Rheumotology Flashcards
Auto Immune syndromes
Lupus, Rheum Arthritis, Hashimotos Thyroiditis, IBS, interstitial lung disease, MS
auto immune arthritis- 4 chronic groups
rheum arthritis, systemic lupus erythmatosus, seronegative spondloarthopathy, infection
seronegative spondyloarthropathy
ankylosing spondytitis
IBS
psoriatic arthritis
reactive arthritis
biologic MARD
• Etanercept (Enbrel) • Infliximab(remicade) • Adalimumab (humira) • Golimumab(simponi) • Certolizumab(simzia) anti TNF agents and growing RA
DMARD (pneumonic)
disease modifying anti-rheum drugs for RA
types of DMARD
• Methotrexate, leflunomide • Plaquenil/sulfasalazine • Prednisone- not long term use due to SE for RA 1st line
methotrexate
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
RA
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
SLE
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)
methotrexate SE
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
RH false positive in ____
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.
synovial fluid in R.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
SLE s&S pneumotic
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)
SLE tx
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)
hydroxychloroquine (Plaquenil)
200mg PO BID for long term SLE to reduce flare increase survival and taper steroids
methotrexate
7.5-15mg/week with 1mg/day of folic acid to help SLE for 6month> tx
SLE education
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
OA
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
OA risk factors
age, obese, stress, females, genetics, prior jt trauma, hem/metabolic/neuro conditions
heberdens nodes
DIP in OA
boney hard non tender
bouchard nodes
PIP in OA
boney hard non-tender
no mcp jts involved
OA usually only DIP, PIP and 1st CMC jt of thumb
OA tx
DOC- tyelnol
then NSAIDS, cox2
capsaicin HP cream, corticosteroid injections (if PO fails), hyaluronic acid injection, glucosamine/chondroitin supplement, sx
capsaicin HP cream SE
to knees or hands- best for R.A small effects on OA, 3 days to burn red on site area- dont touch eyes/mouth
OA patient education
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
FM
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
FM differential
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
11 of 18 tender points
FM- occiput (b/l), low cervical (b/l), trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, knee
FM tx
control pain, enhance, sleep, maintain function, exercise/self management/cognitive behavioral therapy
restoration of restorative sleep for FM
amitriptyline 10-20mg qhs (tca)
or trazadone or ambien
pain relief medications for FM
tyelnol, tramadol, cyclobenzaprine, gabapentin, pregablin (lyrica), lidocaine injection
antidepressant and pain relief for FM
fluoxetine (prozac), milnacipran (savella), duloxetine(cymbalta), venlafaxine
Gout
inflammatory response to the formation of monosodium urate monohydrate cyrstals which develop secondary to hyperuricemia
gout s&s
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
tx of acute gout
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
tx of chronic gout
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)
gout meds
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
gout patient edu
crystals ID dx
lifestyle changes- weight, limit etoh, meals with meats/fish rich in purines
dietary factors of gout
alcohol, red meat, organ meat, sardines, anchovies, nuts, sweatbread, shellfish
meds that decreased excretion in gout
ASA, diuretics, cyclosporine, PZA, ethambutol, nicotinic acid
meds that increased excretion in gout
asa high dose, probenecid, steroids, xray dye, warfarin
tx of hyperuricemia
probenecid allopurinal- start low then titrate quickly febuxostat pegloticase >1 attack/yr and tophi
tx of gouty attack
NSAIDS
colchicine - GI se
steroids
IL- 1 blockade
FM non-pharm acronym ExPRESS
exercise x psychiatric regaining function education sleep hygiene stress management
