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
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
3
Q
Anti Jo 1 antibody signification ?
A
Anti synthetase syndrome
4
Q
Anti Mi2 antibody signification ?
A
Associated with classic form of DM
Highly responsive to tx and favorable prognosis
5
Q
Anti NXP2 and anti TIF1 antibodies ?
A
Highly associated with malignancy in myositis
6
Q
Anti RNP signification ?
A
Required for dx of MCTD
7
Q
Anti Ro/SSA signification ?
A
Risk of congenital heart block and neonatal cutaneous lupus
Also seen in Sjogren
8
Q
Antibody in limited/crest scleroderma ?
A
Anti centromere 60%
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
10
Q
Can you give live attenuated vaccines to pts on immunosuppression?
A
Hold tx for certain period and 4 weeks after
11
Q
Can you give MTX and leflunomide if pregnant ?
A
No teratogenic
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
13
Q
Can you use NSAIDs and prednisone in pregnancy ?
A
Avoid especially in third trimester
Low dose < 20mg of pred OK
14
Q
Can you use urea lowering therapy with AZA ?
A
No risk of bone marrow failure
15
Q
Catastrophic APS tx ?
A
Full dose anticoag
High dose gluco + PLEX or IvIg
Eculizumab esp if TMA renal manifest
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
17
Q
Concentric joint space narrowing, Osteopenia, Erosions on X RAY : dx ?
A
PAR
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
19
Q
Crystals in synovial fluid : negative and positive birefring ?
A
negative is gout
positive is CPPD
20
Q
DDX OF RF + ?
A
HCV / cryo
Endocarditis
Malignancy like B cell neoplasms
Age
Other CTD
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
22
Q
Dermatomyositis / polymyositis clinical features of muscle weakness ?
A
Insidious over weeks/months, SYMMETRIC and PROXIMAL > distal, neck flexors
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
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
25
Diet that is a RF for gout ?
beer, red meat, seafood
26
Difference entre stevens johnson et nécrolyse épidermique toxique ?
NET si > 30% de la peau
27
Disease for which finger flexor weakness if hallmark ?
Inclusion Body Myositis
28
Do you have arthritis in acute or chronic lyme infection ?
Acute infection : arthalgias and myalgias
Lyme arthritis if late onset (>6 m post infection) : oligoarthritis with synovitis and swelling often the knee
29
Does malar rash cross nasolabial folds ?
NO but rosacea does
30
Drug induced lupus ?
HYDRALAZINE, procainmaide, quinidine
Also isoniazid, PTU, TNFi
31
Eccentric joint narrowing in which disease vs concentric joint space narrowing ?
Eccentric in OA
Concentric in RA
32
Eccentric joint narrowing, Osteophytes, Subchondral sclerosis and cysts on X RAY : dx ?
OA
33
eGPA presentation ?
Presents with asthma, allergic rhinitis, peripheral eosinophilia, peripheral neuropathy
P ANCA
34
Erosions with overhanging osteophytes and tophi in which disease ?
Gout
35
Exclusion criteria for IgG4 disease ?
fever, no response to steroids, positive serology, peripheral eosinophils, splenomegaly, non-consistent pathology
36
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
Etanercept !
MTX et leflunomide somt hépatotoxiques
Plaquenil non car arthrite mod-sev
37
GI bleeding in a scleroderma patient ?
GAVE : gastric antral vascular ectasia
Watermelon stomach
38
Giant cell arteritis : timing for bx if on steroids ?
Within 14 days of starting steroids
39
Gonococcal arthritis syndromes?
1) Tenosynovitis + vesiculopustular skin lesions + migratory polyarthralgias without purulent arthritis
2) Purulent arthritis without skin lesions
40
Gout : which medication should you use for HTN between diuretis, CCB and losartan ?
CCB and losartan as are uricosuric
Avoid diuretics
41
GPA manifestations ?
Pulmonary renal syndrome and ENT SYMPTOMS (nasal crusting, sinusitis)
C ANCA
42
Healthy patients that have ANA titer of > 1/160 ?
5%
43
Herpes zoster vaccination recommendations for pts on biologics ?
• 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
44
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?
Myositeàcorpsd'inclusion
45
How do you diagnose PAR ?
Do not need serology or XR for dx especially with early disease
46
How do you differentiate PTT from scleroderma renal crisis ?
