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rheumatology > lesson 1 > Flashcards

lesson 1 Flashcards

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1
Q

What is rheumatology often compared to in the context of its status among medical branches?

A

Cinderella

This comparison reflects how rheumatology was historically undervalued compared to other medical specialties.

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2
Q

What has improved our knowledge about the pathogenesis of rheumatic diseases?

A

Advances in medical research

These advances have led to better treatment options for patients.

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3
Q

What type of healthcare professional is a rheumatologist?

A

An internist or pediatrician trained in musculoskeletal disorders

This includes disorders affecting joints and muscles.

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4
Q

What is the prevalence of osteoarthritis among older adults?

A

Almost everyone after the fifth/sixth decade of life will be affected

Osteoarthritis is a common rheumatic disorder.

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5
Q

How is a disorder classified as rare in Europe?

A

Less than five cases out of 10,000

This definition helps categorize certain rheumatic diseases.

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6
Q

What are the two types of costs associated with rheumatic disorders?

A
  • Direct costs
  • Indirect costs

Direct costs include specialist visits; indirect costs include loss of work days.

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7
Q

What is a significant consequence of rheumatic disorders beyond joint issues?

A

Higher risk of additional conditions, like cardiovascular disease

This highlights the systemic impact of rheumatic diseases.

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8
Q

What are the main groups proposed by the Italian Society of Rheumatology for classifying rheumatic diseases?

A
  • Inflammatory articular and periarticular diseases
  • Connective tissue diseases and systemic vasculitis
  • Infectious arthritis
  • Microcrystalline arthropathies
  • Osteoarthritis
  • Auto-inflammatory disorders
  • IgG4-related disease
  • Adult onset skin disease

This classification aids in the understanding and treatment of rheumatic disorders.

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9
Q

Which skin manifestation is associated with rheumatic fever?

A

Erythema marginatum

This is a distinctive rash linked to rheumatic fever.

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10
Q

What cardiovascular risk is associated with inflammatory disorders like SLE?

A

Increased risk of myocardial infarction

This risk underscores the importance of managing inflammatory conditions.

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11
Q

Which lung condition is commonly associated with systemic sclerosis?

A

Interstitial lung disease

This condition can complicate the clinical picture in rheumatic diseases.

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12
Q

What is a negative prognostic factor in SLE?

A

Involvement of the kidney

Renal involvement indicates a more severe disease course.

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13
Q

Why is accurate and timely diagnosis important in rheumatology?

A

It significantly impacts patient outcomes

Early treatment leads to better overall health and quality of life.

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14
Q

What factors should be considered when gathering a patient’s history?

A
  • Patient’s sex
  • Age
  • Family history
  • Ethnic and geographical factors
  • Recent events (infections, travel)
  • Comorbidities and medication use

These factors can influence the prevalence and type of rheumatic disorders.

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15
Q

What is the significance of distinguishing between articular and non-articular pain?

A

It helps in assessing the source of pain

Understanding the pain’s origin is crucial for diagnosis.

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16
Q

How long does the stiffness last in inflammatory conditions like rheumatoid arthritis?

A

More than 60 minutes in the morning

This is a key characteristic distinguishing inflammatory from non-inflammatory pain.

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17
Q

What is the first step in the assessment process for rheumatic disorders?

A

Physical examination

This examination should evaluate multiple body systems.

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18
Q

What is the squeeze test used for?

A

Identifying inflammation in the hands

A positive result can indicate inflammatory arthritis.

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19
Q

What are the ideal features of a lab test in rheumatology?

A
  • Safety for the patient
  • Low cost
  • High sensitivity
  • High specificity

These features ensure effective diagnosis and management.

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20
Q

What does an elevated ESR indicate?

A

Inflammation in the body

A high rate suggests that proteins are causing red blood cells to clump together.

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21
Q

What are autoantibodies?

A

Immunoglobulins that target self-proteins

They can serve as disease markers or have pathogenic roles.

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22
Q

What is the primary technique for detecting antinuclear antibodies (ANA)?

A

Indirect immunofluorescence test

This test provides valuable information for diagnosing autoimmune diseases.

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23
Q

What is the most effective technique for detecting ANAs?

A

Indirect immunofluorescence test

This technique reports results as staining patterns and end-point titre.

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24
Q

What does a titre of 1:80 indicate for ANAs?

