Intro to Rheum

Question 1

many rheum diseases involve what two processes?

Answer 1

autoimmunity and inflammation (also some with non immune and non inflammatory processes)

Question 2

intra-articular and inflammatory diseases (8)

Answer 2

RA
Systemic lupus erythematosus
Septic arthritis
Gout
Pseudogout
spondyloarthropathy
Polymyalgia rheumatica
psoriatic arthritis

Question 3

extra articular and inflammatory diseases (4)

Answer 3

tendinitis
bursitis
myositis
vasculitis

Question 4

non inflammatory and intraarticular disease

Answer 4

osteoarthritis

Question 5

extra-articular and noninflammatory disease

Answer 5

fibromyalgia

Question 6

RA is a __________ disease, with an ________ in baseline over time. Its pattern is ______

Answer 6

progressive; increase; wavy

Question 7

Gout is characterized by acute ______ over time; how is the pain severity over time?

Answer 7

acute attacks (periods of symptoms); pain severity decreases over time (first is the worst)

Question 8

Fibromyalgia process pattern

Answer 8

increases in pain severity until a plateau is hit (plateau is hit early on)

Question 9

osteoarthritis process pattern

Answer 9

slow incline in pain severity over time and then sharp increase

Question 10

Traumatic arthritis process pattern

Answer 10

present over time but no pain until a traumatic event triggers pain/flare

Question 11

autoimmunity: problem with what? not _____, usually ______, just

Answer 11

problem with the immune system failing to recognize self; not weak (immunosuppressed), usually strong, just misdirected

Question 12

what is the goal of drugs used to treat rheum diseases?

Answer 12

goal is to suppress cell division so that there is less release of cytokines

Question 13

adiponectin is beneficial in fighting what? its decreased in what?

Answer 13

fighting inflammation; decreased in obesity

Question 14

activation of the immune system leads to ______ ______ through _________

Answer 14

tissue damage through inflammation

Question 15

inflammation occurs when?

Answer 15

there is tissue death and inflammatory cells called (macrophages, white cells, complement, and enzymes)

Question 16

immunity usually leads to _________

Answer 16

inflammation

Question 17

can have inflammation without ______ ________ being active

Answer 17

immune system

Question 18

what two types of effects can you have with inflammation?

Answer 18

local and systemic (fever, fatigue)

Question 19

Hadley says this test is pretty good at detecting systemic inflammation

Answer 19

sed rate

Question 20

factors that increase ESR (6)

Answer 20

1) . advancing age
2) . female sex
3) . pregnancy
4) . hypercholesterolemia
5) . B cell neoplasm
6) . Renal failure

Question 21

factors that decrease ESR (8)

Answer 21

1) . congestive heart failure
2) . sickle cell
3) . altered erythrocyte shape
4) . polycythemia
5) . extreme leukocytosis
6) . cachexia
7) . hypofibrinogenemia
8) . hyper viscosity attributable to paraproteinemia

Question 22

what are the two types of inflammation?

Answer 22

acute and chronic

Question 23

Local effects of inflammation (5)

Answer 23

redness, swelling, heat and pain, loss of function

Question 24

local effects of inflammation: ______ blood flow and migration of ______

Answer 24

increased; WBCs

Question 25

what two chemicals have a role in local inflammation?

Answer 25

histamine and prostaglandins

Question 26

what response occurs during systemic inflammation?

Answer 26

acute-phase

Question 27

what are some acute phase reactants? (4)

Answer 27

CRP, ESR, and WBCs | labs that go up with any severe illness or trauma (very non specific)

Question 28

4 symptoms with systemic inflammation

Answer 28

fever, lethargy, malaise, weight loss

Question 29

acute inflammation: _________ response with release of ________ and ________ to bring in blood and cells

Answer 29

vascular response; histamines and vasodilation

Question 30

chronic inflammation: releases ______ that cause _____ formation (more _______)

Answer 30

cytokines; scar; damage

Question 31

sometimes inflammation causes _________ damage

Answer 31

permanent

Question 32

____________ is the most commonly involved process with rheum illnesses

Answer 32

autoimmunity

Question 33

autoimmunity: can occur in almost any ______ or any _____; causes damage by activation of the _______ system and then __________ system

Answer 33

tissue or cell; immune or inflammatory

Question 34

is autoimmunity simple or complex?

Answer 34

complex, usually a series of things go wrong to lose tolerance and recognize self as foreign antigen

Question 35

what gene causes an increased risk of RA?

Answer 35

HLA-DR4

Question 36

increased autoimmunity in what gender?

Answer 36

female

Question 37

Woman get a preponderance of rheumatologic illness with exception of ______ and ______________

Answer 37

gout; spondyloarthropathy

Question 38

what are the three major drug groups used to tx autoimmunity?

Answer 38

1) . steroids- suppress cell division but can cause skin atrophy 2) . immunosuppressants 3) . biologic txs

Question 39

``` what do WBC levels tell you? <200 <3000 3000-50000 >50000 ```

Answer 39

<200- normal <3000 non inflammatory 3000-5000: inflammatory (could be infected) >50,000- assume infected

Question 40

what does pauciarticular mean?

Answer 40

2-4 joints

Question 41

examples of peripheral, girdle and axial joints

Answer 41

peripheral- shoulder girdle- hip axial- spine

Question 42

acute is less than ____ weeks; three examples of acute inflammation

Answer 42

6 weeks: gout, infection, fracture

Question 43

chronic is more than ____ weeks; two examples of chronic inflammation

Answer 43

6 weeks: RA and osteoarthritis

Question 44

two pauciarticular conditions

Answer 44

psoriatic arthritis, juvenile idiopathic arthritis

Question 45

example of polyarticular condition

Answer 45

RA (more than 5 joints)

Question 46

what three conditions involve the DIP joints?

Answer 46

Gout, PSA, OA

Question 47

what condition more often involves the PIP and MCP joints?

Answer 47

RA

Question 48

what are three asymmetric diseases?

Answer 48

SNA, Lyme arthritis, crystal arthritis

Question 49

inflammatory conditions involve the _____ _____ (have what consistency?) VS non inflammatory have ______ ______

Answer 49

inflammatory- soft tissue (gooey or gummy) | non inflammatory- bone spurs (osteophytes)

Question 50

extra-articular manifestations are always suggestive of __________ disease

Answer 50

systemic

Question 51

female to male ratio: SLE, RA, OA, AS

Answer 51

SLE 9:1 RA 3:1 OA 1:1 AS 1:5

Question 52

the F:M ratio disappears for SLE and RA after age ___

Answer 52

50

Question 53

gout is very ___ in women before menopause

Answer 53

rare

Question 54

what two conditions occur mainly in Caucasians?

Answer 54

PMR, Wegner's

Question 55

what two conditions occur mainly in African americans?

Answer 55

SLE, sarcoidosis

Question 56

acute conditions usually affect how many joints? chronic?

Answer 56

acute- more common for monoarticular | chronic- more common for polyarticular