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MSK > Lecture 13: Rheumatologic Disorders > Flashcards

Lecture 13: Rheumatologic Disorders Flashcards

1
Q

SNOUT and SPPIN refer to testing sens and spec.

What do they stand for?

A
  • SNOUT = a highly sensitive test that comes back negative means you can confidently rule OUT the disease.
  • SPPIN = a highly specific test that comes back positive means you can confidently rule IN the disease.
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2
Q

The starting test for autoimmune disorders is a () test, which has high sens but low spec. It is positive if the titer is >= 1:160.

A

ANA: antinuclear antibody

You just need a positive and then you move onto SPECIFIC testing.

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3
Q

The only autoimmune disease that ALWAYS has ANA present is…

A

Drug induced lupus

SLE is 95%

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4
Q

Anti-Mi-2, Anti-Jo-1, and Anti-SRP correspond to what autoimmune diseases?

A

Dermato and polymyositis.

Mi and Joe were married (derm), but Jo cheated with Sarah, which is poly

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5
Q

Anti-histone corresponds to what autoimmune disease?

A

Drug induced Lupus

HIStory of meds

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6
Q

Anti-centromere corresponds to what autoimmune disease?

A

CREST syndrome

Its like the only one that starts with a C

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7
Q

Anti-SSA (Ro) and Anti-SSB (La) correspond to what autoimmune disease?

A

SLE/Sjogren’s

The two S diseases = SS

Also L for lupus and Ro for Sjogren’s (pronounciation)

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8
Q

Anti-Scl-70 corresponds to what autoimmune disease?

A

Progressive systemic sclerosis

Scl = sclerosis

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9
Q

ENA labs are a () lab with a (+) ANA

A

Reflex lab

Usually if you suspect a CT disorder

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10
Q

MCTD, mixed connective tissue disorder, encompasses 3 overlapping diseases:

A
  • SLE
  • Systemic scleroderma
  • Polymyositis
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11
Q

T/F: Besides rheumatoid arthritis, RF is useful.

A

False.

Found in cancers and autoimmune and HEALTHY

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12
Q

Besides RA, RF is found in what other disease with a similar sensitivity?

A

Sjogren’s

75-95%, technically a little higher than RA

Also increases with age

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13
Q

The most specific test for RA is…

A

Anti-CCP

Very specific for RA

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14
Q

CRP vs ESR. Which is better for acute inflammation vs chronic?

A
  • CRP = acute
  • ESR = Chronic (Extended)
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15
Q

A normal ESR can rule out what disease?

A

Temporal arteritis + polymyalgia rheumatica

Since they are a spectrum of the same dz

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16
Q

ANCA comes in two types: p and c.

Since c-ANCA is for less diseases, its easier to remember, bc it is only positive in two diseases: () and ()

A
  • GPA/Wegener’s
  • Churg-Strauss syndrome/EGPA

Eosinophilic GPA

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17
Q

Classic SLE pt is (gender) and (ethnicity)

A

Native American Female

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18
Q

SLE is a (flaring/consistent) disease precipitated primarily by ()

A

Flaring disease precipitated by stress

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19
Q

SLE has a classic triad:

  • (systemic sign)
  • () pain
  • (be specific) rash
A
  • Low grade fever
  • Joint pain
  • Malar/butterfly rash on the cheeks and nose.
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20
Q

SLE requires 4 out of 11 S/S to be diagnosed.

  1. Constitutional (sign)
  2. Cutaneous (name a few)
  3. Arthritis (how many joints minimum)
  4. Neurologic
  5. Serositis (effusion of…)
  6. Hematologic (2 penias)
  7. Renal (syndrome)
  8. Antiphospholipid
  9. Complement (low or high)
  10. Specific antibodies (2)
A
  1. Fever
  2. Alopecia/oral ulcers/discoid/acute malar rash
  3. 2+ joints for 30+ mins in the AM
  4. Neuro psychosis/delirium/seizure
  5. Either pleural or pericardial effusion or even pericarditis
  6. Leukopenia or thrombocytopenia
  7. Proteinuria
  8. APL
  9. Low complement C3/C4
  10. Anti-dsDNA or Anti-Smith

Highlighting what ive seen on anki cards pointed out

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21
Q

The two most specific antibodies for SLE are…

A
  • Anti-dsDNA
  • Anti-Smith

SSA and SSB overlap with Sjogren’s

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22
Q

A false positive syphilis test is associated with what antibody?

