Systemic Inflammation Rheumatic Disorders Flashcards
Cigarette smoking is the best documented environmental risk factor for what systemic inflammation rheumatic disorder?
Rheumatoid Arthritis
What is the peak onset for Rheumatoid Arthritis?
35 and 75 years old
Rhematoid Arthritis continues to result in SUBSTANTIAL morbidity for most patients primarily related to what?
increased cardiovascular burden
Rheumatoid arthritis typically spares what?
Spares the thoracolumbar spine and DIP joints
What is the pathogenesis of rheumatoid arthritis?
Synovial hyperplasia
Chronic inflammation
Pathological immune response
What are the key features in rheumatoid arthritis?
Symptoms >6 weeks duration
Palpable synovial swelling – tender, boggy feeling
Fatigue is profound
Symmetrical and polyarticular (>3 joints)
Stiffness – will be stiff for a long period of time in the morning, will take awhile to get going
What is the most characteristic feature of rheumatoid arthritis?
joint destruction
What is the most frequent extra-articular manifestation of rheumatoid arthritis?
nodules
Felty’s Syndrome triad consists of what?
leukopenia
Splenomegaly
Erosive deforming RA
What is an extremely rare manifestation of RA
renal involvement
What lab finding is very specific for RA?
anti-CCP (Anti-cyclic citrullinated peptide)
Chronic connective tissue disorder characterized by immune-mediated destruction of exocrine glands
Sjogren’s Syndrome
What condition is a well recognized extra-articular manifestation of Rheumatoid Arthritis
Sjogren’s Syndrome
Which condition is associated with 33-44x increased risk for lymphoma?
Sjogren’s Syndrome
What are two tests used in Sjogren’s Syndrome?
Schirmer-I test or Rose Bengal Score
Joint inflammation <17 years old
Juvenile Arthritis
What antibodies are associated with Sjorgen syndrome?
Type A (anti-RO-SS-A) in 60%
Type B (Anti-LA-SS-B) in 30%
What is the most common rheumatic disease?
Juvenile Arthritis
What are the three main types of JRA (based on onset)?
Systemic onset
Pauciarticular
Polyarticular
What is the key factor in systemic onset juvenile arthritis?
fever (Quotidian)
Describe a Quotidian fever
> 39 degrees
Intermittent
Daily or twice daily fever
What sign/symptom are you likely to see in Pauciarticular type juvenile arthritis?
Uveitis
Which type is most likely to end up with adult rheumatoid arthritis?
Polyarticular juvenile arthritis
In Psoriatic Arthritis, which manifestation typically comes first?
Psoriasis precedes arthritis - 67%
Which disease process presents as destructive, erosive polyarthritis affecting the hands and feet
Psoriatic Arthritis
You may see “telescoping of digits” or “pencil in a cup” lesion in what disease process?
Psoriatic Arthritis
What disease process is described below?
Primarily affects boys 8 years and older
Affects large joints of lower extremities
Heel pain and achilles tendinitis
Sacroilitis – 90% of cases
Enthesitis Related Arthritis
Which disease process is described below:
Autoimmune multisystem disease
More common in females 9:1
Peak age 15-25
Major late cause of a death is cardiovascular disease
Systemic Lupus Erythematosus
What are the four different types of Systemic Lupus Erythematosus?
Discoid
Subacute cutaneous
Drug induced
Systemic
What is a major late cause of death in SLE?
cardiovascular disease
Name some features of SLE
Jaccoud’s arthropathy
Malar rash
Hair is thin and fragile
Nephritis
Raynaud’s phenomenon
Photosensitive skin eruptions
Serositis
Pneumonitis
Myocarditis
Miscarriages
Which type of SLE is limited to the skin?
Discoid
Which type of SLE will you see a prominent, widespread
non-scarring skin lesions with marked photosensitivity, gets worse with sun exposure, and CNS and renal involvement rare
Subacute cutaneous
Which type of SLE will you get a lupus-like reaction after taking a drug/medication?
Drug Induced
What is a common medication you will see that causes drug induced SLE?
Procainamide
Malar rash and Interarticular dermatitis are likely to indicate which disease?
Systemic Lupus
Which two lab findings are specific for SLE?
Anti-ds DNA
Anti-Sm
What is a common lab finding in SLE but is not specific?
ANA
A history of thrombosis in a patient thought to be otherwise at low
risk of such an event often prompts the search for what disease?
Antiphospholipid Syndrome
Name three common presentations for Antiphospholipid Syndrome?
A history of thrombosis in a patient thought to be otherwise at low
risk
Recurrent spontaneous abortions
Refractory thrombocytopenia
What is Catastrophic APL syndrome?
Refers to the fulminant organ failure from widespread thromboses
