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Rhumatologie > Polyarthrite Rhumatoide > Flashcards

Polyarthrite Rhumatoide Flashcards

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1
Q

epidemiologie PR

A

moy=50ans ; 0,3-0,8% de la pop ; F>M

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2
Q

cli PR débutante

A

polyarthrite bilat, sym et nue(70%) / polyarthrite aigue febrile(15%) / atteinte rhizo / monoarthrite… / SIB (90%)

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3
Q

clinique palyarthrite bilat sym et nue

A

dlrs infla poignet, MCP, IPP et respect IPD avec synovite; squeeze test +; doigt en fuseau

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4
Q

description squeeze test

A

positif si dlrs a la compression laterale des MTP ou MCP

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5
Q

Critere ACR de la PR

A

PR si score > 6
0 pt : 1 grosse rtic/ CRPetVS N/pas FRniACAN/ 6sem
2pts : 1-3 petites artic / FR ou ACAN faiblement +
3pts : 4-10 petites artic / FR ou ACANx3
5 pts : >10 artic dont 1 petite

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6
Q

diag differentiel polyarthrite+fievre (en dh PR)

A

bact (EI, pyo, gono, Lyme, strepto ou post-strepto), virale(PB19,VIH,rubeole, oreillons, rougeole, BHC, VHB), goutte ou CCA, parasite

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7
Q

diag diff polyarthrite+souffle (en dh PR)

A

EI, RAA, endocardite de libman-sachs(=lupique), IA

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8
Q

diag diff polyarthrite+BAV (en dh PR)

A

endocardite avec abces septal, mala Lyme ou mala lupique

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9
Q

diag diff polyarthrite+pericardite (en dh PR)

A

LED

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10
Q

diag diff polyarthrite+erytheme noueux

A

strepto, enterocolopathie, sarcoidose, lepre, tbc

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11
Q

diag diff polyarthrite+pso ou keratodermite

A

rhum pso

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12
Q

diag diff polyarthrite+pustulose

A

si septique : gono ; si aseptique : mala behçet, rhum pso, sd FLR

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13
Q

diag diff polyarthrite+vascularite

A

micropolyangéite, PAR, mala Wegener…

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14
Q

diag diff polyarthrite+tophus

A

goutte

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15
Q

diag diff polyarthrite+diarrhées glairo-sanglantes

A

enterocolopathieinfla

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16
Q

diag diff polyarthrie+diarrhée simple

A

spondyloarthropathie, mala Wipple

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17
Q

diag diff polyarthrite récurrente+dlrs abdo

A

fievre periodiaque

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18
Q

diag diff polyarthrite+sd icterique

A

hepatopathies aigue ou chronique AI

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19
Q

diag diff polyarthrite+conjonctivite

A

sd FLR(si aigue), sd Gougerot-Sjogren (si seche)

