Mixed Flashcards by Berni Mariño

MC abnormality of valves in RA?

Mitral regurgitation

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MC part affected by OA

Base of the thumb

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OA Joints affected by heritability

Hip and hand - 50%
Knee - 30%

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Common RA diseases in men

AS, Spondylitis, Gout

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3 Rheuma diseases more common in Men than women

Gout
Spondyloarthritis
AS

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Expected synovial fluid for gouty arthritis

2000-60,000

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Colchicine and NSAID may be poorly tolerated in what conditions?

Elderly
GI dse
Renal insufficiency

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Involvement of what joint in RA will predispose to concomittant OA

DIP

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Involved joints in RA

wrist, MCP, PIP

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Most sensitive and specific marker for RA

Most specific - Anti CCP
Sensitivity Anti CCP = RF

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Expected cell count for infectious arthtitis

25,000 - 250,000 (ave 100,000)

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Gonorrhea is best cultured in what organ?

Mucosa sites aka cervix

Synovial- almost none
Blood - 45%

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Protective factor against SLE

Alcohol drinking

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Which class of nephritis requires aggressive immunosuppression to avoid ESRD

Class III, IV

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Autoantibody associated with dry eyes and mouth

Anto Ro (SSA)

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Benefit of anti malarials in SLE

FAD

Fatigue
Arthritis
Dermatitis

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Distinguishing hallmark for systemic sclerosis

WOF

Widespread capillary loss
Obliterative microangiopathy
Fibrosis

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Avoid in scleroderma renal crisis

Steroids

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Treatment of choice in scleroderma crisis

Symptomatic - acei arbs ccb endothelim antagonists

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Most frequent complication SSc

Raynaud’s Disease

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Clinical presentation of inclusion body myositis

Early predilection of wrists and finger with atrophy at age 50 or older with slightly elevated CK leves

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Myositis mechanic hands and fever and non erosive arthritis indicate what?

Anti synthetase syndrome

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Characterized by acute symmetric proximal weakness with underlying CTD/ statin use

Immune mediated necrotizing myopathy

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For inflammatory myopathies when is it indicated to start a second line agent aside from steroids?

Severe weakness
Increases steroid complications
Development of necrotizing myopathy
Failure to improve 2-4 weeks

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Drug to start if refractory to steroids and other second line agent

Rituximab

Inflammatory myopathy (IM) where M=F and M > F

M=F: NM M> F: IBM

Adult onset predilection for IM types

PM IBM > 55 yo

Most IM are proximal muscle group involvement except for what which involves finger, wrist, knee extensors

IBM

Associated with HMGCR or anti SRP antibodies

Associated with anti CN1A antibodies, granular lymphocytes and reduced CD4/CD8 ratio

IBM

Match muscle biopsy findings with IM type Perimysial and perivascular Endomysial and perivascular Necrotic Perimysial fragmentation with Alk phos staining Endomysial and perivascular with MHC-1 expression

Perimysial and perivascular: DM Endomysial and perivascular: PM Necrotic: NM Perimysial fragmentation with Alk phos staining: ASS Endomysial and perivascular with MHC-1 expression:IBM

Cellular infiltrate to IM typing: CD 4 and CD8

CD4: DM, ASS CD8: PM, IBM Macrophage: NM

IM with no to minimal response to Tx

IBM

IM triggered by statin use

Mechanic hands, ILD, non errosive arthritis, Raynaud phenomenon IM

ASS

IM type: Sarcoidosis, scleroderma

IBM

Drugs that need G6PD testing in RA

Sulfasalazine

ACR criteria for diagnosis

Fulfillment of 6 or more Joints 1 large joint-0 2 -10 large joints -1 1-3 small joints -2 4-10 small joints -3 >10 joints- 5 Acute phase reactants Normal 0 Abnormal ESR or CRP 1 Serology Normal anti CCP or RF 0 <= 3x elevation 2 >3x elevation 3 Duration < 6 weeks - 0 >= 6 weeks - 1

Environmental factors in RA

Smoking Porphyromonas gingivalis

Xray findings in RA

- **Peri-articular osteopenia → initial radiographic finding** - **Soft tissue swelling**, symmetric joint space loss, **subchondral erosions (MCPs, PIPs, MTPs)** - **Lateral aspect of 5th MTP is usually targeted first** - ADVANCED DISEASE → **joint subluxation and collapse**

Chronic inflammation leads to ____ in RA

Chronic inflammation leads to synovial lining hyperplasia and formation of pannus

RA is often considered to be a _-driven disease

Macrophage

MC cause of death in RA

CV disease

Best diagnostic imaging for AS?

Pelvic MRI

Risk Factors for Extra-Articular Disease in RA

- **History of Smoking** - **Early onset significant physical disability** - **Positive serum RF or anti-CCP antibodies**

Types of fractures MC caused in RA

Hip

MC type of lymphoma in RA

DLBCL

initial treatment of moderate-severe RA

MTX

Administered in low-to-moderate doses to achieve rapid disease control before onset of fully effective DMARD therapy

Steroids

Administered in low-to-moderate doses to achieve rapid disease control before onset of fully effective DMARD therapy

Steroids

Contraindication for Anti TNF

Chronic HBV; HF NYHA FC III-IV

Contraindication for Anti TNF

Chronic HBV; HF NYHA FC III-IV

Definition of remission in RA

<=1 Tender, swollen joints; CRP <=1 SDAI score <= 3.3

DOC RA in flare during pregnancy

Low dose prednisone May use HCQ and Sulfasalazine

MC systemic manifestation in SSC

Raynaud's phenomenon

More common manifestations in lssc?

Mucocutaneous telangiectasia GERD PAH Barretts Calcinosis cutis Digital ischemic ulcers

More common manifestations in lssc?

Mucocutaneous telangiectasia GERD PAH Barretts Calcinosis cutis Digital ischemic ulcers

LSSC VS DSSC Raynauds antedates skin involvement Frequent calcinosis cutis Autoantibodies

Raynauds antedates skin involvement Frequent calcinosis cutis Autoantibodies -lssc: Anti centromere -dssc: Anti topoisomerase I anti RNA polymerase III

Pathophysiology of Scleroderma renal crisis

Obliterative vasculopathy intravascular hemolysis, - activation of the complement pathways -

Pathophysiology of Scleroderma renal crisis

Obliterative vasculopathy intravascular hemolysis, - activation of the complement pathways -

Most commonly implicated organism in infectious arthritis?

N. gonnorhea If non gonorrhea --> S. aureus

Diagnosis of ARF

2 major or 1 major + 2 minor

Diagnosis of recurrent ARF

2 major 1 Major + 2 minor 3 minor

Major criteria for ARF

<3 PECS Carditis Polyarthritis/arthralgia Erythema marginatum Chorea SC nodules

Difference in criteria between low/high risk population for ARF

MAJOR Polyarthritis - Monoarthritis MINOR Polyarthralgia - Monoarthralgia Fever >= 38.5C - > 38C ESR >= 60 - ESR >= 30

Diagnosis of AS

< 45 y/o, chronic back pain > 3mos, IBP

Diagnostic of choice

Pelvic MRI

First-line of pharmacologic therapy for AS

NSAIDS

First-line of pharmacologic therapy for AS

NSAIDS

MOST COMMON INDICATION FOR SURGERY IN PATIENTS WITH AS

Severe hip joint arthriti