Flashcards in Exam 1 -- Rheumatology #6 Deck (98):
What are overall causes for vasculitis conditions?
Infection (hepatitis B and C; HIV), autoimmune diseases, medications (diabetic meds, diuretics, gout meds, antibiotics), smoking
What are some common symptoms of vasculitis conditions?
Peripheral neuropathy, fever, fatigue, malaise, palpable purpura, pulmonary and renal involvement
Which vasculitis conditions are considered to be large vessel conditions?
Giant cell arteritis, polymyalgia rheumatica, Takayasu arteritis
Which vasculitis conditions are considered to be medium vessel conditions?
Polyarteritis nodosa, Kawasaki disease
Which vasculitis conditions are considered to be small vessel conditions?
Granulomatosis with polyangitis, microscopic polyangitis, eosinophilic granulomatosis with polyangitis
Giant cell arteritis often occurs with what other large vessel vasculitis?
What is the average age of onset for giant cell arteritis?
72 (onset is rare below age 50)*
Which gender has a higher prevalence for giant cell arteritis?
True or false: African Americans are affected more with giant cell arteritis than are Caucasians
False; Caucasians are more often affected
Giant cell arteritis increases risk of what type of aneurysm?
Prevalence of giant cell arteritis is higher in patients with what other conditions?
RA, lupus, other vasculitis conditions
What is another name for giant cell arteritis?
Temporal arteritis; also anterior arteritic ischemic optic neuropathy (AAION )
True or false: the ophthalmic artery and the posterior ciliary arteries can be affected in giant cell arteritis
What are the most common symptoms of giant cell arteritis?
Severe HA*, scalp tenderness*, jaw claudication*, tenderness/swelling of temporal artery*, sudden, transient painless vision loss in one eye*
What percentage of patients with giant cell arteritis experience severe HA?
True or false: less common symptoms of giant cell arteritis include peripheral muscle weakness and respiratory difficulty
What percentage of patients with giant cell arteritis experience blurred vision (20/200 or worse)?
What ocular symptoms can occur in giant cell arteritis?
Blurred vision, monocular transient vision loss*, APD, swollen or pale optic nerve*, diplopia, CRAO, visual field loss
What tests can be performed for giant cell arteritis?
ESR (>50mm/hr) and CRP*, temporal artery biopsy (gold standard)*, pulse
How would you treat giant cell arteritis?
40-60mg oral prednisone (IV methylprednisolone if very severe), low dose aspirin as an anti-platelet, can add concurrent methotrexate or cyclophosphamide if patient isn't responding to steroids or doesn't tolerate high-dose steroids)
If you are suspicious of giant cell arteritis in a patient who has recently experienced monocular transient vision loss, would you consider it an emergency?
Yes; there is risk of an aortic aneurysm, as well as vision loss in the other eye within a few hours or days
True or false: the tapering of corticoteroids in treating giant cell arteritis can take years
True or false: almost all patients with giant cell arteritis have complete vision recovery eventually
False; many have permanent partial or complete vision loss
What percentage of giant cell arteritis patients eventually have some improved vision?
Patients with giant cell arteritis have a higher risk of what conditions?
Stroke and coronary artery disease
Polymyalgia rheumatica is characterized by sudden stiffness and severe pain in what parts of the body?
Neck, shoulders, and hips
True or false: polymyalgia rheumatica is common under age 50
Flase; it is rare under age 50*
Which gender has a higher prevalence for polymyalgia rheumatica?
Is the pain from polymyalgia rheumatica worse in the morning or later in the day?
The pain from polymyalgia rheumatica is generally ____________ (bilateral/unilateral).
Apart from pain, what are some symptoms of polymyalgia rheumatica?
Fatigue, weight loss, malaise, night sweats, bursitis, pitting edema
What testing can be done for polymyalgia rheumatica?
ESR and CRP
A patient has already been diagnosed with polymyalgia rheumatica and you are suspicious for giant cell arteritis. What percentage of patients like this have a temporal artery biopsy that shows giant cells?
How would you treat polymyalgia rheumatica?
10-15mg prednisone in the morning
Takayasu arteritis is rare, except in which country?
Takayasu arteritis is also known as?
Pulseless disease, or aortic arch syndrome
Which gender has a higher prevalence for Takayasu arteritis?
What is the age of onset for Takayasu arteritis?
What are the main non-ocular symptoms that can occur in Takayasu arteritis?
Absent peripheral pulse (unilateral; could lead to gangrene or ulcerations)*, asymmetric BP*, peripheral claudication*, chest pain, renal dysfunction, arthralgia, myalgia, syncope, dementia
What ocular symptoms can occur in Takayasu arteritis?
VF loss, HA, retinal hemorrhages, decreased vision
What sort of testing can you do for Takayasu arteritis?
Bruit, angiography, imaging
How would you treat Takayasu arteritis?
45-60 mg oral prednisone, methotrexate, azathioprine, TNF agents, cyclophosphamide, bypass grafts, low dose aspirin
What is the 5-year survival rate for patients with Takayasu arteritis?
Which gender has the higher prevalence of polyarteritis nodosa?
True or false: polyarteritis nodosa affects middle-aged men most commonly
One-third of patients with polyarteritis nodosa also have what viral infection?
