autoimmune Flashcards
(77 cards)
1
Q
autoimmune disease
A
pathologic condition caused by an adaptive autoimmune response
2
Q
rheumatic disease
A
up to 25% of patients with rheumatic disease with systemic symptoms cannot be definitively diagnosed
3
Q
arthralgia
A
joint pain
symptom of injury, infection, illness (arthritis) or allergic rxn to medication
4
Q
sensitivity
A
proportion of patients with a disease who have had a + test result
5
Q
specificity
A
proportion of patients without the disease who have had a - test result
6
Q
high positive predictive value
A
patient with a + result most likely has the disease
7
Q
high negative predictive value
A
patient with a - result most likely doesn’t have the disease
8
Q
+ rheumatologic test
A
predictive value of a + rheum test in patients with poly-arthralgia is likely to be higher in a rheum practice than in a family physician’s office
9
Q
evaluative tests
A
monitor disease over time
10
Q
ESR and CRP
A
non specific inflammatory markers
11
Q
RF
A
rheumatoid factor
12
Q
ANA
A
antinuclear antibody
13
Q
ACPA
A
anti-citrullinated peptide antibodies ; also known as anti-CCP
14
Q
anti dsDNA
A
antibody to native double strand DNA
15
Q
anti-Sm
A
anti-Smith antibody
16
Q
ANCA
A
antineutrophil cystoplasmic antibody
17
Q
aPLs
A
antiphospholipid antibodies
18
Q
lyme serologies
A
ELISA and western block
19
Q
SLE
A
anti ds DNA
anti Smith Ag
20
Q
Drug induced SLE
A
Anti-Histone
21
Q
CREST syndrome
A
Anticentromere
22
Q
Mixed connective disease
A
Anticentromere
23
Q
Scleroderma
A
Anti SCL 70
24
Q
Dermatomyositis
A
Anti Jo1
25
Sjorgen's syndrome
```
Anti Ro (anti-SS-A)
anti La (anti-SS-B)
```
26
Wegener's granulomatosis
ANCA
27
<2000 WBC joint fluid analysis
non-inflammatory
| OA, viral infection
28
> 2000 - 10,000 WBC joint fluid analysis
inflammatory
| gout, pseudogout
29
> 100,000 WBC joint fluid analysis
septic
| even less than 100,000 with fever, consider septic unless proven otherwise
30
red fluid WBC joint fluid analysis
hemorrhagic
| trauma, tumor, coagulopathy
31
PMN
polymorphonuclear leukocytes
32
> 75% PMN
inflammatory
33
analysis of synovial fluid should include
- % PMNs
- crystal anaylsis
- gram staining and culture
- arthrocentesis - mandatory if infection is suspected
- warfarin is not contraindication
34
acute arthritis
acute - less than 6 weeks
arthritis - inflammation localized to the articular structures,
swelling, warmth, discomfort, redness
distinct from arthralgia, peri-arthritis, tendinitis, bursitis
35
MSK emergencies
infection
-septic arthritis, septic emboli, osteomyelitis
fracture
operable full/partial tendon/ligament tears
compartment syndrome
entrapment neuropathy/mononeuritis multiplex
myelopathy/myelitis
primary or secondary bone tumors
vascular - DVT or arterial insufficiency
36
goals for initial evaluation of joint complaints
```
articular vs nonarticular
inflamm vs noninflamm
triage MS emergencies
assess systemic rheum disease
obtain appropriate necessary testing
short term & long term plan
when to refer
```
37
acute monoarthritis
if there is bacterial infection -> it may cause rapid joint destruction and eventual sepsis
38
septic arthritis
hematogenous seeding of synovium can be extension from site trauma or osteomyelitis
knee and hip especially susceptible
also abnormal synovial joints previously damaged by trauma, inflammation or degenerative process are also more susceptible
39
acute monoarthritis
| differential diagnosis
infection
- bacteria
- --gonoccocal vs non-gonococcal
- viruses
- fungi/spirochetes/mycobacteria
- --coccidiodomycosis, lyme, spirotrichosis, blastomycosis
crystal induced arthropathies
- gout, pseudogout (CPPD)
- gout is risk factor for septic arthritis
trauma
hemarthrosis
osteonecrosis
40
early monoarticular presentations of polyarticular diseases
```
RA
Reiter's syndrome
ankylosing spondylitis
psoriatic arthritis
sarcoidosis
arthritis of IBD
```
41
infection
common cause of acute pain and swelling in a single joint
42
myelodysplastic and leukemic disorders
also can cause arthralgias and arthritis
43
gonococcal monoarthritis
| infectious inflamm monoarthritis
```
incidence decreasing
sexually active young adults
female > male
polyarthralgia can precede but monoarthritis in 50%
fever
tenosynovitis, especially in wrist 68%
minimal joint effusion
skin lesions 75%
anogenital infection often asymptomatic
```
+blood culture
sterile joint fluid
44
septic joint stage
monoarticular vs polyarticular symptoms with marked joint swelling and effusion
can recover organism from joints in 50% of patients
45
bacterial septic arthritis
NON GONOCOCCAL
infectious inflamm monoarthritis
