Exam Flashcards
(153 cards)
1
Q
PMR: Polymyalgia Rheumatica affects
A
older adults
2
Q
Behçet’s affects which ethnicity
A
Turks/Koreans
3
Q
What is lab value is pos in 95% of ankylosing spondylosis
A
HLA-B27 (also pos in 70% Reiter’s)
4
Q
Gout v Pseudogout
A
Gout: affects younger, 1st MTP
Pseudogout: older popu, Ca salt
differentiate from septic joint
5
Q
Monoarthritis Pattern
A
Gout Pseudogout Septic Joint Osteoarthritis Lyme Injury/Internal Derangement/Overuse Others
6
Q
Symmetrical Polyarthritis
A
Rheumatoid Arthritis Osteoarthritis SLE Juvenile Idiopathic Arthritis Undifferentiated Connective Tissue Disease Others
7
Q
Asymmetrical Pauciarticular
A
Psoriatic Reactive Arthritis (formerly Reiter’s): post-infection Microcrystalline Juvenile Idiopathic Arthritis Lyme disease Others
8
Q
Inflammatory Back Pain
A
Improvement with exercise Pain at night (with improvement upon arising) Insidious onset Age of onset less than 40 years No improvement with rest
9
Q
Functional Classification
A
I : Completely able to carry out all usual duties of daily living
II: Able to perform usual self care and vocational activities, but limited in avocational activities
III: Able to perform usual self care activities, but limited in vocational and avocational activities
IV: Limited in ability to perform usual self care, vocational, and avocational activities
10
Q
Periungual Telangiectasias is seen in
A
connective tissue disorders: SLE, scleroderma, myositis
11
Q
Nail Pitting with onycholysis
A
Psoriatic nails
12
Q
Palpable purpura
A
vasculitis
13
Q
Pyoderma Gangrenosum
A
Found in inflammatory bowel diseases, Rheumatoid Arthritis, SLE
ulcerated lesion but no organisms
no LE edema so not vessel insufficiency
14
Q
tophi
A
chunks of uric acid crystals in other parts of the body
in gout
15
Q
xerostomia
A
dry mouth
eg Sjögren’s Syndrome
16
Q
Sjogren’s syndrome
A
dry eyes, dry mouth
17
Q
Behçet’s Syndrome
A
recurrent oral and vagina ulcerations
18
Q
Raynaud’s phenomenon
A
Cold induced vasospasms, dead white yellow coloring (BLANCHING)
19
Q
Scleroderma and CREST can have what effect in GI
A
Esophageal dysfunction
20
Q
Polymyositis presents as
A
muscular weakness
21
Q
medial epicondylitis
A
golfer’s elbow
22
Q
lateral epicondylitis
A
tennis elbow
23
Q
Why don’t you tap between medial epicondyle and olecranon process
A
ulnar nerve
24
Q
FABER maneuver
A
Flexion, Abduction, External Rotation (This is a important exam for hip disease - whole hip will come off table)
25
Rheumatoid Factor
Antibodies directed against the Fc portion of IgG
In many bacterial, viral, and inflammatory dz
not specific for RA* (neg does exclude RA)
can be in normal individuals
26
Rheumatoid Factor is pos in
80% rheumatoid arthritis
| nephelometry and ELISA detects IgM, IgG, and IgA Rheumatoid Factors
27
+RF in RA correlates with
more severe articular disease
| more extra-articular disease (especially in men)
28
When do you order rheumatoid factor
in patients who present with an inflammatory polyarthritis
29
Anti-citrullinated peptide antibody(CCP Antibody)
citrulline naturally produced in body from arginine metabolism
in RA joints, conversion more quickly, causes body to CCP AB production by body
detect w/ELISA