A

Low concentration of ANAs in the serum

A titre of 1:80 is considered the cutoff for a positive result.

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25
Which antibodies are highly specific for systemic lupus erythematosus (SLE)?
Anti-Sm antibodies ## Footnote These antibodies are present in only 20-30% of SLE cases.
26
What are the two distinct patterns displayed by ANCAs?
Perinuclear and cytoplasmic patterns ## Footnote These patterns are identified using an indirect immunofluorescence test.
27
What role do antiphospholipid antibodies play in antiphospholipid syndrome?
Associated with thrombosis, recurrent miscarriages, fetal death, and thrombocytopenia ## Footnote These antibodies recognize phospholipids or proteins bound to phospholipids.
28
What is the normal cell count in synovial fluid?
Less than 200 cells per microliter ## Footnote A count exceeding 50,000 cells suggests infection.
29
What is the purpose of performing an arthrocentesis?
To obtain synovial fluid for examination ## Footnote This procedure can help diagnose joint disorders.
30
What indicates a normal viscosity in synovial fluid?
High viscosity ## Footnote A decrease in viscosity may indicate a disorder.
31
What is a significant environmental factor contributing to rheumatoid arthritis (RA)?
Smoking ## Footnote Smoking increases the risk and severity of RA.
32
What does the presence of rheumatoid factor (RF) in serum suggest?
Possibility of rheumatoid arthritis ## Footnote RF is not highly specific and can also be found in healthy individuals.
33
What is the shared epitope associated with rheumatoid arthritis?
A specific amino acid sequence in the HLA-DRB1 gene ## Footnote Almost all RA patients possess this epitope.
34
What is the role of anti-dsDNA antibodies in systemic lupus erythematosus?
Markers and pathogenic agents ## Footnote They can form immune complexes and activate the complement system.
35
What are the two techniques used to demonstrate anti-dsDNA?
Indirect immunofluorescent test and Crithidia Lucidiae test ## Footnote Crithidia Lucidiae contains DNA in its kinetoplast.
36
What is the typical antibody type for rheumatoid factor?
IgM antibody ## Footnote It can also be of IgG or IgA isotypes.
37
What is the significance of elevated levels of Prevotella Copri in RA patients?
May trigger autoimmunity through molecular mimicry ## Footnote This bacterium shares peptides with some autoantigens.
38
What is the mucin clotting test used for?
To assess the viscosity of synovial fluid ## Footnote A normal test shows a clot that remains intact and viscous when shaken.
39
What are the clinical features of rheumatoid arthritis?
Inflammation, swelling, redness, and pain in joints ## Footnote RA primarily affects the joints but can have systemic manifestations.
40
What factors contribute to the development of autoimmune diseases?
Endogenous and exogenous factors ## Footnote Genetic predisposition, sex, hormonal influences, and environmental factors like pollution.
41
What is the role of immunosuppressive treatments in autoimmune diseases?
They alleviate symptoms, suggesting an autoimmune mechanism ## Footnote This is not always true for auto-inflammatory diseases.
42
What defines an autoimmune disease according to the postulates?
Detection of autoreactive cells or autoantibodies ## Footnote The disease can also be replicated in an animal model.
43
What is a common laboratory test used to check for rheumatoid factor?
Latex agglutination test ## Footnote This method uses latex particles coated with gamma globulins.
44
What can rheumatoid factor (RF) do in the body?
Activate the complement system, promote the production of inflammatory cytokines, enhance antigen presentation ## Footnote These actions lead to the infiltration of B and T lymphocytes into the joints, contributing to ongoing inflammation.
45
What type of antibodies are anti-citrullinated protein antibodies (ACPA)?
Antibodies that target citrulline, an amino acid found in proteins such as filaggrin, keratin, fibrinogen, and vimentin ## Footnote Citrulline is formed by the enzyme peptidylarginine deiminase (PAD), which is induced in the lungs, especially in smokers.
46
How are ACPA detected?
Using immunoenzymatic tests, such as ELISA.
47
What is osteoclastogenesis associated with in rheumatoid arthritis?
Damage to the bone surface and the formation of erosions.
48
Which factors influence genetic predisposition to rheumatoid arthritis?
Various factors, with smoking being the most significant.
49
What characterizes the preclinical phase of rheumatoid arthritis?
Genetic predisposition without clinical symptoms.
50
What are the key cytokines involved in rheumatoid arthritis?
