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Endo rhumato ça flow > Rhumato > Flashcards

Rhumato Flashcards

1
Q

A 28-year-old female with SLE since 18 years of age on the basis of arthritis, malar rash, and hemolytic anemia maintained on hydroxychloroquine presents with increasing creatinine. Renal biopsy shows changes consistent with class I lupus nephritis. She undergoes 24h urine collection that shows 2.6g of proteinuria per day. Her blood pressure measured in clinic is 134/90mmHg.
Which is the next best treatment?
a) Add perindopril
b) Start prednisone + azathioprine
c) Continue hydroxychloroquine monotherapy
d) Add perindopril, prednisone, azathioprine and continue hydroxychloroquine

A

A) add perindopril

For all patients with SLE nephritis: RAAS
blockade (ACE-I), BP control (<130/80),+ HCQ

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2
Q

A 35-year-old female previously healthy presents with recurrent fevers (T max 39.1) and arthralgias after URTI over 1 month ago. On examination, she is febrile with left wrist synovitis and a truncal rash. Blood work demonstrates the following:
Hb 110, WBC 10.1, Plts 220. ALT 60, AST 80, ALP 22. Ferritin 2080. Serology negative for ANA, RF, anti-CCP, dsDNA, and normal complements. You proceed with an arthrocentesis of her wrist.
Which of the following is NOT appropriate initial management?
A. Naproxen
B. Ceftriaxone
C. Vancomycin
D. Doxycycline

A

Doxy not appropriate as no suspicion of lyme disease

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3
Q

Anti Jo 1 antibody signification ?

A

Anti synthetase syndrome

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4
Q

Anti Mi2 antibody signification ?

A

Associated with classic form of DM
Highly responsive to tx and favorable prognosis

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5
Q

Anti NXP2 and anti TIF1 antibodies ?

A

Highly associated with malignancy in myositis

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6
Q

Anti RNP signification ?

A

Required for dx of MCTD

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7
Q

Anti Ro/SSA signification ?

A

Risk of congenital heart block and neonatal cutaneous lupus
Also seen in Sjogren

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8
Q

Antibody in limited/crest scleroderma ?

A

Anti centromere 60%

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9
Q

ATB if septic arthritis and nothing on gram stain ? if gram neg bacilli or cocci ?

A

Vanco and ceftri if nothing on gram stain
Ceftri if gram neg bacilli or cocci

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10
Q

Can you give live attenuated vaccines to pts on immunosuppression?

A

Hold tx for certain period and 4 weeks after

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11
Q

Can you give MTX and leflunomide if pregnant ?

A

No teratogenic

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12
Q

Can you give non live vaccines to patients on immunosuppression ?

A

Yes but with modifications
- MTX : hold 2 weeks after influenza, unchanged for all other vaccines
- Ritux: time all vaccines for when next dose is due and delay RTX for > 2w
- Pred : OK but defer other than influenza if > 20mg

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13
Q

Can you use NSAIDs and prednisone in pregnancy ?

A

Avoid especially in third trimester
Low dose < 20mg of pred OK

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14
Q

Can you use urea lowering therapy with AZA ?

A

No risk of bone marrow failure

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15
Q

Catastrophic APS tx ?

A

Full dose anticoag
High dose gluco + PLEX or IvIg
Eculizumab esp if TMA renal manifest

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16
Q

CI to TNFi in PAR ?

A

Dont start if hx of NYHA class III or IV heart failure
If develop heart failure on TNFi : switch to other agent

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17
Q

Concentric joint space narrowing, Osteopenia, Erosions on X RAY : dx ?

A

PAR

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18
Q

Cryoglobulinemic vasculitis treatment ?

A

TYPE II and III
- If mild : low dose cortico / colchicine
- if severe : ritux/CYC + GC
PLEX if life threatening

IF HEP C ASSOCIATED
if mild : antiviral +/- cortico
if severe : RITUX + GC and antiviral therapy as maintenance
if life threatening : PLEX + cortico + ritux/CYC and antiviral therapy as maintenance

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19
Q

Crystals in synovial fluid : negative and positive birefring ?