Rarely present in Hep C, unlike RF
30
Risk factor for RA
smoking
31
CCP v RF
CCP just as sensitive but more specific
| but don't Tx asymp just bc CCP pos
32
Antinuclear Antibody (ANA)
```
indirect immunofluorescence more sensitive than solid phase assay (cheaper)
29 diff staining patterns
pos suggest AB AB to nucleosomes
in RA, SLE, drug-induced Lupus
many false pos in gen popu
but neg suggest not SLE***
can't monitor dz progression
```
33
Positive in 99% of patients with SLE
ANA
34
What is Anti-SSA(Ro)/SSB(La) Antibody assoc w/
Sjögren's Syndrome (70%)
35
p-ANCA is found in
vasculitis
| especially microscopic polyangiitis and allergic angiitis and granulomatosis (Churg-Strauss Syndrome)
36
c-ANCA is found in
Wegener’s (highly specific; granulomatosis with polyangiitis) and RPGN
37
Anti-neutrophil Cytoplasmic Antibody (ANCA) is found in
vasculitis
38
ESR is very useful in*
diagnosis and monitoring of Polymyalgia Rheumatica and Giant Cell Arteritis
39
Synovial Fluid: Group I
Pale yellow, transparent, high viscosity
WBC is less than 2,000 cells/mm3 usually: low
Negative culture, no crystals
Non-inflammatory conditions such as Osteoarthritis, trauma
40
Synovial Fluid: Group II
Deeper yellow color, translucent
WBC 2,000 - 75,000+ cells/mm3
Cultures negative, crystals found in some
Inflammatory conditions such as Rheumatoid Arthritis, Psoriasis, connective tissue dz
41
Synovial Fluid: Group III
Septic (Bacterial)
Purulent, opaque fluid
WBC often over 50,000 cells/mm3 (but can be as low as 2,000) with predominance of PMNs (> 90%)
Gram stains and cultures are positive
42
Synovial Fluid: Group IV
Blood start to come out immediately as you pull needle back!!*
Hemorrhagic
Bloody appearance
Due to trauma, neuropathic joints, bleeding disorders, tumors, sickle cell disease, Charcot joint in DM
43
Subluxation in RA
Subluxation of C1-C2 can press on spinal cord (numbness, tingling)
normal distance between C1-2: 3mm
need stabilization by neurosurgery
44
Pencil in cup erosion
psoriatic arthritis, usu asymm
45
Psoriatic spondylitis v Ankylosing spondylitis
Psoriatic: Large asymmetrical bulky syndesmophytes (bony growth originating inside a ligament) as opposed to the thin, symmetrical syndesmophytes found in Ankylosing Spondylitis
46
Squaring of the vertebral corners with “shiny, ivory corners”
ankylosing spondylitis
| ivory borders from inflammation
47
punched out erosions with overhanging edges of cortex
gout from tophi
48
calcium pyrophosphate dihydrate crystal deposition disease (CPPD)
Ca deposit around joints
calcified meniscus
chondrocalcinosis
49
RA – Diagnosis: ACR Criteria
RA 6 or more points
50
MCP involvement in RA
More severe dz
51
Vaughan Jackson Deformity
dorsal synovitis at wrist in RA
| can have Tear of the extensor tendons of the 4th and 5th fingers due to erosive disease at the distal ulna
52
Felty’s Syndrome***
Triad: Splenomegaly, RA, Neutropenia
| with associated infections (recurrent bc low WBC) and leg ulcerations
53
Rheumatoid nodules are on
extensor surfaces, pressure points
20-35% of RA
ALWAYS RF pos!
unilateral, hard
54
What organ is rarely involved in RA
Kidney, think of other causes
55
When does the 50% max damage from RA occur?
