Seroneg Spondyloarthropathies, Pain syndromes, Fibromyalgia

Question 1

commonality of seronegative spondyloarthropathies

Answer 1

HLA-B27

Question 2

seronegative means

Answer 2

negative for RF and lack of ANA

Question 3

MS manifestations in seroneg spondyloarthropathies

Answer 3

back pain complaint, axial skeleton involvement, and enthesitis

Question 4

list seronegative spondyloarthropathies

Answer 4

ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and colitic arthritis

Question 5

most common of the spondyloarthropathies

Answer 5

ankylosing spondylities

Question 6

most common extra-articular symptom of ankylosing spondyloarthropathy

Answer 6

unilateral uveitis

Question 7

BAMBOO spine may be CM that presents late in course of…

Answer 7

ankylosing spondylitis

Question 8

what therapy is first line for ankylosing spondylitis

Answer 8

NSAIDS- improvement in 1-2 days

Question 9

ankylosing spondylitis patients have increased risk of what fracture

Answer 9

spinal fracture

Question 10

population affected in reactive arthritis and ankylosing spondylitis

Answer 10

men ages 20-40

Question 11

arthropahy most commonly affecting knees, ankles, and feet after GI or GU infection

Answer 11

reactive arthritis

Question 12

fibromyalgia is a chronic pain condition that affects what parts of body?

Answer 12

SOFT tissues- muscles, tendons, and ligaments. SPARES JOINTS.

Question 13

diagnostic criteria for fibromyalgia

Answer 13

widespread pain in all 4 quadrants of body present for 3 months with axial skeleton involvement and 2. pain upon palpation of 11 or more of 18 tender sites (SYMMETRIC)

Question 14

tx of fibromyalgia focuses on symptom control. education, lifestyle modification, PT, CBT. pharmocologic FDA approved include:

Answer 14

duloxetine, pregabalin

Question 15

2 major differences between myofacial pain syndrome and fibromyalgia

Answer 15

1. MPS pain and tenderness can be cured. 2. often just one body region in MPS affected- localized, focal pain

Question 16

pain syndrome that often follows an injury or traumatic event causing soft tissue injury or fracture

Answer 16

complex regional pain syndrome

Question 17

what can you expect to see in 3 diff stages of complex regional pain syndrome

Answer 17

initially- severe pain in affected area, burning, throbbing, sensitive to temp, edema. 2nd stage soft tissue edema, muscle wasting, brawny skin. 3rd stage- limited ROM

Question 18

population most often seen in complex regional pain syndrome

Answer 18

females in 6-7 decade

Question 19

autonomic testing in complex regional pain syndrome

Answer 19

resting sweat output, resting skin temperature, quantitiave sudomotor axon reflex test

Question 20

systemic necrotizing vasculitis affecting medium sized muscular arteries causing transmural, segmental inflammation of aa.

Answer 20

polyarteritis nodosa

Question 21

polyarteritis nodosa can affect any organ. most commonly affected is ___ and often spares ___

Answer 21

kidneys, lungs

Question 22

diagnosis of polyarteritis nodosa

Answer 22

get biopsy of medium sized arteries- containing polymorphonuclear cells

Question 23

polyarteritis nodosa a/w which disorders

Answer 23

hep b and c infection, hairy cell leukemia

Question 24

patient with polyarteritis nodosa has negative ANCA test. what does this mean?

Answer 24

moreso confirms diagnosis. if it was positive, would look at other vasculitis disorders

Question 25

untreated polyarteritids nodosa causes poor prognosis. TREAT. what do you choose-

Answer 25

glucocorticoids

Question 26

chronic vasculitis of large and medium sized vessels, more commonly cranial branches of aa originating from the aortic arch

Answer 26

giant cell arteritis

Question 27

polymyalgia rheumatica a/w increased risk for

Answer 27

giant cell arteritis

Question 28

polymyalgia rheumatica tx and for how long? prognosis?

Answer 28

glucocorticoids at lesat 1-2 years. prognosis is good. self limited but relapses common. worry about giant cell arteritis risk

Question 29

what co-existing condition occurs in almost half of the patients with giant cell arteritis?

Answer 29

polymyalgia rheumatica

Question 30

erythematous, violaceious papules, macules, eruptions - think

Answer 30

DERMATOMYOSITIS

Question 31

describe skin manifestations in drematomyositis

Answer 31

GGHHPP- gottron’s papules (symmetric MCP and IP joints), gottron’s sign (elbow, knee, ankle), heliotrope eruptions, holster sign (lateral thighs), periungal changes, psoriasiform changes in scalp

Question 32

disorder a/w proximal skeletal muscle WEAKNESS and muscle inflammation. NO pain or stiffness.lab and dx? tx?

Answer 32

lab- elevated muscle enzymes, muscle or skin biopsy useful. polymyositis and dermatomyositis. glucocorticoids, skin care

Question 33

polymyositis and dermatomyositis has increased risk of…

Answer 33

malignancy. treat and monitor