gram + 80% of time
S. Aureus predominates
gram - 20%
E. coli, proteus, klebsiella, Enterobacter
very young, elderly, injection drug use, immunocompromised
anerobes uncommon, diabetes risk factor
prodrome of malaise and fever
mild fever
large joint predilection
requires aggressive management
-serial aspiration, parenteral antibiotics, splinting and PT
46
Monoarthritis - lyme
| infectious inflamm monoarthritis
features dependent on phase of disease
early disseminated lyme
-poly arthralgia, ELISA may be negative very early
```
late lyme
weeks to months after infection
ELISA +
mono,oligo, poly arthritis
tends to be asymmetric
large effusion in a single knee in most
```
47
infectious inflamm monoarthritis
| OTHER infectious organisms
mycobacterial infection
HIV patients are at risk
HIV infection: at onset of HIV syndrome, look for acute monoarticular or oligoarticular arthritis
48
noninfectious inflammatory monoarthritis
```
acute gout
pseudo gout
immunologic disease::::
-RA
-Reiter's
-ankylosing spondylitis
-psoriatic arthritis
-arthritis associated with IBD
```
49
noninflamm monoarthritis
acute trauma: meniscus, fracture extending into joint space, trauma resulting in hemoarthrosis
osteoarthritis: degeneration of hyaline articular cartilage with adjacent bony sclerosis proliferation (may be painful and inflamed)
50
monoarthritis history
review for septic cause
review for acute trauma
ask about prior attacks - thinking of gout
review alcohol use - thinking gout, trauma, infection
ask about back pain/stiffness - spondyloarthropathies
in younger patients - Reiter's , ankylosing spondyltis, GC
co-morbidities - IBD, psoriasis, hypothyroidism, h/o gout
meds
SH - work / travel
FH - connective tissue disease, psoriasis, IBD, gout
51
rapid onset vs slow/insidious
rapid: trauma, septic, crystalline
slow: systemic rheum or non-inflamm process like osteoarthritis
52
AM vs PM
AM: prolonged in systemic rheum disease
PM: sprain/strain/non-inflamm process
53
worse with activity or rest
activity: tendinitis/bursitis/non-inflamm
rest: systemic rheum diseases
54
rapid from no symptoms to maximal intensity
trauma
septic
crystalline
55
confined to joints vs inter-articular
localized to joints: arthritis/arthralgia
| inter-articular: diffuse pain syndromes
56
mono vs oligo vs polyarticular
poly articular less likely to be septic arthritis
| monoarticular can still be early presentation of a systematic rheum disease
57
0-10 pain scale /touch me not
often septic or crystalline
58
stiffness > pain
systemic rheum diseases
59
vague, deep ache
hyperparathyroidism
osteomalacia
bone lesions: night pain
60
burning/numbness/tingling
neurogenic
61
claudication
vascular vs spinal stenosis
62
constitutional / prodromal symptoms
infection or systemic rheum diseases, occasionally crystalline
63
prior similar episodes
less likely infectious
| intercritical return to complete normality: crystalline arthritis
64
special indicators of systemic rheum diseases
cutaneous manifestations:
psoriasis, photosensitivity, skin thickening, purpura etc
```
swollen glands
Raynaud's
oral/nasal ulcers
pleurisy/pericarditis
eye inflammation
nail changes
dry eyes/mouth
proximal muscle weakness
sinusitis
hearing loss
```
65
physical exam re: articular
inspection
range of motion
palpation:
-warmth, erythema, swelling, effusion, tenderness, deformity, crepitus, stability
66
tendinitis/bursitis
symmetry: uncommon
inflammation: over tendon/bursa
tenderness: focal
instability: uncommon
locking: unusual - expect with tears
multi-system disease: no
67
non-inflammatory
symmetry: occasional
inflammation: unusual
tenderness: unusual
instability: occasional
locking: possible
multi-system disease: no
68
systemic rheumatic disease
symmetry: common
inflammation: common
tenderness: over entire joint space
instability: uncommon
locking: uncommon
multi-system disease: often
69
fever
+ septic arthritis
| +/- low grade -> gout /RA
70
necrotic lesions
GC
71
splinter hemorrhages
endocarditis
| HIV/IVDA - needle tracks
72
pitting of nails
psoriasis
73
erythema nodosum
sarcoidosis;
| IBD
74
keratoderma blenorhagicum/
| cirinate balanitis
Reiter's syndrome
75
spine: restriction of motion; tenderness
spondylitis
76
labs for monoarthritis
no standard - mostly H&P
CBC, blood cultures, coag studies, X-rays
elevated uric acid does not exclude septic arthritis
CT or MRI if you suspect osteomyelitis or soft tissue abscesses
77
evaluation of polyarthritis
are symptoms ARTICULAR or NON-ARTICULAR (periarticular - occuring around the joint)
INFLAMM OR DEGENerative
(red, warm, swollen, or boggy)
local or systemic
