Spondylarthropathies, polyarthritis rheumatica, fibromyalgia

Question 1

What antibodies are associated with spondyloarthropathies?

Answer 1

HLA B27 antibodies

Question 2

Inflammation of sites where tendons and ligaments attach to bone

Answer 2

enthesitis

Question 3

Chronic inflammatory disease of the joints of the axial skeleton. Changes seen in sacroiliac joints and hips

Answer 3

ankylosing spondylitis

Question 4

Extra-articular manifestations of ankylosing spondylitis

Answer 4

anterior uveitis, aortic valvular disease, restricted chest expansion

Question 5

How long must a patient have low back pain to be classified as ankylosing spondylitis?

Answer 5

3 months

Question 6

Describe the stiffness/back pain associated with ankylosing spondylitis?

Answer 6

awakend by pain during 2nd half of night, morning stiffness, and pain that improves with excercise

Question 7

Characteristic radiographic finding for ankylosing spondylitis

Answer 7

“bamboo spine”

Question 8

What should always be ordered for any patient suspected of having ankylosing spondylitis?

Answer 8

AP view of the pelvis

Question 9

Acute inflammatory arthritis occurring 1-3 weeks after infectious event

Answer 9

reactive arthritis

Question 10

Triad of reactive arthritis

Answer 10

arthritis, urethritis, conjunctivitis

Question 11

Most common cause of reactive arthritis

Answer 11

post-veneral onset (Reiter’s)

Question 12

Chronic inflammatory arthropathy in setting of psoriasis

Answer 12

psoriatic arthritis

Question 13

Nail changes often noted in psoriatic arthritis

Answer 13

pitting, dystrophy, onyholysis

Question 14

Characteristic inflammatory changes associated with psoriatic arthritis

Answer 14

Arthritis in DIPs, sausage digits, and no rheumatoid nodules

Question 15

Effective for inflammatory back pain, spinal stiffness, peripheral arthritis, enthesopathy. Doesn’t inhibit disease progression

Answer 15

NSAIDs

Question 16

Considered when antiinflammatory therapy is insufficient to control symptoms. Progression of inflammatory axial disease noted. Active persistent polyarthritis or uncontrolled extra-articular disease

Answer 16

DMARDs

Question 17

What needs to be supplemented for when a patient is prescribed methotrexate?

Answer 17

folate

Question 18

Characterized by aching & stiffness in the shoulder and pelvic girdles and the neck. Usually responds to low doses of steroids

Answer 18

polymyalgia rheumatica

Question 19

Age that polymyalgia rheumatica occurs

Answer 19

> 50yrs

Question 20

Describe pain pattern associated with polymyalgia rheumatica

Answer 20

aching, morning stiffness that lasts 30 minutes. Is bilateral and worse w/movement

Question 21

Exam findings of polymyalgia rheumatica that can differentiate it from other arthritides

Answer 21

little evidence of proximal joint swelling or tenderness

Question 22

Treatment for polymyalgia rheumatica

Answer 22

Corticosteroids are drugs of choice (10-20mg/day) for 1-2 yrs.

Question 23

How soon does polymyalgia rheumatica resolve after intitiation of treatment?

Answer 23

Complete or nearly complete resolution of sx is seen in a few days. absence of improvement should cause one to question diagnosis

Question 24

Chronic vasculitis of medium and large vessels. Symptoms are due to end-organ ischemia. More common at age > 50

Answer 24

Giant cell arteritis

Question 25

Most frequent symptom of giant cell arteritis

Answer 25

headache

Question 26

Complications of giant cell arteritis

Answer 26

blindness, aortic aneurysms, stroke

Question 27

Should be performed in all patients with suspected giant cell arteritis (GCA)

Answer 27

temporal artery biopsy

Question 28

Initial treatment for GCA

Answer 28

high dose 40-60mg prednisone. IV pulse methylpresnisolone 1000mg x 3days if vision loss present

Question 29

A clinical syndrome characterized by widespread muscular pain (usually chronic), fatigue and muscle tenderness

Answer 29

Fibromyalgia Syndrome (FMS)

Question 30

What is thought to be the underlying pathology of fibromyalgia (FMS)?

Answer 30

abnormal sensory processing in CNS that causes them to be extremely sensitive to pain

Question 31

Associated symptoms include: poor sleep*, HA, IBS, cognitive/memory problems, and paresthesias in fingers/toes

Answer 31

fibromyalgia (FMS)

Question 32

important in transmission and amplification of pain signals to and from brain

Answer 32

substance P

Question 33

Patients with what other rheumatologic disorders are more likely to develop FMS?

Answer 33

Rheumatoid arthritis and SLE (Lupus)

Question 34

How many positive tender points are generally needed to make the diagnosis of FMS?

Answer 34

11 of 18

Question 35

T/F fibromyalgia co-aggregates with somatoform disorder in families

Answer 35

false, it co-aggregates with major mood disorders in families

Question 36

What are the levels of inflammatory markers (ESR, CPR) in FMS?

Answer 36

normal

Question 37

What is the first-line approach for patients with moderate to severe pain due to FMS?

Answer 37

Trial with low-dose TCAs, SSRI, SNRI, or antiseizure medication