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Internal Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Define fibromyalgia

A

Chronic widespread muscular pain, tenderness, and fatigue for at least 3 months involving all 4 quadrants of the body

  • pain above & below the waist
  • pain on the left and right sides of body
  • Pain in at least 11/18 discrete tender points

MC in middle-aged women

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2
Q

What makes fibromyalgia symptoms worse/flare?

A

Physical and psychological stress

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3
Q

How do you treat fibromyalgia?

A

Tricyclic antidepressants –> Cymbalta

Lyrica only med FDA approved to treat fibromyalgia

Neurontin

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4
Q

Purine rich foods to warn patients with gout to avoid

A
  • alcohol
  • red meats
  • liver
  • seafood
  • sugary foods & sodas
  • yeasts
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5
Q

What is gout? What is tophi?

A

Gout is an accumulation of uric acid in the tissue of joints & bones –> 80% monoarthropathy

Tophi is a collection of solid uric acid in soft tissue

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6
Q

What medications can cause gout?

A 
Diuretics- thiazide & loop
ACE-i
Ethambutol
ASA
ARBs
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7
Q

What is pseudogout?

A

Calcium Pyrophosphate Dihydrae (CCPD) crystals in connective tissues

Knee most common

**associated with hyperparathyroidism

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8
Q

What is a diagnostic uric acid level for gout?

A

> 7.5

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9
Q

Acute gout management

A
  • NSAIDs –> Indomethacin

- Colchicine = 2nd line

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10
Q

Chronic gout management

A

Tophi and/or >2 gout flares per year

Allopurinol + NSAIDs or Colchicine for 6 months to prevent acute flares

Goal is uric acid <6

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11
Q

Pseudogout treatment

A

Corticosteroids = 1st line

Colchicine = prophylaxis

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12
Q

Polyarteritis Nodosa signs & symptoms

A

Inflammation of small & medium sized arteries ==> restricts blood flow ==> organ damage

  • renal HTN
  • myalgias & arthralgias
  • peripheral neuropathy
  • livedo reticularis / gangrene/ Raynaud’s

The inflammation weakens blood vessels which leads to the formation of aneurysms

MC in middle-aged men 40-60 years old

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13
Q

Polyarteritis nodosa diagnosis

A
  1. Tissue biopsy showing necrotizing arteries
  2. Angiography = aneurysms
  3. ↑ ESR

** ANA negative**

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14
Q

Polyarteritis nodosa treatment

A

Prednisone +/- cyclophosphamide

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15
Q

What other conditions is polyarteritis nodosa associated with?

A
  • *Hepatitis B**

- Microaneurysms

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16
Q

Polymyalgia rheumatica definition

A

An idiopathic inflammatory condition affecting the JOINTS –> PAINFUL synovitis, bursitis, and tenosynovitis

S/S

  • proximal stiff joints in pts >50 years old
    - shoulders
    - hips
    - neck
  • fatigue
  • weakness
  • “can’t lift arms over head to brush hair”
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17
Q

Physical Exam findings in Polymyalgia rheumatica

A
  • Normal strength

- Limited passive ROM in all directions

18
Q

What other condition is polymyalgia rheumatica closely related to?

A

Giant Cell Arteritis aka Temporal Arteritis

19
Q

How do you treat polymyalgia rheumatica?

A

-LOW dose corticosteroids

may be required for up to 2 years

20
Q

Define polymyositis

A

Chronic idiopathic inflammatory disease of MUSCLE

  • symmetrical
  • proximal
  • PAINLESS
  • *muscle weakness**
21
Q

Physical Exam findings in Polymyositis?

A

-Decreased strength

22
Q

Polymyositis diagnosis

A
    • creatine phosphokinase –> indicating muscle injury
  • elevated ESR
    • ANA
    • anti-Jo-1

Confirmed by muscle biopsy

23
Q

How do you treat polymyositis?

A

High dose corticosteroids

24
Q

Define Reactive Arthritis

A

Autoimmune response to an infection

Common Triggers

  • Salmonella
  • Shigella
  • Chlamydia trachomatis
  • Neisseria gonorrhea
25
Q

Reactive Arthritis symptoms

A
  • *Triad**
  • inflammatory arthritis of large joints
  • inflammation of eyes = conjunctivitis, uveitis
  • urethritis

“Cant see, pee, or climb a tree”

26
Q

Reactive Arthritis labs

A

++ HLA-B27

CBC: ↑ WBC, ↑ ESR, ↑ IgG

27
Q

Treatment of Reactive Arthritis

A
  • NSAIDs

- ABX to treat infection

28
Q

Define Rheumatoid Arthritis

A

A chronic autoimmune inflammatory disease with persistent, symmetric polyarthritis

       - bone erosion
       - cartilage destruction
       - joint structure loss
29
Q

Signs & Symptoms of rheumatoid arthritis

A 
Joint stiffness worse in the morning, >30 minutes…improves throughout the day
•	Worse with rest
•	Prodrome 
               -Fevers
               -Fatigue
               -Weight loss
               -anorexia
•	Small symmetric joint stiffness 
                -MCP
                -PIP
                -WRIST
                -Knee
30
Q

Rheumatoid Arthritis Diagnosis

A

Morning stiffness + arthritis in >3 joints for > 6 weeks

+ RF (80%)

+anti-CCP (60%– more specific)

Xrays –> narrowed joint space

- ulnar deviation 
- swan neck deformity (DIP)
- boutonniere deformity (PIP)
31
Q

Rheumatoid Arthritis Treatment

A
  1. Methotrexate

+/- hydroxychloroquine
+/- sulfasalazine

  1. NSAIDs & low dose corticosteroids for pain control
32
Q

Sjogren Syndrome definition

A

Chronic systemic autoimmune inflammatory disorder that affects the exocrine glands

Relatively common – 2nd MC autoimmune disease

Unknown cause

33
Q

Sjogren Syndrome symptoms

A 
-Parotid gland = dry mouth --> loss of teeth & cavities
==> difficulty swallowing & talking 
-enlarged
-nontender
-firm

-Lacrimal gland = dry eyes

Extra glandular symptoms

  • arthralgias
  • Raynaud’s
  • Lymphadenopathy
  • Vasculitis
  • peripheral neuropathy
34
Q

What is Shirmer’s test & what condition is it used to diagnose??

A

-Tear test –> positive if <5mm lacrimation in 5 minutes

Sjogrens Syndrome

35
Q

How is Sjogren Syndrome diagnosed

A

+ANA
+anti-SSA (anti-Rho)
+anti-SSB (anti-La)
+RF

Salivary gland biopsy

36
Q

Treatment of Sjogren Syndrome

A
  • Artificial tears
  • Pilocarpine = cholinergic
  • Cevimeline = cholinergic
37
Q

What is scleroderma?

A

Systemic connective tissue disorder causing…

  • tight shiny thick skin due to collagen build up
  • systemic involvement –> heart, lungs, kidney, GI
38
Q

What is CREST syndrome?

A

another name/form of scleroderma
C= calcinosis cutis => calcium salt crystals in the skin
R= Raynaud’s
E= esophageal motility disorder & GERD
S= Sclerodactyly => claw hand
T= Telangiectasias => dilated capillaries

39
Q

How is Scleroderma diagnosed?

A

+ anti-centromere Ab = limited CREST disease, better prognosis

+ Anti-SCL-70 Ab = diffuse disease with multiple organ involvement

+ANA

40
Q

How do we treat scleroderma?

A
  • DMARDs ==> methotrexate
  • Steroids
  • Raynauds = calcium channel blockers to vasodilate
  • GERD = PPI or H2 blocker

Internal Medicine (3 decks)

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