first 5 yrs
| irreversible loss of cartilage
56
CDAI
Quantitative Clinical Measurements of outcome in RA
57
Toxicities of Corticosteroids
```
Hyperglycemia: Be VERY CAREFUL in DM pts
Osteopenia/Osteoporosis
Cataracts
Osteonecrosis
Skin ecchymosis
Increase incidence of infections
Increased cardiovascular disease
```
58
DMARDs: Disease Modifying Anti-Rheumatic Drugs - slow acting agents
Slow acting agents includes Methotrexate, Hydroxychloroquine (Plaquenil®), Sulfasalazine (Azulfidine®), Azathioprine (Imuran®) and Leflunomide (Arava®)
59
DMARDs: Disease Modifying Anti-Rheumatic Drugs - biological agents
TNF Inhibitors: Etanercept (Enbrel®), Infliximab (Remicade®), Adalimumab (Humira®), Certolizumab (Cimzia®), and Golimumab (Simponi®)
IL-1 Inhibitors: Anakinra (Kineret®)
Co-stimulation Modulator: Abatacept (Orencia®)
B-cell depletion: Rituximab (Rituxan®)
IL-6 Inhibitor: Tocilizumab (Actemra®) Sarilumab (Kevzara ®) JAK inhibitor: Tofacitinib (Xeljanz®)Baricitinib (Olumiant ®) Upadacitinib (Rinvoq®)
60
Methotrexate in RA
antimetabolite which inhibits dihydrofolate reductase interfering with purine synthesis: Stuns T cells
SQ route has less GI upset and better bioavailability
Takes 1-2 months to benefit
60-75% response rate
May produce liver fibrosis and cirrhosis
Use supplemental Folic acid 1 mg daily-prevents stomatitis, alopecia, marrow suppression
61
ocular SE of Hydroxychloroquine
Retinal pigmentation “bulls-eye” around the macula
| rare
62
What should you monitor w/Sulfasalazine (Azulfidine®)
CBC: leukopenia, neutropenia
63
ACR in RA
Quantifies improvement before and after drug Tx
20, 50, or 70% improvement
based on assessments by pt, physician, ESR/CRP
64
Sharp Score in RA
Utilizes XRays:
| erosion score, joint space narrowing
65
Leflunomide (Arava®)
Pyrimidine synthesis inhibitor
| effective in RA in combo w/MTX
66
Sulfasalazine (Azulfidine®)
salicylate and antibacterial agent
| effective in combination with methotrexate and hydroxychloroquine for RA
67
Examples of cytokines, role in RA
Tumor Necrosis Factor (TNF) and Interleukin-6 (IL-6)
| TNF and IL-6 trigger inflammation and subsequent damage to the joints in patients with Rheumatoid Arthritis
68
anti-TNF agents, used in RA
```
Etanercept (Enbrel®): effective
Infliximab (Remicade®): use w/MTX
Adalimumab (Humira®): use w/MTX
Certolizumab (Cimzia®): use w/MTX
Golimumab (Simponi®): use w/MTX
```
69
Nomenclature of biologics
●"-cept" refers to fusion of a receptor to the Fc part of human immunoglobulin G1 (IgG1)
●"-mab" indicates a monoclonal antibody (mAb)
●"-ximab" indicates a chimeric mAb
●"-zumab" indicates a humanized mAb
●"-umab" indicates a fully human mAb
70
Biological DMARDs: Safety Considerations*
```
Serious Infections
Opportunistic Infections (TB, Fungal)
Lymphoma
Demyelinating Diseases: contraindicated in MS
CHF
Skin Cancers
Drug induced autoimmunity: Lupus, psoriasis, vascu
Local Reactions
```
71
Who does not get gout?*
pre-menopausal women
| Bc Estrogen gets rid of uric acid through kidneys (uricosuria)
72
Dx gout best by
ASPIRATE THE JOINT AND LOOK FOR CRYSTALS-NEEDLE SHAPED, STRONGLY NEGATIVE BIREFRINGENT
(Don’t rely on the serum uric acid level
Don’t rely on the joint involved
Don’t be fooled by leukocytosis, fever, skin erythema, synovial fluid WBC, normal or abnormal x-ray)
73
Acute Gouty Arthritis: Treatment (2nd stage gout)
NSAIDs: Indomethacin, Sulindac, Naproxen, etc
Steroids
Colchicine (expensive now)
