Week 2 Flashcards
Which joint is commonly affected in OA, but rarely in RA?
The Carpal Metacarpal {CMC} of the thumb.
What are Heberden’s Nodes and Bouchard’s Nodes?
Both are bony swellings. Heberden’s are on the DIP, Bouchard’s on the PIP; associated with osteoarthritis.
Viscosupplementation involves?
Hyaluronic Acid Injections into the joint. Moderately effective and primarily used in the knees or when surgery is not an option.
How is Osteoarthritis treated? What is the only thing which truly improves OA?
Tylenol PRN -> Tylenol ATC -> NSAIDs -> Opioids; Weight Loss.
Peroneus means?
Fibular; I know it’s stupid. Just live with it.
What, in general terms, is Vasculitis?
An auto-immune based inflammation of the blood vessel which causes infiltration and necrosis {especially of the muscular portion} of the vascular wall. It may be Granulomatous {Cell Mediated} or Immune Complex Related {Humoral Mediated}.
Temporal Arteritis is associated with what other condition? What four findings are characteristic of TA?
Polymyalgia Rheumatica {PMR}.
- Swollen Temporal Artery
- Scalp Tenderness
- Jaw Claudication
- Visual Complaints {BLIND}
What do you use to treat things like TA, Vasculitis, PMR…?
Prednisone!!! Depending on the dose and patient Bisphosphonates and Vitamin D may need to be given to protect your bones.
Whats the big gun to use for bad Lupus?
Cyclophosphamide
What is Scleroderma? What is Morphea? What is Limited Scleroderma?
An uncommon connective tissue disease which involves a thickening of the skin; a hardened patch of skin, NO internal organ involvement; CREST syndrome, equally severe - specific features.
What is CREST Syndrome?
Limited Scleroderma: Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, Telangiectasia.
What often presents with Scleroderma?
Raynaud’s Phenomenon
Dermatomyositis presents with?
Pruritis, Heliotrope Eruptions, and Gottron’s Papules.
What are each of the 3 COX involved with?
COX-1: GI
COX-2: Inflammation
COX-3: Fever and Analgesia
Two fun facts about ASA, how do you know you are taking to much, and what drug do you need to be extra careful with?
You get Tinnitus with really high doses, displaces many drugs off of Albumin – Notably Warfarin.
What NSAID is used to close PDA in premature infants and cannot be used in pregnant women?
Indomethacin
Methotrexate is an antimetabolite of?
Folic Acid
How does Polymyalgia Rheumatica present?
People > 50 with bilateral shoulder and/or pelvic pain. Usually affects proximal muscles and joints. PROLONGED morning stiffness and asymmetrical arthritis of the wrists, hands, ankles, and feet as well as systemic features {fever, weight loss, malaise} are also common. ESR and CRP are often elevated in Polymyalgia Rheumatica.
Name some large vessel vasculitis.
Temporal and Takayasu’s
AKA Giant Cell Arteritis
Name some medium vessel vasculitis.
Polyarteritis Nodosa, Kawasaki’s, and ANCA Associated {Wegner’s granulomatosis, Microscopic polyangiitis, and Churgg Strauss}
Name some small vessel vasculitis.
Henoch Schonlein, Cryoglobulinemic, and Anti GBM disease,
Vasculitis is a{n}?
Autoimmune based inflammation and necrosis of blood vessels.
Cell mediated is granulomatous and Humoral mediated is via immune complex deposition.
What form of vasculitis presents with swelling vessels and may cause blindness?
Temporal Arteritis
How should vasculitis be treated?
How dose steroids, immunosupression, or biologics.
Churg-Strauss is a?
Eosinophilic Granulomatosis with Polyangiitis presenting with asthma, allergic sinusitis, nasal polyps, and eosinophilia.
Henoch Schonlein Purpura presents as?
Mainly purpura and malaise; may involve the kidney or bowel. Tissue contains IgA and it may occur post viral or drug reaction.
What biologic can be used to treat vasculitis?
What immunosuppressive medications are commonly used for vasculitis?
Rituximab {B cell depleting}
Methotrexate and Cyclophosphamide {the BIG GUN}.
How long should vasculitis be treated for?
6 - 12 months after patients enter remission.