TNF-alpha, IL-6, and IL-1.
51
What is rheumatoid pannus?
A hyperplastic layer formed due to synoviocyte proliferation that invades and destroys cartilage.
52
What are common early symptoms of rheumatoid arthritis?
General fatigue, mild pain, and stiffness lasting more than 60 minutes in the morning.
53
What is a Baker’s cyst?
A cyst that forms due to an increase in synovial fluid, typically in the knee.
54
What does the ABCDS method in diagnostic imaging stand for?
* A: Articular * B: Bone * C: Cartilage * D: Distribution * S: Soft tissue
55
What is the typical joint involvement in rheumatoid arthritis?
Wrist, metacarpophalangeal joints, and proximal interphalangeal joints with generally symmetric involvement.
56
What are the two groups of DMARDs?
* Synthetic (conventional and targeted) * Biologics (biological originators and biosimilars)
57
What is the first choice among conventional synthetic DMARDs?
Methotrexate.
58
What is the goal of rheumatoid arthritis treatment?
Eliminate pain and halt disease progression.
59
What is Felty’s syndrome?
The association of rheumatoid arthritis, splenomegaly, and reduced white blood cell count.
60
What is the 'window of opportunity' in rheumatoid arthritis treatment?
The first 3-6 months after diagnosis where active treatment can significantly reduce disease progression.
61
What should be assessed during the evaluation of disease activity in rheumatoid arthritis?
* Number of swollen joints * Tender joints * Levels of ESR or CRP * Patient’s general health
62
True or False: Early treatment of rheumatoid arthritis can reduce the risk of disability.
True.
63
Fill in the blank: Rheumatoid arthritis can lead to __________, which are erosions and deformities in the joints.
joint damage.
64
What imaging method is preferred for evaluating soft tissues in rheumatoid arthritis?
Ultrasonography.
65
What are common deformities seen in rheumatoid arthritis?
* Boutonniere deviation of the hand * Z deformity of the thumb * Swan deformity (ulnar deviation)
66
What is rituximab used for?
Rituximab acts against CD20, a B cell antigen, thus inhibiting B cells. ## Footnote Rituximab is commonly used in the treatment of certain autoimmune diseases and cancers.
67
What factors should be considered when choosing the best drug for a patient?
Factors include: * Drug features (dosage, route of administration, side effects, contraindications) * Patient features (sex, age, allergies, medical history) ## Footnote It's also beneficial to consider the patient's lifestyle preferences.
68
What is the EULAR recommendation regarding treatment decisions?
Treatment should be based on a shared decision between the patient and the rheumatologist. ## Footnote This emphasizes the importance of patient involvement in their treatment plan.
69
When should DMARDs be started according to EULAR recommendations?
DMARDs need to be started as soon as possible (Window of Opportunity concept). ## Footnote Early treatment can significantly affect the long-term outcomes in rheumatic diseases.
70
What is the first drug of choice for treatment?
The first drug of choice is methotrexate; alternatives include leflunomide or sulfasalazine if contraindicated. ## Footnote Sulfasalazine is considered less powerful than methotrexate.
71
What are glucocorticoids recommended for?
Glucocorticoids can be combined but must be used for a short period with the lowest dosage due to side effects. ## Footnote Long-term use of glucocorticoids can lead to significant side effects.
72
What should be assessed after 3 months of treatment?
Perform a physical examination and evaluate: * Pain during physical activities * Prognostic factors (ACPA, CRP, ESR titres) * Patient’s response to treatment (especially to methotrexate) ## Footnote Regular monitoring is essential for adjusting treatment plans.
73
What indicates the need for biologic drugs or other conventional DMARDs?
Presence of poor prognostic factors and poor drug response. ## Footnote Poor prognostic factors include high values of RF, ACPA, CRP, ESR, and bone erosion.
74
What are the exceptions for JAK2 inhibitors?
Exceptions include: * Age over 65 years * History of smoking * Cardiovascular and thromboembolic risk factors * Hypertension * Diabetes ## Footnote These factors increase the risk of complications with JAK2 inhibitors.
75
Who should make the final decision regarding the investigation of rheumatoid arthritis?
The final decision should always come from the rheumatologist. ## Footnote The rheumatologist is responsible for evaluating the patient's condition and determining the appropriate next steps.

rheumatology (1 decks)

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