IL-1 blockers if above are contraindicated, but never used
74
Second Acute Attack of Gout Tx
Treat acutely
institute Urate Lowering Therapy (ULT):
Begin prophylaxis w/NSAID or low dose prednisone or colchicine 0.6 mg BID
1wk after starting prophylaxis, gradually add in a ULT (eg allopurinol, febuxostat, probenecid)
titrate up until you get serum uric acid of 6 mg/dl or less
will have to treat it forever but can stop prophylaxis (yrs ot get rid of load)
75
Goal of --> Gout: Chronic Pharmacological Treatment with ULT
GOAL is to reach a serum uric acid ≤ 6.0 mg/dl (even below 5.0 mg/dl in patients with tophi)
76
Allopurinol Adverse Effects
Rash
Leukopenia/thrombocytopenia
Diarrhea
Allopurinol Hypersensitivity Syndrome: Severe cutaneous reaction (Toxic epidermal necrolysis and Stevens-Johnson Syndrome with fever, hepatitis, eosinophilia, acute renal failure
77
Allopurinol Hypersensitivity Syndrome
severe cutaneous reaction (Toxic epidermal necrolysis and Stevens-Johnson Syndrome with fever, hepatitis, eosinophilia, acute renal failure
78
Dx of SLE
at least 4 criteria including at least one clinical criterion and one immunologic criterion
presence of 4 or more criteria has a sensitivity of 97% and specificity of 84%
79
Limited Scleroderma: CREST*
```
Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
Anticentromere antibodies*
MAKE DZ OFF SKIN EXAM***
```
80
RA Triple therapy
MTX
Sulfasalazine
Hydroxychloroquine
81
OA diseases are characterized by
joint pain, tenderness, limitation of motion, crepitus, occasional stiffness, and variable degrees of inflammation without systemic effects
82
Most common of all joint diseases
OA
| relationship to obesity
83
Most frequent cause of physical impairment
OA
| relationship to obesity
84
If you see OA, eval whether
Primary or Secondary*
85
If you see MCP involvement in suspected OA, *
think secondary cause, bc normally spare MCP
86
OA in DIP
Heberden's node*
87
OA in PIP
Bouchard's node*
88
“Crain’s or Kellgren’s Syndrome”
“Erosive OA” involving the DIPs (so called sea gull deformity)
89
Large vessel vasculitis (LVV)
```
Takayasu arteritis (TAK)
Giant cell arteritis (GCA)
```
90
Medium vessel vasculitis (MVV)
```
Polyarteritis nodosa (PAN)
Kawasaki disease (KD)
```
91
Small vessel vasculitis (SVV)
Microscopic polyangiitis (MPA)
Granulomatosis with polyangiitis (Wegener’s) (GPA)
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)(EGPA)
92
Variable vessel vasculitis (VVV)
Behcet’s disease (BD)
| Cogan’s syndrome (CS)
93
Giant Cell Arteritis***
aka temporal arteritis
Granulomatous vasculitis of medium to large arteries
Often involves temporal artery and ophthalmic arteries
Can also involve the arteries that originate from the aortic arch
*New Headache: from ischemia
older popu
need biopsy
marked elevated ESR
94
Giant Cell Arteritis - Treatment
High Dose Steroids (Prednisone 60 mg daily)
Slowly taper based on Sx and ESR, Many need Tx for a year or more
low dose ASA
95
Appearance of vasculitis v atherosclerosis
long tapering appearance
96
Polymyalgia Rheumatica (PMR) Tx
Excellent response to moderate dosage of prednisone* (15mg daily) --> confirms DX!!!***
May taper over months to years following symptoms and ESR
97
Dx Wegener's granulomatosis
c-ANCA (anti proteinase 3, PR3) is a sensitive and specific marker
Found in 90% with the classic triad of upper respiratory, pulmonary, and renal disease
Few False positive tests
*needed biopsy for Dx
98
Who should be tested for osteoporosis?