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20
Q

diag diff polyarthrite+uvéite

A

sarcoidose, mala Behçet, spondylarthropathie

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21
Q

diag diff polyarthrite+scérite

A

Wegener ou PR plus ancienne

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22
Q

diag diff polyarthrite+convulsions

A

LED, SAPL, vascularite, neuro-behçet, SGS

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23
Q

diag diff polyarthrite+neuropathies periph

A

SGS, vascularite, méningoradiculite de Lyme, PR ancienne

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24
Q

diag diff polyarthrite+ulcérations buccales

A

Behcet, lupus, crohn

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25
diag diff polyarthrite+xerostomie et csq dentaire
SGS
26
diag diff polyarthrite+uretrite
sd FLR, gono
27
diag diff polyarthrite+balanite circinée
rhum pso ou autres spondyloarthropathies
28
imagerie devant suspicion PR
RT + radio mains-poignet(F) et pieds (3/4 et F) +/- echo, IRM
29
bio devant suspicion PR
NFS, VS, CRP, BH, iono-creat, BU +/- ponction articulaire | FR, ACPA (si neg : anti-keratine..), ACAN(svt neg ou peu)
30
caracteristique ponction artic dans PR
liquide infla non spé riche en cellules (PNN++) | pfs predom lymphocytaire
31
evolution de la PR
par poussées, entrecouppées d'accalmies voir de remissions vraies
32
atteinte des mains dans la PR
svt inaugurale, coup de vent cubital, col de cygne, boutonniere(50%), maillet(=marteau), pouce en Z
33
atteinte poignets dans PR
touche de piano(luxatioin styloide cubitale)
34
atteinte pieds dans PR
90%, invalidant, pieds plats puis ronds, risque complic
35
atteinte epaules dans PR
40%, attitude vicieuse en flessum
36
atteinte rachis cervic dans PR
arthrite C1-C2, risque compression médullaire
37
artic touchées dans PR
mains, poignets, pieds, epaules, coxite rhumatoides... (TOUTES)
38
temps d'apparition des signes cliniques de la PR
6mois-1an
39
éléments radio caractéristiques de la PR
érosions puis géodes juxta-artic, pincement. | pieds(MTP5), mains, poignet
40
clinique PR (extra-artic)
AEG(20%), nodules rhumato(15%), adp(25%), vascularite rhumato, sd sec, atteinte <3, rein(amylose AA), pneumo(fibrose, ddb...), atteinte oeil, anémie, sd Felty, lymphocytose
41
Facteurs pronostics de la PR
début aigu polyartic, atteinte extra-artic, erosions radio precoce, CRP++, FR++(dont anti-CCP), HLA DR 0401-0404-04-05,resist tt, pb socio-eco
42
Causes de mortalité dans la PR
cardio-vascu, inf, neo(surtt LNH), iatro, vascularite rhumato, amylose AA, atteinte neuro C1-C2
43
suivi de la PR
cs 1-2/an, DAS28, CRP et VS, Hb, radio a 6 mois puis a 1an pdt 3-4 ans puis /2-3ans
44
traitement sympto de la PR
repos, antalgiques, AINS+/-AIS ou cc si resist, physiothérap et rééducation + infiltrations cc
45
caractéristiques rééducation dans PR
intense quand accalmie et doux quand phase infla
46
type de traitement de fond PR
1=MTX, 2=leflunomide, puis tt anti-TNFalpha si refractaire/severe++ autres :rituximab, atabacept, tocilizumab ou plaquenyl
47
traitement PR active sans gravité
MTX PO 10mg/sem + folates (si besoin augm dose tous les mois, max=)25mg/sem)
48
tt PR active sans gravité mais CI MTX
leflunomide 20mg/j ou sulfasalazine (1g/j, augm progress)
49
tt PR active sans gravité mais intol MTX PO/pas de rep
MTX IM ou SC
50
tt PR active sévère d'emblée
MTX+infliximab/etanercept/adalimumab ou MTX+sulfasalazine+cc+proguanyl
51
EI MTX (=novatrex)
stomatites, cytopenies, hepatite, alopecie, pnp. | surv : NFS, BH, creat
52
EI sulfasalazine (=salazopyrine)
dyspepsie, cephalées, dermatose, cytopenie, pnp, hepatite | surv : NFS, creat, BH
53
EI hydroxychloroquinie (=plaquenyl)
dyspepsie, cephalée, tb humeur, retinopathie, neuro-myo tox, cytopenie, hepatite, coloration cut surv : opht, BH, NFS,
54
EI azathiprine (=imurel)
cytopenie, inf, hepatite, pancreatite, dyspepsie, pnp | surv : NFS, creat, BH et pancreas
55
EI leflunomide (=arava)
diarrhées, cytolyse hepa, HTA, aphte, cephalée, cytopenie, dermatose surv : TA, NFS, BH
56
EI infliximab (=remicade)
inf, hypersensib, AutoAc | surv : NFS, ASAT, ALAT
57
EI etanercept (=embrel)
inf, eruption, cytopenie, AutoAc | surv : NFS
58
EI adalinumab (=humira)
inf, eruption | surv : NFS
59
EI rituximab (=mabthera)
reaction a l'injection, inf | surv : NFS, dosage Ig
60
EI abatacept (=orencia)
inf, cephalées, nausées | surv : NFS
61
tt chir dans la PR
antalgie et prev destruction : synovectomie, arthroplastie, arthrodese

Rhumatologie (10 decks)

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