A

negative is gout
positive is CPPD

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20
Q

DDX OF RF + ?

A

HCV / cryo
Endocarditis
Malignancy like B cell neoplasms
Age
Other CTD

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21
Q

De Quervain epidemiology ?

A

Women between the ages of 30 and 50 years, also post partum period
Pain and tenderness at the radial side of the wrist

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22
Q

Dermatomyositis / polymyositis clinical features of muscle weakness ?

A

Insidious over weeks/months, SYMMETRIC and PROXIMAL > distal, neck flexors

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23
Q

Dermatomyositis tx ?

A

High dose steroids
+ MTX or AZA
or PCQ for skin only
or MMF/cyclo if ILD

IF SEVERE or refractory : IvIg / ritux

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24
Q

Dermatomyositis/polymyositis extra muscle manifestations ?

A

Cardiac aN
ILD / pulm HTN
Gottron’s papules, shawl sign, heliotrope rash, generalized erythroderma, periungal
erythema, mechanic’s hands, scalp psoriasiform changes, calcinosis cutis

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25
Q

Diet that is a RF for gout ?

A

beer, red meat, seafood

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26
Q

Difference entre stevens johnson et nécrolyse épidermique toxique ?

A

NET si > 30% de la peau

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27
Q

Disease for which finger flexor weakness if hallmark ?

A

Inclusion Body Myositis

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28
Q

Do you have arthritis in acute or chronic lyme infection ?

A

Acute infection : arthalgias and myalgias
Lyme arthritis if late onset (>6 m post infection) : oligoarthritis with synovitis and swelling often the knee

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29
Q

Does malar rash cross nasolabial folds ?

A

NO but rosacea does

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30
Q

Drug induced lupus ?

A

HYDRALAZINE, procainmaide, quinidine
Also isoniazid, PTU, TNFi

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31
Q

Eccentric joint narrowing in which disease vs concentric joint space narrowing ?

A

Eccentric in OA
Concentric in RA

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32
Q

Eccentric joint narrowing, Osteophytes, Subchondral sclerosis and cysts on X RAY : dx ?

A

OA

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33
Q

eGPA presentation ?

A

Presents with asthma, allergic rhinitis, peripheral eosinophilia, peripheral neuropathy
P ANCA

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34
Q

Erosions with overhanging osteophytes and tophi in which disease ?

A

Gout

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35
Q

Exclusion criteria for IgG4 disease ?

A

fever, no response to steroids, positive serology, peripheral eosinophils, splenomegaly, non-consistent pathology

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36
Q

Femme obèse de 38 ans avec IMC à 45 vous est référée pour évaluer de nouvelles douleurs articulaires. Connue HTA, DbII, DLP. À l’histoire douleurs inflammatoires toutes MCP/MTP, chevilles et poignets avec synovites à l’examen. RDS négative par ailleurs et examen sans particularité. Aux labos, rien de spécial sauf PLT à 467 et AST\ALT autour de 90. Creat N. Qu’allez-vous débuter comme traitement?
A) MTX
B) leflunomide
C) etanercept
D) plaquenil

A

Etanercept !
MTX et leflunomide somt hépatotoxiques
Plaquenil non car arthrite mod-sev

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37
Q

GI bleeding in a scleroderma patient ?

A

GAVE : gastric antral vascular ectasia
Watermelon stomach

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38
Q

Giant cell arteritis : timing for bx if on steroids ?

A

Within 14 days of starting steroids

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39
Q

Gonococcal arthritis syndromes?

A

1) Tenosynovitis + vesiculopustular skin lesions + migratory polyarthralgias without purulent arthritis
2) Purulent arthritis without skin lesions

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40
Q

Gout : which medication should you use for HTN between diuretis, CCB and losartan ?

A

CCB and losartan as are uricosuric
Avoid diuretics

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41
Q

GPA manifestations ?

A

Pulmonary renal syndrome and ENT SYMPTOMS (nasal crusting, sinusitis)
C ANCA

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42
Q

Healthy patients that have ANA titer of > 1/160 ?

A

5%

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43
Q

Herpes zoster vaccination recommendations for pts on biologics ?