All women over the age of 65
All individuals who are taking long term corticosteroids
All individuals over the age of 50 that suffer an “osteoporotic fracture”
Postmenopausal women with major risk factors
Men with hypogonadal conditions
Men over the age of 70
Patients with diseases associated with bone loss and fracture
99
Who should be treated for osteoporosis?
Adults who have an osteoporotic fracture of the hip: FRACTURE BEGOTS FRACTURE; MORE LIKEY TO HAVE ANOTHER ONE IN THE FUTURE
Osteopenia associated vertebral, proximal humerus, pelvis, and wrist fractures
Adults with T-scores ≤ -2.5
Using a FRAX calculator, 10 year absolute risk for osteoporotic fracture of 20% or hip fracture of 3%
100
Osteoporosis Tx
```
Ca 500-600 mg of supplement daily (too high risk of excess CV/mortality)
exercise
bisphosphonates (PO, IV)
SERMs (Raloxifene - Evista®)
PTH derivatives
```
101
Primary OA DOES NOT affect which joint*
elbow
102
Fibromyalgia
common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive disturbance, psychiatric symptoms, and multiple somatic symptoms
no evidence of tissue inflammation***
usu younger popu, female
103
Theory of fibromyalgia pathology
central sensitization: dz of pain regulation
Neuroendocrine Abnormalities --> Abnormal HPA axis (dec serotonin, inc substance P) --> Abnormal regional Cerebral Blood Flow --> Generalized Pain, Altered Pain Threshold
104
Stages of Lyme Dz: Early Localized Dz
erythema migrans 90% - axilla, inguinal region, behind the knees, and belt line, can be "bull's eye"
malaise, myalgias, headache, lymphadenopathy
10% multiple if spirochetemia
105
Stages of Lyme Dz: Early Disseminated Disease
Carditis: 8% of patients, Heart block or mild myopericarditis
Neurologic: Lymphocytic meningitis, Cranial nerve palsies (esp. 7th nerve – bilateral), Radiculoneuritis (pain and numbness)
106
Bannwarth's Syndrome
Neurologic Triad in Early Disseminated Lyme Dz:
| Lymphocytic meningitis, Cranial nerve palsies (esp. 7th nerve – bilateral), Radiculoneuritis
107
Stages of Lyme Dz: Late Dz (chronic)
months to yrs after infection
Musculoskeletal: Arthralgias, Intermittent episodes of arthritis, Chronic monoarthritis (often in knee)
Tertiary Neuroborreliosis: Encephalopathy, Neurocognitive dysfunction, Peripheral neuropathy (uncommon)
Acrodermatitis chronica atrophicans in Europe; rare
108
Dx Lyme
H&P
| Serological tests to confirm, alone not Dx - ELISA, western blot
109
When do IgM and IgG appear in Lyme
IgM: up to 6 wks, decline after 4-6mon
IgG: 6-8wks, peak 4-6mon, may remain even w/Tx, should be pos late dz
110
Lyme Tx
Doxycycline 100 mg BID for 10-21 days (or sub amoxicillin, cefuroxime)
Early disseminated disease with meningitis or third degree heart block: Ceftriaxone 2 grams IV daily for 14-28 days (Cefotaxime, Pen G)
111
Common Features of Spondyloarthropathies*
Assoc w/HLA-B27*
| Enthesitis*
112
Inflammatory back pain
```
Improvement with exercise
Pain at night (with improvement upon arising)
Insidious onset
Age of onset less than 40 years
No improvement with rest
```
113
Dx Ankylosing Spondylitis
Low back pain with inflammatory characteristics (improves with activity, not relieved by rest)
Limitation of lumbar spine motion in sagittal and frontal planes
Decreased chest expansion
Bilateral sacroiliitis grade 2 or higher
Unilateral sacroiliitis grade 3 or higher
XRay
114