BOTH can have MAHA, AKI, proteinuria, hematuria
However think TTP if fever, purpuric rash, bleeding or THROMBOCYTOPENIA
Tx is PLEX + steroids then add ritux
47
How do you manage positive aPL in lupic pregnant pts ?
• 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
48
How do you manage Ro/La + in lupic pregnant patients ?
• 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
49
How do you treat acute gout ? Name 4
- 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
50
How do you treat gout : chronic therapy ?
- Allopurinol 100/d or 50 if CKD4 and titrate until you reach uric acid level < 356 or < 300 if tophi
- Febuxostat 2nd choice
51
How do you treat seronegative spondylarthropathies with axial disease ?
- 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
52
How many PAR are FR negative ?
25% are RF negative
53
How often should you do echo and PFTs in scleroderma patients ?
BNP, echo and PFTs annually
54
How should you manage carotid MVAS ?
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
55
How should you treat Adult Still’s disease ?
NSAIDs if mild-moderate
GC or Anakinra if mod-severe or failed NSAIDs
56
If enlargement of submandibular glands / lacrimal glands without parotide enlargement : dx ?
sending igg4 is now routine
57
If patient is already on chronic allopurinol/ULT therapy do you need to stop it during acute flare ?
No
58
Imaging recommendation for giant cell arteritis ?
- US recommended 1st ligne
- Takayasu : MRA preferred imaging
59
Immune mediated necrotyzing myopathy presentation ?
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
60
Inclusion body myositis presentation ?
Older male, insidious
Distal > proximal muscle weakness
Poor tx response and CK tend to be lower
61
Is there ocular manifestations of reactive arthritis ?
Yes 50-75% uveitis or conjunctivitis
62
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
Diminution MIP
63
Lacrimal gland enlargement even in context of Sjogren : beware of ?
Raises concern for lymphoma
64
Lupus : when should you consider anifrolumab or belimumab ?
If severe disease with extrarenal SLE and non major organ involvement but extensive disease
Anifrolumab +++ if skin disease
65
Lupus nephritis class III/IV and pre conception counselling ?
Stop ACEi, continue HCQ, ensure stable disease
ADD ASA 12-36 wks
ADD AZA if severe flare or CNI
(voclosporin)
66
Lupus tx if organ/life threatening diease ?
IV CYC, Ritux if refractory
67
Lymphoplasmacytic infiltrate/storiform fibrosis : dx ?
IgG4
68
Male pre conception for PAR : can MTX be continued ?
Yes
69
Management of drug induced lupus ?
Discontinue the offending medication like anti TNF
NSAIDs for arthralgia, plaquenil temporaly if still sx after 4-8 weeks
70
Meds that are RF for gout ?
thiazides, low dose ASA, allopurinol, pyrazinamide
71
Monitoring required if patient on cyclophosphamide ?
Bi weekly CBC as risk of myelosuppression
72
Most common myopathy in 60+ ?
Inclusion body myositis
73
Most specific antibodies for lupic nephritis ?
anti ds DNA
74
MPA presentation ?
Pulmonary renal syndrome
P ANCA 65% and C ANCA 30%
75
Myosite secondaire a la colchicine ?
After exposure to colchicine, especially if AKI
Proximal muscule weakness, especially lower extremities with peripheral neuropathy
CK almost always elevated
76
PAN clinical presentation ?
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
PAN vasculitis : which size of vessels ?
Medium
78
PAR : screen for lung disease ?
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
PAR : symmetric or asymmetric ?
Symmetric small joint polyarthritis
80
PAR and hepatitis B ?
• 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
PAR and NASH ?
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
PAR and pregnancy : what to do pre pregnancy ?
STOP MTX at least 1-3 months pre conception
Avoid leflunomide (cholestyramine washout if detectable)
Taper pred < 20
83
PAR long term therapy that is disease modifying ?
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
Pathogen in septic arthritis ?
S aureus #1 in both native and prosthetic joints
Salmonella # 1 in osteomyelitis and septic arthritis in sickle cell disease
85
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
Myosite overlap
Clinical overlap features : polyarthritis, raynaud, sclerodactyly, calcinosis, lower oesophageal hypomotility, DLCO lower than N, discoid lupud, dsDNA…
86
Periarticular osteopenia, joint space narrowing, marginal erosions on XR dx?
PAR
87
Presentation of inclusion body myositis?
3M : 1F
Insidious onset prox and dist weakness with finger flexor weakness
May have dysphagia
Very marked morbidity
88
Psoriasis on X RAY ?