What tests are used to diagnose SLE?
It is a clinical diagnosis. Anti-nuclear Ab +ve in 99% of SLE and 5% of normal population.
Anti-dsDNA and anti-Smith are more specific to SLE. adsDNA changes with disease activity while asm usually remains constant.
Should also be lab evidence of end organ disease.
How is SLE treated?
- Anti-Malarial Medication
- Topical and Systemic Corticosteroids
- Immunosuppressive and Cytotoxic Agents
- Supportive care {ACEi, CCB, Sunscreen}
Mortality in Lupus patients is caused by?
Infection in the first few years followed by cardiovascular disease > 2 years.
What is the pathophysiology of lupus?
It is an antibody mediated disease {anti-nuclear or tissue specific} which damage organs either directly or through immune complexes.
Who typically gets lupus?
Female between 15 - 45. F:M 8:1.
What autoantibodies are present in Systemic Sclerosis?
Antinuclear, Anti-Tropoisomerase I, and Anti-Centromere.
What is the treatment for scleroderma renal crisis?
Rapid lowering of blood pressure. Gold Standard is with ACEi. Renal failure will occur within days if not treated.
Where does the rash of dermatomyositis present?
The hands over small joints, on the face, and the shawl area.
Which muscles are spared in DM and PM?
Which muscles are first affected?
Facial and ocular.
Proximal skeletal muscle weakness without pain presents early.
What is elevated in DM and PM?
Creatine Kinase and Aldolase.
How are PM and DM treated?
- Moderate to high dose corticosteroids.
- Immunosuppression with agents like methotrexate may be needed.
- IVIG
What symptoms are related to Fibromyalgia?
Chronic, widespread musculoskeletal pain all over the place with multiple tender points.
Often associated with sleep disturbance {waking unrefreshed}, chronic fatigue, headaches, irritable bowel, cognitive disturbances, and other forms of chronic discomfort.
What is used to treat Fibromyalgia?
- Pregabalin {Lyrica}
- Duloxetine {Cymbalta}
What are the 4 main Spondylo-Arthropathies?
- Ankylosing Spondylitis
- Reactive Arthritis
- Psoriatic Arthritis
- Arthritis of Inflammatory Bowel Disease
What gene is associated with many Spondylo-Arthropathies?
What else are these associated with?
What are they NOT associated with?
- HLA B27
- Previous Infection, inflammatory disease.
- None are associated with Rheumatoid factor of anti-CCP.
What is Enthesitis?
Inflammation of the Entheses, the site at which tendons and ligaments attach to bones.
How does Ankylosing Spondylitis present?
Severe AM stiffness in the lower back, immobility and eventual fusion of the spine, large joint {asymmetrical} enthesopathy.
How is Ankylosing Spondylitis treated?
Aggressive NSAIDs {indomethacin} and exercise. TNF inhibitors are remarkably effective.
How does Reactive Arthritis Present?
Multi-system response to infection which presents with urethritis {chlamydia} or dysentery {salmonella, shigella, campylobacter, or yersinia} followed by an arthritis, conjunctivitis, painless oral ulcers, and typical skin lesions.
Which joints does Reactive Arthritis generally affect?
SI Joints and a few large peripheral joints.
Enthesitis is more/less common in children than in adults.
More
Sacroiliitis is more/less common in children than adults.
Less
Juvenile Dermatomyositis is/isn’t associated with a higher rate of cancer while Dermatomyositis is/isn’t.
Isn’t
Is
What is Gower’s Sign?
+ve sign is indicative of JDM. Starting prone the child must use their hands braced against their body to “climb” to the standing position.
Which sided curves are more concerning for scoliosis? Which gender will generally always get an MRI?
LEFt sided are less common and more concerning.
Boy get scoliosis less and are more concerning, usually get an MRI.
What do positive Galeazzi, Barlow, and Ortolani tests/signs increase the likelihood of? What are each of these tests?
Developmental Dysplasia of the Hip {DDH}
Galeazzi: Knees flexed so ankles hit the butt while child lays on back. If the knees aren’t level the test is +ve.
Barlow: Adduct the hip to see if it will dislocate.
Ortolani: Follows Barlow. Clunk when the hip relocates after hip and knee flexion/