A

• Recommended for patients aged >18 on immunosuppressants
• Shingrix (non-live, recombinant) preferred
• Live attenuated can be administered to high-risk patients not on biologics
• If starting biologics administer live attenuated at least 4 weeks prior to initiation

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44
Q

Homme de 80 ans. ATCD d’HTA, DLP et hypoT4 de longue date. A cessé sa statine il y a environ 6 mois. Consulte pour des faiblesses. Il a une dysphagie et a récemment fait une pneumonie d’aspiration. À l’examen, il a des faiblesses à la flexion des cuisses, aux poignets, ainsi qu’une faiblesse de préhension au niveau des mains. Quelques valeurs de laboratoire sont données. La TSH est à 0,9. La créatinine est à 90. Les CK sont à 500. Quel est diagnostic est le plus probable?

A

Myositeàcorpsd’inclusion

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45
Q

How do you diagnose PAR ?

A

Do not need serology or XR for dx especially with early disease

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46
Q

How do you differentiate PTT from scleroderma renal crisis ?

A

BOTH can have MAHA, AKI, proteinuria, hematuria

However think TTP if fever, purpuric rash, bleeding or THROMBOCYTOPENIA

Tx is PLEX + steroids then add ritux

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47
Q

How do you manage positive aPL in lupic pregnant pts ?

A

• No APS= ASA alone
• OB APS= ASA 81mg + prophylactic heparin until 6-12 weeks PP
• Thrombotic APS= ASA 81mg + therapeutic heparin during pregnancy and PP

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48
Q

How do you manage Ro/La + in lupic pregnant patients ?

A

• No history of neonatal lupus: HCQ + serial fetal echo from week 16-26
• History of neonatal lupus: HCQ + serial fetal echo weekly from week 16-26

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49
Q

How do you treat acute gout ? Name 4

A
  • NSAIDs
  • Colchicine
    1.2 load then 0.6 an hour later then 0.6 BID until sx resolve
  • Gluco IA / po
  • IL1 blocker anakinra if CI to other agents and frequent flares
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50
Q

How do you treat gout : chronic therapy ?

A
  • Allopurinol 100/d or 50 if CKD4 and titrate until you reach uric acid level < 356 or < 300 if tophi
  • Febuxostat 2nd choice
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51
Q

How do you treat seronegative spondylarthropathies with axial disease ?

A
  • NSAIDS
  • TNFi if no response/intolerance to at least 2 different NSAIDs at maximal doses over 1 month or incomplete response to at least 2NSAIDs over 2 months
    2nd line is IL17i
    3rd is JAKi
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52
Q

How many PAR are FR negative ?

A

25% are RF negative

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53
Q

How often should you do echo and PFTs in scleroderma patients ?

A

BNP, echo and PFTs annually

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54
Q

How should you manage carotid MVAS ?

A

If stenosis 70-99% and sx : revasc within 2 weeks
If stenosis 50-69% and sx : revasc within 2 weeks, beyond 2 weeks benefit is less certain

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55
Q

How should you treat Adult Still’s disease ?

A

NSAIDs if mild-moderate
GC or Anakinra if mod-severe or failed NSAIDs

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56
Q

If enlargement of submandibular glands / lacrimal glands without parotide enlargement : dx ?

A

sending igg4 is now routine

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57
Q

If patient is already on chronic allopurinol/ULT therapy do you need to stop it during acute flare ?

A

No

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58
Q

Imaging recommendation for giant cell arteritis ?

A
  • US recommended 1st ligne
  • Takayasu : MRA preferred imaging
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59
Q

Immune mediated necrotyzing myopathy presentation ?

A

Severe myopathy with high CK
Presistent after d/c statin
Absence of skin manifestations
Anti HMG CoA reductase antibody (up to 50% are actually statin naive)
R/O paraneoplasic syndrome

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60
Q

Inclusion body myositis presentation ?

A

Older male, insidious
Distal > proximal muscle weakness
Poor tx response and CK tend to be lower

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61
Q

Is there ocular manifestations of reactive arthritis ?