Marignal erosions
Pencil and cup deformity
PERIOSTITIS
89
Quel dx chez patient avec perte d’audition, rhinosinusite récurritente, ulcères oraux/nasaux….
Granulomatose avec polyangéite
90
Quels anticorps ont retrouve dans la maladie de Still ?
FR et ANA négatif dans les critères mineux
FR parfois positifs chez < 10%
91
Reactive arthritis : timing ? Which infection?
Occurs several days to around 4 week after GASTRO ENTERITIS OR URETHRITIS
92
Relationship between GCA and PMR ?
50% GCA will have PMR
15% PMR will have GCA
93
Rhomboid shaped positively birefringent crystal ?
CPPD
94
Sclerderma renal crisis in diffuse or limited scleroderma ? What about pulmonary hypertension ?
Scleroderma renal crisis in 10-20% of diffuse systemic sclerosis
Pulmonary hypertension more common in limited
95
Scleroderma renal crisis presentation ?
Acute/progressive renal failure + HTN + mild proteinuria
96
Scleroderma renal crisis RF ?
Increased risk with prednisone, RNAP3 autoantibodies, early disease
97
Secondary causes of CPPD / pseudo gout ?
HypoT4, hypoMg, hypoPO4, hemochromatosis, hyperPTH, Wilson
98
Serology of scleroderma ?
Anticentromere : LIMITED CREST 60%, diffuse 15%
AntiScl 70/topo I : 40% of scleroderma pts, mostly diffuse disease
99
Should you use systemic glucocorticoids for peripheral disease of seronegative spondylarthropathies ?
No should be avoided
100
Should you use systemic glucocorticoids to treat axial disease of seronegative spondylarthropathies ?
NO
101
Skin lesions in gonorrhea ?
Pustulo vesicular, painless
On distal extremities
Often transient and last only 3-4 days
102
Syndrome de Felty ?
PAR seropositive de longue date + splenomegalie + neutropenie
103
Syndrome d’Evans ?
Co occurrence of two or more immune cytopenias, most often AIHA and ITP
104
Synovial fluid analysis : WBC count if inflammatory / crystals ?
> 2000-50 000 with > 50% PMNs
105
Synovial fluid analysis if septic ?
WBC > 50 000 bacterial
WBC 10-30 000 fungal or mycobacterial
> 75 PMH indicative of bacterial infections
106
Tabes dorsalis en syphilis ?
Ataxie, atteinte cordons posterieurs, douleurs lancinantes
107
TNFi induced lupus labs ?
Usually anti histone - but ds DNA +
which is atypical for drug induced lupus
Get baselin ANA and antidsDNA to compare !
108
Treatment of giant cell arteritis ?
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
Tx epanchement pleural de PAR ?
- Resolution spontanée ou avec tx de l’arthrite generalement
- Si sx : AINS premier choix puis GC
110
Tx fibromyalgie?
Tricyclique puis SSRI type duloxetine
111
Tx for PMR ?
Pred 12.5-20mg/d x 2-4 weeks
then taper to 10mg/d within 1-2 m if response
112
Tx if high risk APS profile without prior thrombosis ?
ASA 81 for life
HCQ for pte with SLE an APS
113
Tx of bullous pemphigoid ?
Cortico and oral doxycycline
114
Tx of ILD in systemic sclerosis pt : tx ?
STRONG recommendation AGAINST GC
Use MMF, toci, ritux
115
Tx of PAN ?
If HBV : GC, antivirals +/- PLEX
If idiopathic :
non severe : GC + MTX/AZA
severe : GC IV + CYC x 3-6m
116
Tx pour ténosynovite de quervain ?
Attelle SPICA
117
Typical causative agents of reactive arthritis ?
C. trachomatis, Yersinia, Salmonella, Shigella & Campylobacter
118
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
C)
119
What are the benefits of HCQ in lupus ?
Has mortaliry benefit and reduces risk of renal flare
Potential antithrombotic effects in SLE aPL or APS
120
What are the classes of membranous lupus nephritis ?
Class V
121
What are the classes of proliferative lupus nephritis ?
Class III and IV
122
What are the indications of urate lowering therapy in gout ?
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
What are the risks in prescribing colchicine ?
• Risks: diarrhea, nausea, vomiting, (myopathy for long term use)
• OD is life-threatening and is non dialyzable with no anti-dote
124
What are the three different types of cryo ?
