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Rhumatologie > Polyarthrite Rhumatoide > Flashcards

Polyarthrite Rhumatoide Flashcards

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
Q

diag diff polyarthrite+xerostomie et csq dentaire

A

SGS

26
Q

diag diff polyarthrite+uretrite

A

sd FLR, gono

27
Q

diag diff polyarthrite+balanite circinée

A

rhum pso ou autres spondyloarthropathies

28
Q

imagerie devant suspicion PR

A

RT + radio mains-poignet(F) et pieds (3/4 et F) +/- echo, IRM

29
Q

bio devant suspicion PR

A

NFS, VS, CRP, BH, iono-creat, BU +/- ponction articulaire

FR, ACPA (si neg : anti-keratine..), ACAN(svt neg ou peu)

30
Q

caracteristique ponction artic dans PR

A

liquide infla non spé riche en cellules (PNN++)

pfs predom lymphocytaire

31
Q

evolution de la PR

A

par poussées, entrecouppées d’accalmies voir de remissions vraies

32
Q

atteinte des mains dans la PR

A

svt inaugurale, coup de vent cubital, col de cygne, boutonniere(50%), maillet(=marteau), pouce en Z

33
Q

atteinte poignets dans PR

A

touche de piano(luxatioin styloide cubitale)

34
Q

atteinte pieds dans PR

A

90%, invalidant, pieds plats puis ronds, risque complic

35
Q

atteinte epaules dans PR

A

40%, attitude vicieuse en flessum

36
Q

atteinte rachis cervic dans PR

A

arthrite C1-C2, risque compression médullaire

37
Q

artic touchées dans PR

A

mains, poignets, pieds, epaules, coxite rhumatoides… (TOUTES)

38
Q

temps d’apparition des signes cliniques de la PR

A

6mois-1an

39
Q

éléments radio caractéristiques de la PR

A

érosions puis géodes juxta-artic, pincement.

pieds(MTP5), mains, poignet

40
Q

clinique PR (extra-artic)

A

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
Q

Facteurs pronostics de la PR

A

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
Q

Causes de mortalité dans la PR

A

cardio-vascu, inf, neo(surtt LNH), iatro, vascularite rhumato, amylose AA, atteinte neuro C1-C2

43
Q

suivi de la PR

A

cs 1-2/an, DAS28, CRP et VS, Hb, radio a 6 mois puis a 1an pdt 3-4 ans puis /2-3ans

44
Q

traitement sympto de la PR

A

repos, antalgiques, AINS+/-AIS ou cc si resist, physiothérap et rééducation
+ infiltrations cc

45
Q

caractéristiques rééducation dans PR

A

intense quand accalmie et doux quand phase infla

46
Q

type de traitement de fond PR

A

1=MTX, 2=leflunomide, puis tt anti-TNFalpha si refractaire/severe++
autres :rituximab, atabacept, tocilizumab ou plaquenyl

47
Q

traitement PR active sans gravité

A

MTX PO 10mg/sem + folates (si besoin augm dose tous les mois, max=)25mg/sem)

48
Q

tt PR active sans gravité mais CI MTX

A

leflunomide 20mg/j ou sulfasalazine (1g/j, augm progress)

49
Q

tt PR active sans gravité mais intol MTX PO/pas de rep

A

MTX IM ou SC

50
Q

tt PR active sévère d’emblée

A

MTX+infliximab/etanercept/adalimumab ou MTX+sulfasalazine+cc+proguanyl

51
Q

EI MTX (=novatrex)

A

stomatites, cytopenies, hepatite, alopecie, pnp.

surv : NFS, BH, creat

52
Q

EI sulfasalazine (=salazopyrine)

A

dyspepsie, cephalées, dermatose, cytopenie, pnp, hepatite

surv : NFS, creat, BH

53
Q

EI hydroxychloroquinie (=plaquenyl)

A

dyspepsie, cephalée, tb humeur, retinopathie, neuro-myo tox, cytopenie, hepatite, coloration cut
surv : opht, BH, NFS,

54
Q

EI azathiprine (=imurel)

A

cytopenie, inf, hepatite, pancreatite, dyspepsie, pnp

surv : NFS, creat, BH et pancreas

55
Q

EI leflunomide (=arava)

A

diarrhées, cytolyse hepa, HTA, aphte, cephalée, cytopenie, dermatose
surv : TA, NFS, BH

56
Q

EI infliximab (=remicade)

A

inf, hypersensib, AutoAc

surv : NFS, ASAT, ALAT

57
Q

EI etanercept (=embrel)

A

inf, eruption, cytopenie, AutoAc

surv : NFS

58
Q

EI adalinumab (=humira)

A

inf, eruption

surv : NFS

59
Q

EI rituximab (=mabthera)

A

reaction a l’injection, inf

surv : NFS, dosage Ig

60
Q

EI abatacept (=orencia)

A

inf, cephalées, nausées

surv : NFS

61
Q

tt chir dans la PR

A

antalgie et prev destruction : synovectomie, arthroplastie, arthrodese

Rhumatologie (10 decks)

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