A

Yes 50-75% uveitis or conjunctivitis

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62
Q

Jeune femme connue de Lupus présentant un tableau classique de shrinking lung. Quel est le changement le plus sensible?
A- Augmentation pCO2
B- Diminution VEMS
C- Diminution CVF
D- Diminution MIP

A

Diminution MIP

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63
Q

Lacrimal gland enlargement even in context of Sjogren : beware of ?

A

Raises concern for lymphoma

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64
Q

Lupus : when should you consider anifrolumab or belimumab ?

A

If severe disease with extrarenal SLE and non major organ involvement but extensive disease
Anifrolumab +++ if skin disease

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65
Q

Lupus nephritis class III/IV and pre conception counselling ?

A

Stop ACEi, continue HCQ, ensure stable disease
ADD ASA 12-36 wks
ADD AZA if severe flare or CNI
(voclosporin)

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66
Q

Lupus tx if organ/life threatening diease ?

A

IV CYC, Ritux if refractory

67
Q

Lymphoplasmacytic infiltrate/storiform fibrosis : dx ?

A

IgG4

68
Q

Male pre conception for PAR : can MTX be continued ?

A

Yes

69
Q

Management of drug induced lupus ?

A

Discontinue the offending medication like anti TNF
NSAIDs for arthralgia, plaquenil temporaly if still sx after 4-8 weeks

70
Q

Meds that are RF for gout ?

A

thiazides, low dose ASA, allopurinol, pyrazinamide

71
Q

Monitoring required if patient on cyclophosphamide ?

A

Bi weekly CBC as risk of myelosuppression

72
Q

Most common myopathy in 60+ ?

A

Inclusion body myositis

73
Q

Most specific antibodies for lupic nephritis ?

A

anti ds DNA

74
Q

MPA presentation ?

A

Pulmonary renal syndrome
P ANCA 65% and C ANCA 30%

75
Q

Myosite secondaire a la colchicine ?

A

After exposure to colchicine, especially if AKI
Proximal muscule weakness, especially lower extremities with peripheral neuropathy
CK almost always elevated

76
Q

PAN clinical presentation ?

A

Fever, weight loss
Testicular pain
Abdo pain post prandial
Arthritis
Polyneuropathy
Arteriographic abnormalities: Aneurysms or stenotic lesions in mesenteric/hepatic/renal arteries + branches
Associated with HBV

77
Q

PAN vasculitis : which size of vessels ?

A

Medium

78
Q

PAR : screen for lung disease ?

A

Yes screen at baseline with PFTs and high resolution CT
If baseline parenchymal lung disease incidental/mild/stable : can use MTX if arthritis mod-sev

79
Q

PAR : symmetric or asymmetric ?

A

Symmetric small joint polyarthritis

80
Q

PAR and hepatitis B ?

A

• If Hep B core Ab Positive, SAg + : prophylactic antiviral therapy while starting all biologic dMARD
• If starting rituximab : prophylactic antiviral therapy even if surface antigen neg, if core Ab +

81
Q

PAR and NASH ?

A

Can still use MTX if liver enzymes normal, liver function tests normal, no advanced liver fibrosis, and patient has moderate to severe disease activity, with more frequent (q4-8wk) monitoring of LFTs

82
Q

PAR and pregnancy : what to do pre pregnancy ?

A

STOP MTX at least 1-3 months pre conception
Avoid leflunomide (cholestyramine washout if detectable)
Taper pred < 20

83
Q

PAR long term therapy that is disease modifying ?

A

If low disease : hydroxychloroquine
If mod-high disease : MTX monotherapy
If failed MTX : TNFi and continue MTX for synergistic effect / prevent formation of anti drug Ab

84
Q

Pathogen in septic arthritis ?

A

S aureus #1 in both native and prosthetic joints
Salmonella # 1 in osteomyelitis and septic arthritis in sickle cell disease

85
Q

Patient qui se présente avec douleurs musculaires proximales, Raynaud, polyarthrite, Désature légèrement à l’air ambiant et RXP démontre infiltrat aux bases. Bilan: CK 1500. Dx?
a)Polymyosite
b)Sjogren Primaire
c)CIDP
d)myosite overlap

A

Myosite overlap

Clinical overlap features : polyarthritis, raynaud, sclerodactyly, calcinosis, lower oesophageal hypomotility, DLCO lower than N, discoid lupud, dsDNA…

86
Q

Periarticular osteopenia, joint space narrowing, marginal erosions on XR dx?