What extra-articular manifestation can occur in ankylosing spondylosis
uveitis
115
psoriatic spondylitis v ankylosing spondylitis
Large asymmetrical bulky syndesmophytes as opposed to the thin, symmetrical syndesmophytes found in AS
116
Joint emergencies
```
septic joint**
compartment syndrome**
acute myelopathy
osteomyelitis
avascular necrosis
cancer, mets
```
117
Most organism that causes septic arthritis*
S. aureus
118
Monoarticular DiffDx
```
DJD
Crystalline Arthropathies
Hemarthrosis
Avascular Necrosis
Osteomyelitis
Tendonitis/Synovitis/Epicondylitis
Septic Arthritis
Trauma
Tumor
```
119
Polyarticular DiffDx
```
Polyarthritis
Viral arthritis
Post-infectious or reactive arthritis
Fibromyalgia
Multiple sites of bursitis or tendinitis
Soft tissue abnormalities
Hypothyroidism
Neuropathic pain
Metabolic bone disease
Depression
```
120
With any joint pain, need to ask about*
FEVER!
121
tests to order for synovial fluid
cell count
aerobic and anaerobic cultures
gram stain
crystal analysis
122
Which population does not get gout*
pre-menopausal women: estrogen gets rid of uric acid through kidneys
123
How long before an acute attack of gout
Often requires 15-20 years of sustained hyperuricemia before an acute attack
At puberty, serum urate concentrations increase by 1-2 mg/dl
dont need to Tx asymp hyperuricemia unless very high
124
When should you NOT start ULT (allopurinol) in gout?
during acute attack
125
Whipple’s Disease
Middle aged men with diarrhea, weight loss, and steatorrhea
small bowel biopsy: PAS positive staining of intestinal lipodystrophy
Pleuritis, hyperpigmentation, hypotension, lymphadenopathy, and progressive pseudodementia
Seronegative oligoarthritis
Cause: Gram positive actinomycete
Tx: antibiotics penicillin and tetracycline for prolonged periods (one year)
126
Syndesmophyte
calcification that bridges 2 vertebrae
127
DISH: Diffuse Idiopathic Skeletal Hyperostosis
Flowing calcification of at least 4 contiguous vertebral levels
Relative preservation of intervertebral disk
Absence of sacroiliac joint erosions or sclerosis
Commonly involves the anterior longitudinal ligament of the spine (mid thoracic is most common, but other areas can be involved)
More common in DMII
128
DDx for palpable purpura
leukocytoclastic vasculitis*
polyarteritis nodosa
microscopic polyangitis
IgA Vasculitis (IgAV)Henoch-Schönlein purpura
Drug induced (Antibiotics, Diuretics, NSAIDs, Anticonvulsant)
Infections: Streptococcal, Viral, Hepatitis B, Hepatitis C
Connective Tissue Diseases (SLE, RA, Sjogrens)
Idiopathic: most of the time
129
A single inflamed joint should always undergo*
aspiration for evaluation
| unless overlying cellulitis
130
Chronic Tophaceous Gout
chronic polyarticular phase
Tophaceous deposits can accumulate in time (takes long time of Tx to get rid of accumulation)
Often in an irregular, asymmetric distribution
Erosions with overhanging edges on x-ray
131
Gouty Arthritis on Xray*
Large, punched out erosions with overhanging edges
132
Calcium Pyrophosphate Deposition Disease (CPPD)
Characteristic intra-articular calcified deposits in synovium, articular cartilage, or menisci*
Can be asymptomatic or presents with a variety of clinical syndromes (eg pseudogout)
aspirate: rod shaped, weakly positive birefringence* crystal
133
Endocrine disorders that can cause CPPD
```
Hyperparathyroidism
Hypothyroidism
Hemochromatosis
Hypomagnesemia
