	Etanercept (Enbrel)
•	Infliximab(remicade)
•	Adalimumab (humira)
•	Golimumab(simponi)
•	Certolizumab(simzia)
anti TNF agents and growing
RA
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5
Q

DMARD (pneumonic)

A

disease modifying anti-rheum drugs for RA

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6
Q

types of DMARD

A 
•	Methotrexate, leflunomide
•	Plaquenil/sulfasalazine
•	Prednisone- not long term use due to SE
for RA
1st line
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7
Q

methotrexate

A

use : RA, JRA, pSA, myositis, SLE,sarcoidosis
antagonis that interacts with inflammatory prosess
SE>: infeciton, GI, oral uclers, bm suppression, liver effects, CBC/LFT monitor every 8 weeks

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8
Q

RA

A

chronic systemic inflammatory autoimmune polyarthritis of >3 joints (small jts most common), morning stiffness >1 hr, symmetric painful joints, radiographic erosion, nodules
thicken, boggy, tender joints with shiny thin ruddy skin over it
peaks in 20s and 60s, F>M

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9
Q

SLE

A

Multi- system autoimmune inflammatory disease characterized by a chronic relapsing/remitting course; varies from mild to severe and may be life-threatening (CNS and renal forms)

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10
Q

methotrexate SE

A

DOC for R.A= 7.5–25 mg per week PO. The DMARD with most predictable benefit. Many significant side effects, but the addition of folate reduces toxicity. 3–6-month trial. Monitor CBC, renal, and liver function every 8–12 weeks. Contraindicated in renal disease

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11
Q

RH false positive in ____

A

for R.A
• Disorders that may yield false-positive RF results: Sjögren syndrome, mixed cryoglobulinemia, parasitic infections (e.g., malaria), liver disease, endocarditis, acute viral infections.

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12
Q

synovial fluid in R.A

A 
No pathognomonic findings
Yellowish-white, turbid, poor viscosity
WBC increased (3,500–50,000)
Protein: ∼4.2 g/dL (42 g/L)
Serum-synovial glucose difference ≥30 mg/dL (≥1.67 mmol/L)
pannus invades cartilage and bone
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13
Q

SLE s&S pneumotic

A

MDSOAP BRAIN
malar rash, discoid rash, serositis , oral painless ulcers, arhtirtis (mild than RA non erosive no jt deformities, photosensitive, blood (anemia), renal (proteinuria), ANA(false + in elderly, women thyroid- low titer not alarming), immune (VDLR false +, ptt, anti-phos) neuro (seizures, psychosis)

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14
Q

SLE tx

A

NSAIDS for pain/fever/serositis
hydroxychloroquine - DOC for flares and taper steroids
steroids- prednisone- increase dose for organ threaten)
6 month > tx- azathioprine, mycophenolate mofetil, cyclophosphamide, methotrexate with folic acid)

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15
Q

hydroxychloroquine (Plaquenil)

A

200mg PO BID for long term SLE to reduce flare increase survival and taper steroids

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16
Q

methotrexate

A

7.5-15mg/week with 1mg/day of folic acid to help SLE for 6month> tx

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17
Q

SLE education

A 
avoid sun, SPF >30/clothing
statin, omega 3, vit d and calcium for CV and osteoporosis and chol prevention
GYN check up- HPV/dysplasia
exercise
smoke cessation
screen for depression
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18
Q

OA

A

most common progressive degenerative synovial joint disease
2nd or 3rd decade in life
hips/knees/spine/pip/dips/thumb
central load off center and increasing shearing force= problem
xray NOT correlate with symptoms

19
Q

OA risk factors

A

age, obese, stress, females, genetics, prior jt trauma, hem/metabolic/neuro conditions

20
Q

heberdens nodes

A

DIP in OA

boney hard non tender

21
Q

bouchard nodes

A

PIP in OA

boney hard non-tender

22
Q

no mcp jts involved

A

OA usually only DIP, PIP and 1st CMC jt of thumb

23
Q

OA tx

A

DOC- tyelnol
then NSAIDS, cox2
capsaicin HP cream, corticosteroid injections (if PO fails), hyaluronic acid injection, glucosamine/chondroitin supplement, sx

