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Clin Med MSKII > Johnston > Flashcards

Johnston Flashcards

1
Q

ESR rises with age and are higher in women and can be used to monitor disease activity, especially in what diseases

A
  • polymyalgia rheumatic

- giant cell arteritis

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2
Q

what marker of inflammation is used for assessment of disease activity, synthesized in liver, increased by proinflammatory cytokines and can activate complement and promote phagocytosis

A

CRP

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3
Q

what level of CR is inflammatory

A

greater than 8

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4
Q

this is an autoantibody that targets the Fc portion of IgG?

What type of antibody is it most commonly

A
  • RF

- IgM

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5
Q

Rheumatoid factor and RA

A
  • 70-80% of patients
  • 100% with “nodular” RA
  • RF is found in many other diseases
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6
Q

Anti CCP plus + RF

A

99.5% specificity for RA

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7
Q 
Homogenous pattern immunofluorescense for ANA?
Rim pattern?
Anti Sm antibodies?
Speckled anti SSA/B?
Anticentromere?
A
  • Drug induced (procainamide, hydralazine Dilantin)
  • Anti DS DNA
  • SLE
  • Sjogren
  • Scleroderma
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8
Q

the malar rash in SLE spares what

A

nasolabial folds

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9
Q

arthritis in SLE

A

-2 or more peripheral joints

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10
Q

hematologic finding in SLE

A

basically every down except reticulocytes are up

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11
Q

what can give a false positibe RPR (test for syphilis)

A

SLE

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12
Q

what is the Jones Criteria for Rheumatic Fever?

A
  • Carditis
  • Joint involvement (arthritis)
  • Chorea
  • Erythema Marginatum
  • Subcutaneous nodules
  • Evidence of preceding Strep infection
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13
Q

what level of uric acid is hyperuricemia?

A

> 6.8 mg/dl

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14
Q

what are tophi

A

nodular deposits of monosodium urate crystals in the skin from gout

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15
Q

what is podagra

A

acute onset, monoarticular, often 1st MTP joint affected by gout

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16
Q

Treatment of acute Gout

A
  • NSAIDs
  • Colchicine
  • Steroids
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17
Q

chronic management of gout

A
  • Xanthine oxidase inhibitor (uricouric drug)

- Probenecid: block tubular resorption of urate and increased uric acid excretion

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18
Q

what imaging is sensitive for soft tissue abnormalities (synovitis, tendonitis, bursitis) and erosions

A

US

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19
Q

what imaging for RA symmetrical involvement of MCP, periarticular osteopenia erosions

A

Radiography

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20
Q

MRI is good for what?

downfalls?

A
  • spine, SI, synovitis, tenosynovitis, erosions
  • Gadolinium contrast taken up in inflamed synovium (thickened pannus) . . IV gadolinium can cause nephrogenic systemic fibrosis in patient with kidney disease
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21
Q

what is Enthesopathy

A

-inflammation of ligaments and tendons where they insert into bony attachments . .hallmark for reactive arthritis

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22
Q
  • 1 joint involved?
  • 3 or less?
  • 5 or less
  • 6 or more?
A
  • arthritis
  • Oligoarthritis
  • Pauciarthritis
  • Polyarthritis
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23
Q

what hand joints are spared in RA

A

DIPs

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24
Q

DIPs involved in OA . .what nodes

A

Herbedens

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25
Q

systemic features of RA

A
  • Fatigue, fever, anemia
  • Elevated Acute phase reactants (ESR, CRP)
  • Constitutional symptoms: malaise, myalgia, depression
26
Q

what is rheumatoid factor produced by

A

B cell in RA synovium

27
Q

what is more sensitive to detecting erosions than X ray

A

CT

28
Q

what do you need to monitor when giving methotrexate for RA

A

blood counts and liver and renal function

29
Q

what disorder improves during pregnancy

A

RA

30
Q

pts with RA have significantly increased mortality due to what

A
  • CAD
  • HF due to endothelial damage from chronic inflammation
  • also increase in infection, renal disease, GI, and malignancy
31
Q

what score on classification of RA is definite RA

A

6/10

32
Q

what part of axial spine is affected by RA?

A
  • C1-C2

- be careful when intubating for anesthesia

33
Q

if rheumatoid nodules present then what will always be + on serology

A

RF

34
Q

Extra-Articular manifestations of RA?