A

PAR

87
Q

Presentation of inclusion body myositis?

A

3M : 1F
Insidious onset prox and dist weakness with finger flexor weakness
May have dysphagia
Very marked morbidity

88
Q

Psoriasis on X RAY ?

A

Marignal erosions
Pencil and cup deformity
PERIOSTITIS

89
Q

Quel dx chez patient avec perte d’audition, rhinosinusite récurritente, ulcères oraux/nasaux….

A

Granulomatose avec polyangéite

90
Q

Quels anticorps ont retrouve dans la maladie de Still ?

A

FR et ANA négatif dans les critères mineux
FR parfois positifs chez < 10%

91
Q

Reactive arthritis : timing ? Which infection?

A

Occurs several days to around 4 week after GASTRO ENTERITIS OR URETHRITIS

92
Q

Relationship between GCA and PMR ?

A

50% GCA will have PMR
15% PMR will have GCA

93
Q

Rhomboid shaped positively birefringent crystal ?

A

CPPD

94
Q

Sclerderma renal crisis in diffuse or limited scleroderma ? What about pulmonary hypertension ?

A

Scleroderma renal crisis in 10-20% of diffuse systemic sclerosis
Pulmonary hypertension more common in limited

95
Q

Scleroderma renal crisis presentation ?

A

Acute/progressive renal failure + HTN + mild proteinuria

96
Q

Scleroderma renal crisis RF ?

A

Increased risk with prednisone, RNAP3 autoantibodies, early disease

97
Q

Secondary causes of CPPD / pseudo gout ?

A

HypoT4, hypoMg, hypoPO4, hemochromatosis, hyperPTH, Wilson

98
Q

Serology of scleroderma ?

A

Anticentromere : LIMITED CREST 60%, diffuse 15%
AntiScl 70/topo I : 40% of scleroderma pts, mostly diffuse disease

99
Q

Should you use systemic glucocorticoids for peripheral disease of seronegative spondylarthropathies ?

A

No should be avoided

100
Q

Should you use systemic glucocorticoids to treat axial disease of seronegative spondylarthropathies ?

A

NO

101
Q

Skin lesions in gonorrhea ?

A

Pustulo vesicular, painless
On distal extremities
Often transient and last only 3-4 days

102
Q

Syndrome de Felty ?

A

PAR seropositive de longue date + splenomegalie + neutropenie

103
Q

Syndrome d’Evans ?

A

Co occurrence of two or more immune cytopenias, most often AIHA and ITP

104
Q

Synovial fluid analysis : WBC count if inflammatory / crystals ?

A

> 2000-50 000 with > 50% PMNs

105
Q

Synovial fluid analysis if septic ?

A

WBC > 50 000 bacterial
WBC 10-30 000 fungal or mycobacterial
> 75 PMH indicative of bacterial infections

106
Q

Tabes dorsalis en syphilis ?

A

Ataxie, atteinte cordons posterieurs, douleurs lancinantes

107
Q

TNFi induced lupus labs ?

A

Usually anti histone - but ds DNA +
which is atypical for drug induced lupus

Get baselin ANA and antidsDNA to compare !

108
Q

Treatment of giant cell arteritis ?

A

Pred + toci
IV pulse steroids if visual sx / critical cranial ischemia
High dose steroids x 1 m then taper
ASA only if critical/low flow limiting lesion of carotid/vertebral arteries

109
Q

Tx epanchement pleural de PAR ?

A
  • Resolution spontanée ou avec tx de l’arthrite generalement
  • Si sx : AINS premier choix puis GC
110
Q

Tx fibromyalgie?

A

Tricyclique puis SSRI type duloxetine

111
Q

Tx for PMR ?

A

Pred 12.5-20mg/d x 2-4 weeks
then taper to 10mg/d within 1-2 m if response

112
Q

Tx if high risk APS profile without prior thrombosis ?