Hypophosphatasia
Bartter’s Syndrome
Familial Hypocalciuric Hypercalcemia
```
134
CPPD: Clinical Features
```
Asymptomatic chondrocalcinosis
Acute arthritis: “Pseudogout”
Pseudo-Osteoarthritis
Pseudo-Rheumatoid Arthritis
Pseudo-Neuropathic arthropathy
```
135
CPPD Crystals
Rhomboid shaped, smaller than WBCs, Weakly positive birefringence
hard to see under microscope
136
CPPD: Radiographic findings
Found in knee menisci and articular cartilage, triangular ligament of the wrist, and fibrocartilage of symphysis pubis
Linear calcification in menisci or diffuse punctate densities in ligaments and joint capsules
Degenerative changes in the joint
137
Pathogenesis of SLE
Pathogenesis of SLE
Autoantibodies
Formation of Immune Complexes: Tissue deposition, C’ activation, Inflammatory cells
tissue injury
138
Jaccoud’s arthropathy
Non erosive, non-damaging arthritis from SLE
| see deformities but still functions well and no erosion on film
139
Scleroderma
deposition of fibrous connective tissue in the skin and other tissues accompanied by vascular lesions, especially in the skin, lungs, and kidneys
140
>90% of scleroderma has*
antecedent Raynaud's phenomenon
141
Leading cause of mortality in scleroderma*
Pulmonary manifestation
Interstitial lung disease; 80%
Occurs in SSc and CREST
Pulmonary hypertension; 50%
142
Scleroderma renal crisis
Rapidly progressive Malignant Hypertension (240/130)
Proteinuria, renal insufficiency, microangiopathic hemolysis
Exaggerated renin response
ACE inhibitors very useful
Pt could die very quickly, 27days life span, without ACE
143
Inflammatory Myositis: Classifications
```
Polymyositis
Dermatomyositis
Juvenile Myositis
Myositis associated with malignancy
Myositis associated with rheumatic diseases
Inclusion body myositis
Immune mediated Necrotizing Myopathy
```
144
Inflammatory Myositis: Clinical Features
```
Muscle weakness (Loss of power as opposed to pain)
Skin Rash
Muscle enzymes (CK and aldolase)
EMG (Myopathic picture)
Muscle biopsy (Inflammatory cells)
Myositis specific autoantibodies:
Anti-Jo-1 (and other anti-synthetase ab)
Anti –SRP (signal recognition particle)
Anti – HMGCR ab (statin induced myopathy)
```
145
Dermatomyositis
Heliotrope Rash
Gottren’s papules: Erythematous raised papules ON KNUCKLES
Shawl Sign
Holster sign
146
Consider vasculitic syndromes when*
2 or more organ systems involved
147
Vasculitis is commonly associated with*
constitutional symptoms: Fever, weight loss, fatigue
anemia
elevated ESR
148
"osteoporotic fracture"
falling from no greater than height
149
Ideal serum levels of Ca
30ng/dL
150
bisphosphonates risks
Osteonecrosis of the Jaw
Subtrochanteric fracture of femur
Duration of therapy: consider drug holiday after a few yrs
151
Septic Arthritis Tx
Gram Stain: Gram Positive cocci - Vancomycin
Gram Stain: Gram Negative bacilli - Third generation cephalosporin (ceftazidime, ceftriaxone, cefotaxime)
Joint drainage surgically
152
Sarcoidosis
Chronic, multisystem, clinically heterogeneous, inflammatory, granulomatous disorder
Lungs, lymph nodes, liver, skin & eyes commonly affected
rheumatologic manifestations (up to 40% of patients)
153
Lofgren’s Syndrome
Acute polyarthritis
Symmetric bilateral hilar lymphadenopathy
Erythema nodosum
Relatively common
Form of sarcoidosis with good prognosis
Often self-limited
Lofgrens’ Syndrome has a ~90% remission rate
Tx: NSAIDs