A

Antiphospholipid antibody

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23
Q

Overall, the system that shows the highest rate of manifestations in SLE is..

A

MSK

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24
Q

SLE is often associated with what cardiac condition and what pulmonary conditions? (2 and 2)

A
  • Pericarditis
  • Myocarditis
  • ILD
  • Pulmonary HTN
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25
Q

Lupus nephritis is proven/diagnosed via…

A

Biopsy

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26
Q

Tim’s way of remembering Lupus demographics

A
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27
Q

The 3 highest risk medications that can induce lupus are… and you should check Drug-induced lupus with what antibody???

A
  • Procainamide
  • Hydralazine
  • Penicillamine
  • Check with an anti-HIStone antibody (HIStory of med use)
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28
Q

Generally, a completely stable SLE pt requires follow up every () months, and () on a CBC is usually indicative of acute flare.

A
  • Q6months
  • Thrombocytopenia suggests acute flare

3-4 months or less for less stable.

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29
Q

A SLE patient should use sunscreen with () SPF and probably supplement with vitamin ()

A
  • > = 55 SPF
  • Vit D supplementation

Since UV exposure can trigger flares.

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30
Q

In a stable SLE patient, you can vaccinate safely with 4 vaccines:

  • (annual)
  • (older)
  • (sex)
  • (liver)
A
  • Influenza
  • Pneumococcal
  • HPV
  • HBV
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31
Q

Smoking () the efficacy of hydroxychloroquine for SLE tx.

A

Lowers

So tell em to quit smoking

32
Q

For someone who already has SLE, the two meds to avoid are…

A
  • Sulfa ABX (Bactrim)
  • Minocycline
33
Q

Your SLE patient wants to have a baby. You advise her to wait at least () months after a flare before attempting.

A

6 months

34
Q

Mild SLE with just skin, joint, and mucosal involvement is treated first-line with…

A

Hydroxychloroquine.

35
Q

Moderate SLE, with signficant manifestations but NO ORGAN threatening manifestations, is treated with…

A

Hydroxychloroquine + NSAID + daily prednisone + MTX or azathioprine

36
Q

Severe SLE, with renal/CNS involvement, is treated with…

A

Hydroxychloroquine + NSAIDs + High dose IV prednisone + Belimumab/Rituximab/Cyclosporine

Mainly switching to IV prednisone + new immunosuppressants

37
Q

The mainstay of treatment for the joint symptoms of SLE is what drug?

A

Hydroxychloroquine

38
Q

Chloroquine toxicity appears as what sign?

A

Bull’s eye retinopathy

Do annual ophtho exams after 5 years!

39
Q

On top of hydroxychloroquine for joint symptoms in SLE, you can add on (specific NSAID) next, and then ().

A
  • Naproxen (might need PPI if long-term)
  • Can use Celebrex to lower GI ulcer/CV risk.
  • Prednisone if hydroxychloroquine and NSAIDs are insufficient.
40
Q

Scleroderma is characterized by () of the skin, internal connective tissue, and organs

A

Hardening

know your greek!

41
Q

Scleroderma is MC in (males/females)

A

Females

42
Q

Scleroderma has 5 million manifestations of every organ system, but it has 4 main subtypes:

  • Limited cutaneous systemic sclerosis: Characterized by manifestations distal to () and on the face/neck. () syndrome.
  • Diffuse cutaneous systemic sclerosis: Disease progresses to include () and () manifestations.
  • Systemic sclerosis sine scleroderma: Rarest kind. Specifically does NOT have () manifestations.
  • Systemic sclerosis with overlap syndrome: overlaps with a diff rheumatologic disorder
A
  • Distal to elbows
  • CREST syndrome describes limited cutaneous systemic sclerosis
  • Diffuse includes proximal and truncal manifestations.
  • Ssstemic sclerosis SINE has no SKIN manifestations.
43
Q

The MC subtype of scleroderma is…

A

Limited cutaneous systemic sclerosis

44
Q

The two areas of the body CREST/limited scleroderma affects are…

A

Head and Hands

45
Q

Up to 90% of scleroderma patients have (organ) symptoms

A

GI

46
Q

The antibody most associated with diffuse cutaneous SSc and lung disease is…

A

Anti-DNA topoisomerase I, aka Anti-Scl-70

47
Q

The antibody most associated with CREST is…

A

Anti-centromere

C for CREST

48
Q

Anti-RNA polymerase III antibody is associated a great risk of () failure and cancer in scleroderma.