A

ASA 81 for life
HCQ for pte with SLE an APS

113
Q

Tx of bullous pemphigoid ?

A

Cortico and oral doxycycline

114
Q

Tx of ILD in systemic sclerosis pt : tx ?

A

STRONG recommendation AGAINST GC
Use MMF, toci, ritux

115
Q

Tx of PAN ?

A

If HBV : GC, antivirals +/- PLEX
If idiopathic :
non severe : GC + MTX/AZA
severe : GC IV + CYC x 3-6m

116
Q

Tx pour ténosynovite de quervain ?

A

Attelle SPICA

117
Q

Typical causative agents of reactive arthritis ?

A

C. trachomatis, Yersinia, Salmonella, Shigella & Campylobacter

118
Q

Un homme diabétique de 42 ans présente depuis quelques mois une atrophie et une faiblesse des muscles de la main droite, sa main dominante. Quel serait un signe suggérant une atteinte du nerf médian?
a) Faiblessedel’hypothénar
b) Pertedesensibilitédudosdelamain
c) Faiblessedel’opposantdupouce
d) Pertedesensibilitédelapartiedistaledu5edoigt

A

C)

119
Q

What are the benefits of HCQ in lupus ?

A

Has mortaliry benefit and reduces risk of renal flare
Potential antithrombotic effects in SLE aPL or APS

120
Q

What are the classes of membranous lupus nephritis ?

A

Class V

121
Q

What are the classes of proliferative lupus nephritis ?

A

Class III and IV

122
Q

What are the indications of urate lowering therapy in gout ?

A

DEFINITE :
- Two or more attacks/y
- Tophaceous gout
- Gouty arthropathy (erosions)

Conditional if acute gout + RF such as CKD STAGE 3 / Uric acid > 535 / UROLITHIASIS

123
Q

What are the risks in prescribing colchicine ?

A

• Risks: diarrhea, nausea, vomiting, (myopathy for long term use)
• OD is life-threatening and is non dialyzable with no anti-dote

124
Q

What are the three different types of cryo ?

A

Type 1 : monoclonal usually IgM
clonal hematologic disease
Type II : polyclonal IgG / monoclonal immunoglobulins
2e to chronic infections like Hep C, connective tissue diseases or SLP
Type III : polyclonal IgM
RF +++

Type II and III : immune complex deposition leading to small/medium vessel vasculitis

125
Q

What is a persistent aPL ?

A

2 measures > 12w apart

126
Q

What is a steroid dose adequate for PMR ?

A

Consider dose increase if prednisone 10mg or less
Usually tx is 12.5-20mg/d x 2-4 weeks

127
Q

What is calcific tendinitis / Milwaukee Shoulder ?

A

(basic calcium phosphate/hydroxyapatite crystals)
• Older female patients
• Acute onset, destructive shoulder arthropathy

128
Q

What is colchicine dose in gout ?

A

1.2mg load then 0.6mg an hour later then 0.6mg BID until symptoms resolve

– Requires dose reduction for CKD – CrCl <30 start 0.3mg per day

129
Q

What is Crowned Dens Syndrome ?

A

Acute or subacute onset upper neck pain (usually with limited ROM), elevated inflammatory markers and often fever Diagnostic of CPPD if clinical/imaging features of CDS present

130
Q

What is EORA ?

A

Elderly onset RA (65y+)
May have PMR like presentation, more large joint, less likely seropositive

131
Q

What is high risk aPL profile ?

A

Positive LAC, double or triple positive

132
Q

What is Nikolsky sign ?

A

Lateral pressure is applied on the border of an intact blister which results in the dislodgment of the normal epidermis and extension of the blister

133
Q

What is one of the earliest signs of RA, neurologic ?

A

Carpal tunnel syndrome

134
Q

What is R3SPE disease ?

A

Remitting seronegative symmetrical synovitis with pitting edeme
OLDER MEN
May be paraneoplastic
VERY responsive to pred

135
Q

What is the bload pressure goal in lupus ?

A

< 130/80

136
Q

What is the clinical manifestation that has the best LR in giant cell arteritis ?