24
Q

capsaicin HP cream SE

A

to knees or hands- best for R.A small effects on OA, 3 days to burn red on site area- dont touch eyes/mouth

25
Q

OA patient education

A 
disease process
rest- avoid triggers
decrease wt by 10-20lbs best THING
exercise, ROM, muscle strengthening
assisted devices
patellar taping
footwear, insoles, bracing
pt/ot
joint protection/energy conservation
26
Q

FM

A

DO with rheum conditions (RA, SLE) characterized by widespread pain, fatigue, non-restorative sleep, depression, HA, GI complaints >3months with 4/11 tender points on digital palpation

27
Q

FM differential

A 
Chronic fatigue syndrome
Myofascial pain (more localized than fibromyalgia)
Connective tissue diseases
Psychiatric illness- depression- anxiety
Sleep disorders
TMJ syndrome
Hypothyroidism
Bursitis or tendinitis
Connective tissue DO: rheum arthritis, lupus, polymyalgia rheumatic and polymyositis
28
Q

11 of 18 tender points

A

FM- occiput (b/l), low cervical (b/l), trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, knee

29
Q

FM tx

A

control pain, enhance, sleep, maintain function, exercise/self management/cognitive behavioral therapy

30
Q

restoration of restorative sleep for FM

A

amitriptyline 10-20mg qhs (tca)

or trazadone or ambien

31
Q

pain relief medications for FM

A

tyelnol, tramadol, cyclobenzaprine, gabapentin, pregablin (lyrica), lidocaine injection

32
Q

antidepressant and pain relief for FM

A

fluoxetine (prozac), milnacipran (savella), duloxetine(cymbalta), venlafaxine

33
Q

Gout

A

inflammatory response to the formation of monosodium urate monohydrate cyrstals which develop secondary to hyperuricemia

34
Q

gout s&s

A

rapid onset, fatigue, fever, chills, tophi on digits on helix or antihelix of ear
warmth, redness, swelling and decreased ROM, 1st MTP of big toe

35
Q

tx of acute gout

A

ideal to confirm iwth jt aspiration, tx with NSAIDs, 1 or 2 joints involved steroids inj useful, oral colchicine used 24-48 hrs of onset of acute attack d/t toxicity, dont tx hyperuricemia during acute attack

36
Q

tx of chronic gout

A

uric acid level <6mg/dL goal, monitor 3-6 months and adjust accordingly, start only if pt has 2 or more attacks/yr, dont use urate-lowering drugs during acute attack, DOC: allopurinol or uricoric durgs, concomitant colchine prophylaxis until uric acid has desired level and no attacks (6months)

37
Q

gout meds

A

meds to control flares of jt pain- NSAIDS, colchicine, steroids
meds to prevent attacks ie. colchicine and NSAIDS
meds help lower uric acid in body
chronic gout- chronic meds

38
Q

gout patient edu

A

crystals ID dx

lifestyle changes- weight, limit etoh, meals with meats/fish rich in purines

39
Q

dietary factors of gout

A

alcohol, red meat, organ meat, sardines, anchovies, nuts, sweatbread, shellfish

40
Q

meds that decreased excretion in gout

A

ASA, diuretics, cyclosporine, PZA, ethambutol, nicotinic acid

41
Q

meds that increased excretion in gout

A

asa high dose, probenecid, steroids, xray dye, warfarin

42
Q

tx of hyperuricemia

A 
probenecid
allopurinal- start low then titrate quickly
febuxostat
pegloticase
>1 attack/yr and tophi
43
Q

tx of gouty attack

A

NSAIDS
colchicine - GI se
steroids
IL- 1 blockade

44
Q

FM non-pharm acronym ExPRESS

A 
exercise
x
psychiatric
regaining function
education
sleep hygiene
stress management

239B (14 decks)

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