Vasculitides and diseases of connective tissue Flashcards
What are the main s/s of SLE (clinical presentation)?
Rash over sun-exposed areas
Joint symptoms in 90% of pts
Anemia, leukopenia, thrombocytopenia
What are some complications of SLE that require hospitalization?
Glomerulonephritis
Pleuritis
Pericarditis
Seizures or psychosis
What are the treatments of SLE?
- Hydroxychloroquine
- NSAIDs
- Corticosteroids
- Rituximab
For nephritis: mycophenolate, cyclophosphamide, azathioprine
For arthritis: methotrexate, belimumab
purple book 8-16
What is this?
A type of interstitial lung disease of unknown etiology characterized in about 90% of patients by granulomatous inflammation of the lung, with onset in the 20s-30s.
sarcoidosis
CURRENT
What is the treatment for sarcoidosis, and when is it indicated?
Oral prednisone
Indications:
- Disabling constitutional symptoms
- Hypercalcemia
- Iritis, uveitis
- Arthritis
- CNS involvement
- Cardiac involvement
- Granulomatous hepatitis
- Cutaneous lesions
- Progressive pulmonary lesions
CURRENT, UpToDate
What is the clinical presentation of rheumatoid arthritis?
Insidious onset pain, swelling of joints >1hr morning stiffness
Joint deformities: ulnar deviation, swan neck, boutonnière, cock-up (toes)
C1-C2 instability
Constitutional: low-grade fever, weight loss, malaise
Extra-articular manifestations: rheumatoid nodules, interstitial lung disease, pericarditis, vasculitis, scleritis, anemia of chronic disease, glomerulonephritis
purple book 8-3
What are the treatments for rheumatoid arthritis?
DMARDs - methotrexate, etanercept, adalimumab, infliximab, rituximab
Hydroxychloroquine
What are some complications of rheumatoid arthritis?
- Damage to the lung tissue (rheumatoid lung)
- Increased risk of hardening of the arteries
- Spinal injury when the neck bones become damaged
- Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
- Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead to congestive heart failure
MedlinePlus
What are the clinical manifestations of septic arthritis?
- Acute onset monoarticular arthritis with pain, swelling, warmth
- Knee most common location
- Constitutional symptoms: fever, sweats, malaise, myalgia
purple book 8-9
How is septic arthritis treated?
- Surgical drainage
- Prompt empiric abx guided by Gram stain after surgical drainage
- If gram pos, e.g. S. aureus: vancomycin
- If gram neg, e.g. N. gonorrhea: ceftriaxone or cefotaxime
- E. coli, Pseudomonas: cefepime or pip-tazo
purple book 8-9
What are the clinical manifestations of gout?
- Sudden onset, frequently nocturnal, of painful monoarticular arthritis, especially of MTP of great toe
- Chronic tophaceous gout: solid monosodium urate crystal deposition in tissue and joints
- Renal: uric acid stones, urate nephropathy (interstitial deposits)
purple book 8-5
What are the treatments for gout?
(acute, chronic, dietary)
- Acute: NSAIDs, colchicine, prednisone
- Chronic: allopurinol, febuxostat, pegloticase, probenecid
- Decrease intake of meat, EtOH, seafood; increase low-fat dairy products
purple book 8-5
What is pseudogout and how is it treated??
- Acute calcium pyrophosphate dihydrate deposition-induced mono- or oligoarticular arthritis, indistinguishable from gout except via synovial fluid exam for crystals
- Treat like gout
purple book 8-6
What are the clinical manifestations of polymyalgia rheumatica?
- Aching and morning stiffness in the shoulders, hip girdle, neck, and torso in patients over the age of 50
- Symptoms are usually symmetric
- Pain – Shoulder pain is more common at presentation (70 to 95 percent of patients) than hip and neck involvement (50 to 70 percent), and may dominate the presenting symptomatology
- Synovitis and bursitis
UpToDate
How is polymyalgia rheumatica treated?
prednisone
UpToDate