A

Jaw claudication LR+ 4.2
Diplopia LR+ 3.4

137
Q

What is the clinical presentation of anti synthetase syndrome ?

A
  • Acute onset constitutional sx, rapidly progressive ILD
  • Raynaud
  • Mechanic’s hands, skin ulceration
  • Arthritis

ANTI JO 1 antibodie

138
Q

What is the difference between IBD type 1 and type 2 arthritis ?

A

IBD Type 1 (oligo, usually large joints, correlates with bowel activity)
ASYMMETRIC AND LARGE

IBD Type 2 (polyarthritis, independent of
bowel)
SYMMETRIC AND SMALL

139
Q

What is the dose of ASA in lupic pregant pts ?

A

ASA 162 mg for everyone prior to 16w gestation

140
Q

What is the entry cirterion for APS ?

A

aPL test within 3 years of aPL clinical criterion

141
Q

What is the presentation of pseudogout/CCPD ?

A

Various
- pseudogout with acute mono/oligo arthritis
- RA like
- OA with CPPD

142
Q

What is the risk of hip corticosteroid injections ?

A

Rapidly destructive hip disease
Should generally not be used

143
Q

What is the tx of inclusion body myositis ?

A

Degenerative muscle condition so no role for immunosuppresive medications

144
Q

What is the tx of reactive arthritis ?

A

NSAIDs, intra articular cortico
DMARDs if recurrent or chronic

145
Q

What is your target in urate lowering therapy ?

A

uric acid level < 356umol/L or <300umol/L if tophi

146
Q

When can you start biologic if latent TB? if active TB ?

A

At least 1 month of tx if latent
Complete full tx if active

147
Q

When should you add ASA in giant cell arteritis ?

A

Only if critical or low flow limiting lesion of carotid or vertebral arteries

148
Q

When should you consider testing for HLA B 5801 before prescribing allopurinol ?

A

Southeast Asian and African Canadian patients at increased risk of hypersensitivity syndrome

149
Q

When should you do cervical cancer screening in lupic patients ?

A

ANNUAL basis regardless of immunosuppression

150
Q

When should you measure APLA in SLE nephritis ?

A

Measure if for ALL

151
Q

When should you offer pneumococcal vaccination for patients on biologics ?

A

Recommended for patients aged < 65 on immunosuppressants

152
Q

When should you use mepolizumab ?

A

In non severe disease of eGPA
Also in severe disease in maintenance therapy with GC

153
Q

When should you worry about malignancy in myositis ?

A

DM asssociated with malignancy : at time of dx or within 1y of dx
Risk is elevated for at least 5y following dx
Age appropriate malignancy screening at dx or any disease flare

154
Q

Which antibody is associated with lupus nephritis ?

A

Anti dsDNA

155
Q

Which biologic if prior skin cancer ?

A

Avoid TNFi as increased risk non melanoma skin cancer

156
Q

Which crystal if needle shaped and negatively birefringent ?

A

Gout : monosodium urate crytals

157
Q

Which disease is associated with pyoderma gangrenosum?

A

IBD

158
Q

Which disease will attack DIP articulations between OA, RA and psoriasis ?

A

OA, psoriasis YES

159
Q

Which lupus nephritis classes does not need immunosuppression as 1st line ?

A

Class I and II : only if prot > 3g / day
Class V : only if proteinuria / HTN refractory
Class VI : NO immunosuppression

160
Q

Which lupus nephritis type warrant aggressive immunosuppression ?

A

Class III and IV

161
Q

Which TNFi is especially safe in pregnancy ?

A

certolizumab ? cimizia marketed as large molecule that cannot cross placenta

162
Q

Which TNFi should you used to treat axial disease of seronegative spondylarthropatheis ?

A

No preferrence over which TNFi is used

163
Q

Which tx for PAR in post partum breastfeeding pt ?

A

Sulfasalazine OK theoritical risk of kernicterus
AVOID MTX and leflunomide

164
Q

Which tx if peripheral arthritis and uveitis/IBD ?

A

Infliximab/adalimumab

Endo rhumato ça flow (2 decks)

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