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
What is a persistent aPL ?
2 measures > 12w apart
126
What is a steroid dose adequate for PMR ?
Consider dose increase if prednisone 10mg or less
Usually tx is 12.5-20mg/d x 2-4 weeks
127
What is calcific tendinitis / Milwaukee Shoulder ?
(basic calcium phosphate/hydroxyapatite crystals)
• Older female patients
• Acute onset, destructive shoulder arthropathy
128
What is colchicine dose in gout ?
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
What is Crowned Dens Syndrome ?
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
What is EORA ?
Elderly onset RA (65y+)
May have PMR like presentation, more large joint, less likely seropositive
131
What is high risk aPL profile ?
Positive LAC, double or triple positive
132
What is Nikolsky sign ?
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
What is one of the earliest signs of RA, neurologic ?
Carpal tunnel syndrome
134
What is R3SPE disease ?
Remitting seronegative symmetrical synovitis with pitting edeme
OLDER MEN
May be paraneoplastic
VERY responsive to pred
135
What is the bload pressure goal in lupus ?
< 130/80
136
What is the clinical manifestation that has the best LR in giant cell arteritis ?
Jaw claudication LR+ 4.2
Diplopia LR+ 3.4
137
What is the clinical presentation of anti synthetase syndrome ?
- Acute onset constitutional sx, rapidly progressive ILD
- Raynaud
- Mechanic’s hands, skin ulceration
- Arthritis
ANTI JO 1 antibodie
138
What is the difference between IBD type 1 and type 2 arthritis ?
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
What is the dose of ASA in lupic pregant pts ?
ASA 162 mg for everyone prior to 16w gestation
140
What is the entry cirterion for APS ?
aPL test within 3 years of aPL clinical criterion
141
What is the presentation of pseudogout/CCPD ?
Various
- pseudogout with acute mono/oligo arthritis
- RA like
- OA with CPPD
142
What is the risk of hip corticosteroid injections ?
Rapidly destructive hip disease
Should generally not be used
143
What is the tx of inclusion body myositis ?
Degenerative muscle condition so no role for immunosuppresive medications
144
What is the tx of reactive arthritis ?
NSAIDs, intra articular cortico
DMARDs if recurrent or chronic
145
What is your target in urate lowering therapy ?
uric acid level < 356umol/L or <300umol/L if tophi
146
When can you start biologic if latent TB? if active TB ?
At least 1 month of tx if latent
Complete full tx if active
147
When should you add ASA in giant cell arteritis ?
Only if critical or low flow limiting lesion of carotid or vertebral arteries
148
When should you consider testing for HLA B 5801 before prescribing allopurinol ?
Southeast Asian and African Canadian patients at increased risk of hypersensitivity syndrome
149
When should you do cervical cancer screening in lupic patients ?
ANNUAL basis regardless of immunosuppression
150
When should you measure APLA in SLE nephritis ?
Measure if for ALL
151
When should you offer pneumococcal vaccination for patients on biologics ?
Recommended for patients aged < 65 on immunosuppressants
152
When should you use mepolizumab ?
In non severe disease of eGPA
Also in severe disease in maintenance therapy with GC
153
When should you worry about malignancy in myositis ?
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
Which antibody is associated with lupus nephritis ?
Anti dsDNA
155
Which biologic if prior skin cancer ?
Avoid TNFi as increased risk non melanoma skin cancer
156
Which crystal if needle shaped and negatively birefringent ?
Gout : monosodium urate crytals
157
Which disease is associated with pyoderma gangrenosum?
IBD
158
Which disease will attack DIP articulations between OA, RA and psoriasis ?
OA, psoriasis YES
159
Which lupus nephritis classes does not need immunosuppression as 1st line ?
Class I and II : only if prot > 3g / day
Class V : only if proteinuria / HTN refractory
Class VI : NO immunosuppression
160
Which lupus nephritis type warrant aggressive immunosuppression ?
Class III and IV
161
Which TNFi is especially safe in pregnancy ?
certolizumab ? cimizia marketed as large molecule that cannot cross placenta
162
Which TNFi should you used to treat axial disease of seronegative spondylarthropatheis ?
No preferrence over which TNFi is used
163
Which tx for PAR in post partum breastfeeding pt ?
Sulfasalazine OK theoritical risk of kernicterus
AVOID MTX and leflunomide
164
Which tx if peripheral arthritis and uveitis/IBD ?
Infliximab/adalimumab