A

Diffuse disease + renal failure

49
Q

You should have baseline testing of the lungs to check for () in scleroderma. What 3 tests?

A

Checking for ILD via PFTs, Echo, and CT Chest

50
Q

The treatment for SSc is organ system based.
Raynaud’s = ()
GERD = ()
Arthritis = ()
RA = ()
Diffuse skin sclerosis/organ involvement = ()

A
  • Raynaud’s = CCB
  • GERD = PPI
  • Arthritis = NSAIDs
  • RA = see slide for stepwise
  • Diffse skin = MTX
51
Q

The top two characteristics for Sjogren’s is () of the eyes and decreased () in the mouth

A
  • Dryness of the eyes/no lacrimation
  • Decreased salivation in the mouth
52
Q

T/F: Drinking more water will help Sjogren’s

A

Eh, no

53
Q

The two antibodies for Sjogren’s are () and ().

A
  • Anti-SSA (Anti-Ro)
  • Anti-SSB (Anti-La)
54
Q

Anyone with eye symptoms in suspected Sjogren’s should get a () test, and a negative test is when greater than () mm is seen.

A

Schirmer test, which is negative if more than 10mm of the strip is wet.

Also get a surface stain test

55
Q

HLA-() is seen in 85% of Sjogren’s pts

A

HLA-DR52

Dry 52, MC age range is 50-60 and its a dry condition.

56
Q

You should be sure to rule out (autoimmune condition), (Hep ?), and Vitamin () Deficiency, which can mimic Sjogren’s.

A
  • HIV
  • HCV
  • Vitamin A deficiency
57
Q

ESR and CRP values in Sjogren’s are often…

A
  • ESR often elevated.
  • CRP is NORMAL.
58
Q

Specifically, women with Sjogrens and high titers of SSA/SSB are at high risk for associated congenital ()

A

Congenital Heart Block

59
Q

What diet/supplement is good for eye health in Sjogren’s? (since its always dry)

A

Omega-3-fatty acids

Eat ur salmon

60
Q

The pharm tx for Sjogren’s is…

A

Pilocarpine, a cholinergic

61
Q

The shared features of polymyositis and dermatomyositis are () skeletal muscle weakness and () inflammation. (PM and DM)

A
  • Proximal muscle weakness
  • Muscle inflammation
62
Q

PM usually peaks during ().
DM usually peaks during () or ()

A
  • PM = adulthood
  • DM = childhood or adulthood

PM is rarer

63
Q

PM and DM have a () onset of symmetric, progressive, (pain/painless) proximal weakness that SPARES () and () muscles.

A
  • Insidious onset
  • Painless weakness
  • Spares eye and facial muscles
64
Q

Increased risk of cancer is primarily with PM vs DM?

A

DM

65
Q

DM has skin manifestations on top of PM.

Raised, violaceous scaly eruptions on the knuckles are known as ()

A blue-purple rash over the face is known as ()

A
  • Gottron’s Papules
  • Heliotrope Eruption
66
Q

A hyperkeratotic, dirty appearing hand is seen in () and is known as () hands

A

DM, mechanic hands

67
Q

A hyperkeratotic macular rash appears on your patients upper back looking like this. You know this is a (), indicative of DM.

A

Shawl sign

68
Q

There are 3 antibodies associated with DM/PM.

1 is only DM.

1 is associated with ILF and mechanic hands

1 is associated with mainly PM, muscle and cardiac manifestations.

A
  • Anti-Mi-2: Just DM.
  • Anti-Jo-1: ILF + Mechanic hands (both PM/DM)
  • Anti-SRP: Mainly PM, muscle weakness and cardiac manifestations.
69
Q

T/F: muscle biopsy is required to diagnose the myositis conditions.

A

False.

70
Q

The two muscle enzymes you want to order in DM/PM are: () and (), which should show greater than () times the upper limit in active disease.

A
  • Aldolase and CK.
  • CK should be 10x ULN
71
Q

The mainstay TOC for PM and DM is…

A

1mg/kg of Prednisone.

72
Q

Cancer screenings, CT chest, abd, pelvis, TVUS, and mammogram should be done every () years for people with PM/DM.

A

Every 2 years.

73
Q

DM mnemonic image

A
74
Q

Lupus mnemonic image

A
75
Q

Lupus Diagnosis Mnemonic

A

MSK (17 decks)

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