Rhueumatology X3

Question 1

Systemic Lupus Erythematosus cause and risks

Answer 1

Autoimmune: Deposition of immune antibody complexes in tissues
F>M
- syptoms during child bearing age
AA> white

Question 2

Lupus Presentation

Answer 2

Gen: fever, fatigue**, LAD, weight loss

• Malar rash
• Discoid patches on sun exposed areas
• Mucocutaneous painless oral or nasal mucosa ulcers
• alopecia
• Raynaus Phenomenon- vasoplasm of digital artereis when exposed to cold
• Nepheritis
• Joint paint or swelling
• N/V ab pain
• ^ risk for MI
• Neuro-seizures or dep or migraines
• can effect many organs so this is not exhaustive

Question 3

Drug induced lupus

Answer 3

Clinical and immunologic pictur similar to spotaneous SLE
Procainamide, isoniazid, hydralazine
+ they will have a pos ANA BUT neg anti-dsDNA anti-Sm Ab

Question 4

SLE dx lab testing

Answer 4

Antinuclear Antibody-ANA
- >95% cardinal feature but not specific
- comes back as a titer
ANA subtypes:
-anti-dsDNA, anti-Sm, antiphospholipid antibodies
* other system tests see slide 20

Question 5

Lupus non pharm tx

Answer 5

Sun prot
diet and exc
smoking cessation
immunixations
tx for comorbid condition ( cholesterol or DM)
Preg and contraception

Question 6

Lupus Pharm Tx

Answer 6

Antimalarials: Hyroxychloroquine
- need eye exam!!
Addition
- NSAIDS, immunosupp, corticosteroids

Question 7

Polymyositis

Answer 7

idiopathic inflammatory condition causing symetric proximal muscle meakness
- delt and hip flexor common
F>M 40-50yo
- gradual onset over weeks to months

Question 8

Polysmyositis pres

Answer 8

Muscle weakness symetric
LungsL cough/SOB (intersitiail lung disease)
Esophageal disease
Cardiac disease
Raynaud phenomenon
risk for aspiration pnemoni and issues with the lungs and heart

Question 9

Dermatomyositis

Answer 9

Polymosisits and cutaneous manifestations

• heliotrope rash
• gattrons papules
• shawls sign
• **link between inflammatory myopathy and occult malignancy!!!

Question 10

Dermatomyositis and Polysmyositis labs and Dx

Answer 10

Muscle enzymes: CK and aldolase elevated
ANA +
might want to check:Chest Xray CT MRI US electromyography, muscle biopsy, skin biopsy

Question 11

Polysmyositis tx

Answer 11

Goal to improve strength and decrease inflammation
1st line glucocorticoids
- steroid sparing agents may be added

Question 12

Sjorgren Syndrome eitology and risks

Answer 12

Systemic chronic autoimmune inflammatory dis with the exocrine gland
- can be primary or associated with other diseases
F>M 40-50

Question 13

Sjorgren Syndrome pres

Answer 13

-affects lacrimal and salviary glads ( sicca complex)
xeropthalmia and xerostomia
- arthritis, myalgia , raynaud, GI, hepatic, renal
- Think about the dryness of other feature other dry areas

Question 14

Sjorgren Syndrome diagnostic

Answer 14

Schirmer test- test tear production
ANA- anti Ro Anti-La 
RF+
ESR,CRP,CBC, Renal/Liver test 
- sometimes salivary gland biopsy

Question 15

Sjorgren Syndrome Tx

Answer 15

Dry eyes: artificial tears cyclosporin
Xerostomia: artificial salvia and sugarless gandy
Extraglandular manifestations
-NSAIDS, acetaminophen

Question 16

Polyarteritis Nodosa PAN

Answer 16

systemic necrotizing vasculitis
- inflammation of muscular arteries also leads to narrowing > resulting in thrombosis, ischemia, infart
M>F middle to older adults
COmmonly affects kidnys, skin, joints, muscles, nerves

Question 17

PAN test

Answer 17

Renal Artery biopsy

• diffuse inflamation
• lumen is narrowed

Question 18

Pan present

Answer 18

Fever wight loss malaise weakness
arthralgia and mysalgia 
cutaneous tender nodules  ulcer purpura 
Bx: will come back as leukocytoclastic vasculitis 
Renal manifestations common

Question 19

Labs for PAN

Answer 19

ESR CRP
serum creatinine, muscle enzymes, liver function studies
ANCA- negative!!
- pos will point to other kinds of vasculitis
-tissue biopsy of affected orans
-arteriography- will se many microaneurisms

Question 20

PAn tx

Answer 20

initial
mild; glucocorticoids
mod: glucocorticoids/immunosuppressive meds
if associated with hep B or C treat those and glucocorticoids depedning on severity

Question 21

Systemic Sclerosis

Answer 21

Autoimmune disorder
causes diffuse fibrosis or skin and internal organs 
vasuclar arrowing of blood vessels 
- more fibroblasts are forming 
F>M
onset 20-50

Question 22

Systemic Sclerosis CREST synd

Answer 22

Calcinosis, Raynauds, esophageal dysfunction, scelrodactyly, telangiectasias

Question 23

Systemic Sclerosis labs

Answer 23

ANA

• ACA- usually limited SSc
• ANtitipoisomerase. diffuse
• Anti RNA poylmerase III> associated with rapidly progressing diffuse SSc