A
  • Skin: subcutaneous nodules; extensor surface of forearm
  • Pyroderma Grangrenosum: tender reddish purple papule; leads to necrotic, non healing ulcer
  • Rheumatoid Vasculitis: purpura, petechial, splinter hemorrhages, digital infarct
  • Heart: HF, pericarditis, CAD due to chronic endothelial inflammation
  • Lung: pleuritis most common, nodules, interstitial lung disease, Caplan syndrome (nodular densities after exposure to coal or silica dust, pulmonary fibrosis
  • Keratoconjunctivitis Sicca: secondary Sjogrens from RA
35
Q

Tests for Sjogren

A
  • Ro/SS-a, La/SS-B (both associated with solivary gland involvement
  • Schrimers test (filter paper under eyelids)
  • slit lamp exam
36
Q
  • RA
  • Splenomegaly
  • Neutropenia (<2000)
  • Fever
  • Anemia
  • thrombocytopenia
  • RF and anti-CCP +
A

Feltys syndrome

37
Q

treatment of RA

A
  • NSAID: pain relief, doesn’t halt disease progression
  • Corticosteroids: low dose, Bridge or flare therapy
  • analgesics for pain controld
  • DMARDS: takes 2-6 months for max effect, methotrexate first line, don’t give with pregnancy,
38
Q

what antimalarial is useful in RA and can be used in pregnant patient

A

hydroxychloroquine

39
Q

what are the anti-TNF biologic agents used in RA

A
  • Etanercept
  • Infliximab
  • Adalimumab
  • Rituximab
40
Q

what are the different spondyloarthropathies

A
  • Ankylosing spondylitis
  • Reactive Arthritis
  • Psoriatic Arthritis
  • enteropathic arthritis
41
Q

HLA for spondyloarthropathies

A

B27

42
Q

describe the joint involvement in spondyloarthropathies

A

Asymmetric peripheral arthritis

43
Q

Term: swelling of a finger or toe

A

Dactylitis

44
Q

Term: enthesis

A

Site of ligamentous attachment to bone

45
Q

Term: Enthesitis

A

inflammatory changes of the ligament, tendinous insertion into bone, or joint capsule

46
Q

Term: inflammation of vertebrae

A

spondylitis

47
Q

Term: anterior displacement of a vertebral body relative to the adjacent vertebral body below

A

Spondylolisthesis

48
Q

Term: defect of the portion of bone b/t the inferior and superior articular process of vertebrae (pars interarticularis)

A

Spondylolysis

49
Q

HLA for RA

A

DR4

50
Q

RA M:F ratio

what about reactive spondyloarthropathies

A
  • 1:3
  • Ankylosing spondylitis is 3;1
  • Reactive: 10:1
51
Q

Reactive arthritis was formerly known as what

A

Reiter’s syndome

52
Q

clinical manifestations of ankylosing spondylitis

A
  • Low back pain > 3 months
  • morning stiffness, improved with exercise, worse with rest
  • Fatigue, weight loss, and fever
  • Symmetrical SI joint pain (sacroiliitis); loss of mobility/flexibility; arthritis of hips
  • Tendonitis, planar fasciitis (Achilles-heel pain)/Enthesitis
53
Q

Extra articular manifestation of ankylosing spondylitis

A
  • Eye: IRITIS (not seen in RA)
  • photophobis, eye pain, blurred vision
  • Aortic insufficiency, aortic aneurysm
  • pulmonary fibrosis
  • IBD
  • Psoriasis
54
Q

pts with ankylosing spondylitis have problems flexing forward . . what is the test for this called?
What is the text for decreased chest expansion?

A
  • Schober test

- Fabere test

55
Q

what are syndesmophytes

A
  • found in ankylosing spondylitis

- bridging of vertebrae (boney bridges cause ankyloses)

56
Q

what are late complications of ankylosing spondylitis

A
  • restrictive lung disease
  • compression fractures
  • cauda equine syndrome
57
Q

age for Ankylosing spondylitis

A

below 40

58
Q

Clinical manifestations of reactive arthritis

A
  • young men
  • asymmetrical oligo-arthritis, lower extremeties (ankles, knees)
  • Enthesitis - Achilles tendon/plantar fasciitis
  • Dactylitis: sausage digit; finger or toe
  • SI pain, asymmetrical
  • urethritis, arthritis, conjunctivitis, mucocutaneous lesions (oral ulcers)
  • Skin: circunate balanitis (vesicles, ulcers on glans penis)
  • Keratoderma blennorrhagicum: painless eruption on palms/soles
59
Q

how will joint manifestations of granulomatosis with polyangiitis differ from RA

A

usually involves large joints (hips, ankles, wrists) and usually spares the small joints of the hand
-also C-anca

60
Q

manifestations and labs of polymyalgia rheumatica

A
  • stiffness and pain in shoulders, hips, and lower back
  • trouble combing hair, putting on coat, and rising from chair
  • markedly elevated ESRs

Clin Med MSKII (16 decks)

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