Systemic Rheumatic Diseases

Question 1

What does scleroderma cause?

Answer 1

Accumulation of collagen and matrix in a variety of tissues

Question 2

In scleroderma, the collagen and matrix buildup causes?

Answer 2

Vascular symptoms
Systemic symptoms
Skin
Carpal tunnel
Raynauds
ILD
Renal impairment
GI

Question 3

Vascular disease from scleroderma

Answer 3

Vascular:
- Widespread vascular lesions and endotheilial dysfunction
- thickening of vascular wall
- narrowing of vascular lumen

Question 4

Systemic symptoms of scleroderma

Answer 4

Systemic:
- fever
- malaise
- weight loss
- myalgias

Question 5

Skin lesions of scleroderma present where?

Answer 5

Skin
- lesions on the fingers, hands, face

Question 6

GI symptoms of scleroderma

Answer 6

GI
- dysmotility
- GERD (aspiration pneumonitis)
- chronic esophagitis
- stricture formation
- vascular ectasia in the stomach (watermelon stomach)

Question 7

Complications of scleroderma presentations

Answer 7

Sclerodermal renal crisis
Respiratory failure
ARDS
Aspiration pneumonitis
Pulmonary HTN
Alveolar hemorrhage
Heart failure
Arrhythmias
Conduction disturbances
Ischemia and gangrene of digits

Question 8

With all scleroderma flares you need to avoid?

Answer 8

Steroids - may precipitate renal crisis

Question 9

What is scleroderma renal crisis?

Answer 9

Emergency
- renal failure
- HTN
- MAHA (microangiopathic hemolytic anemia)

Question 10

Treatment for scleroderma renal crisis?

Answer 10

Emergently treat with ACEI
- captopril 6.25-12.5mg TID
- enalaprilat (if not po tolerant)
- 2nd line CCB

Dialysis is required in 50%, more than 1/2 will recover renal function

Question 11

What is the association between RA and septic arthritis?

Answer 11

Septic arthritis may mimic flares of RA.
- joint aspiration will help differentiate

Question 12

Why are arthritic joints at a higher risk for septic arthritis?

Answer 12

• Joint destructive disease (RA) are at a higher risk for septic arthritis
• amplified by immunosuppressive meds

Question 13

Prevalance of septic arthritis risk in pts with rheumatoid arthritis .

Answer 13

Prevalance of septic arthritis is 2x in patients with RA who are on
- glucocorticoids
- TNFa (tumor necrosis factor a blockers)

Question 14

Why is it harder to diagnose septic arthritis in pts with rheumatoid disease?

Answer 14

Physical findings like severe pain and limited ROM may be absent in cases of septic arthritis in these pts

Question 15

Concern for septic arthritis in a patient with gout?

Answer 15

Presence of gout doesn’t exclude the possibility of concurrent septic arthritis

Question 16

Which rheumatic disease is most associated with atherosclerosis risk?

Answer 16

RA should be considered an independent risk factor for coronary atherosclerosis
- even in the absence of traditional risk factors
- risk is equal to that of DM2

Question 17

Consider ACS in patients with?

Answer 17

Systemic rheumatologic disease
Especially SLE and RA

Question 18

Rheumatoid diseases with an elevated ACS/AMI risk

Answer 18

Antiphospholipid antibody syndrome
Behcet’s disease
Churg-strauss syndrome
Polyarteritis nodosa
RA
SLE
Takaysu’s arteritis

Question 19

How do you manage ACS in rheumatologic disease patients?

Answer 19

Manage the same as traditional ACS