True or false: although polyarteritis nodosa mainly affects arteries, it can affect veins too
False; it only affects arteries. If veins are involved, the condition is not PAN
Most of the systemic organs are involved in polyarteritis nodosa. Which major organ is not invovled?
A patient is tested for ANCA. If the patient only has polyarteritis nodosa, are they likely to test ANCA (+) or ANCA (-)?
Whatis the 5-year survival rate for untreated patients with polyarteritis nodosa?
Whatis the 5-year survival rate for treated patients with polyarteritis nodosa?
What are the main symptoms of polyarteritis nodosa?
Fever, malaise, weight loss*, kidney failure*, livedo reticularis*, abdominal pain, MI and heart failure, gangrene, neuropathy, purpura, ulcers, liver failure, large joint arthritis
What tests can be performed for polyarteritis nodosa?
Skin biopsy, ESR, angiography
How would you treat polyarteritis nodosa?
Prednisone and/or immunosuppressants, antivirals if patient has hepatitis
True or false: Kawasaki disease is the most common vasculitis in children
What is another name for Kawasaki disease?
Mucocutaneous lymph node syndrome
What age group is most commonly affected by Kawasaki disease?
Under 5 years
Kawasaki disease is common in what parts of the world?
Japan and East Asia
Which gender has a higher prevalence for Kawasaki disease?
Acute inflammation in Kawasaki disease lasts for how long?
What are the main symptoms of Kawasaki disease?
Fever for more than 5 days*, conjunctival injection*, dry red lips and tongue*, redness and edema of the palms and soles*, lymphadenopathy*, rash/skin peeling, arthritis
What are complications that can arise from Kawasaki disease?
Cardiac aneurysms, heart failure
What tests can be done for Kawasaki disease?
None, apart from an echocardiogram
How would you treat Kawasaki disease?
Single, high-dose IV Ig, aspirin daily 200-300 mg
What is another name for granulomatosis with polyangitis?
In granulomatosis with polyangitis, lesions occur in what parts of the body?
Lungs/respiratory tract, kidneys, skin (purpura, subcutaneous nodules)
What percentage of patients with granulomatosis with polyangitis test ANCA (+)?
True or false: granulomatosis with polyangitis generally occurs in younger patients
False; it generally occurs in older patients
Which gender has a higher prevalence for granulomatosis with polyangitis?
Neither; prevalence is equal between the genders
True or false: granulomatosis with polyangitis is more common in Caucasians
What are the main symptoms of granulomatosis with polyangitis?
Rhinorrhea, sinusitis, hearing loss*, oral ulcers*, hemoptysis*, saddle-nose*, kidney disease*, painful breathing/cough, hematuria, joint pain
What sort of ocular findings might a patient with granulomatosis with polyangitis have?
Proptosis, uveitis, scleritis, episcleritis
What sort of testing can be performed for granulomatosis with polyangitis?
ANCA*, chest x-ray and/or CT-scan (pulmonary nodules, infiltrates, nodules), renal biopsy, urinalysis (increased protein, abnormal creatinine)
What percentage of patients with granulomatosis with polyangitis are ANCA (+)?
How would you treat a mild case of granulomatosis with polyangitis?
How would you treat a moderate to severe case of granulomatosis with polyangitis?
Prednisone with cyclophosphamide and rituximab
Which medications can be used for maintenance of granulomatosis with polyangitis?
Methotrexate or azathioprine
80% of patients with granulomatosis with polyangitis die within how many years, if untreated?
What percentage of patients with microscopic polyangitis are ANCA (+)?
Microscopic polyangitis is associated with what specific form of ANCA?
How is microscopic polyangitis differentiated from granulomatosis with polyangitis?
Microscopic polyangitis has no inflammatory granulomas in the lung
What percentage of patients with microscopic polyangitis have glomerulonephritis?
How would you treat a mild case of microscopic polyangitis?
How would you treat a moderate to severe case of microscopic polyangitis?
Prednisone with cyclophosphamide and rituximab
Which medications can be used for maintenance of microscopic polyangitis?
Methotrexate or azathioprine
What is another name for eosinophilic granulomatosis with polyangitis?
Which gender has a higher prevalence for EGPA?
What is the typical age of onset for EGPA?
EGPA involves what parts of the body?
Skin, lungs, kidneys, heart
What are the main symptoms of EGPA?
Rhinitis, asthma*, peripheral neuropathy*, skin lesions, GI bleeding
What testing can be done for EGPA?
Eosinophilia*, ANCA, lung or skin biopsy with granulomas
How would you treat EGPA?
Prenisone, can add cyclophosphamide; methotrexate or azathioprine for maintenance
What is the main characteristic of fibromyalgia?
Diffuse musculoskeletal pain
What is the age and gender of a typical patient with fibromyalgia?
True or false: patients with fibromyalgia have a higher than normal pain tolerance
False; their pain tolerance is less than normal
What are the symptoms of fibromyalgia?
Fatigue, morning stiffness, aching, disturbed sleep, anxiety, depression, cognitive dysfunction (slow responses, difficulty concentrating, memory loss)
How would you treat fibromyalgia?
Anti-depressants, anti-anxiety meds, anticonvulsants