Reumotology finals Flashcards
(163 cards)
1
Q
Which Vasculitis are associated with P-ANCA and which with C-ANCA
and each of those Ab, agianst which part?
A
**only the small vessel vasculitis:
**C-ANCA = Wegener (granulomatosis with polyangitis)
P-ANCA= Shug straus (EGPA) , microscopic polyangitis (MPA)
C- cytoplasmin»_space; PR 3
P- perinuclear»_space; MPO
2
Q
If theres a vasculitis with both P and C anca positive.
it can be?
A
Drug induce vasculitis
mainly secondary to Cocaine use
3
Q
What is the main Tx in vasculitis?
A
Steroids + cyclophophamide
4
Q
what can be the use in Azathioprine (imuran) in vasculitis
what we have to check first?
A
maintanance- in GPA/MPA/GCA
must check levels of TPMT - related to severe cytopenias
5
Q
RTX can be use in which type of vasculitis?
A
Microscopic polyangitis
granulomatosis with polyangitis - wegener
late onset neutropenia + HBV reactivation
small veseels.
6
Q
which vascilitus can be treated with tocilizumab?
and what is the MOA
and C/I
A
GCA- giant cell arthritis (Temporal)
* also for RA as 2nd line
MOA- anti IL-6
C/I- Hx of diverticulitis
7
Q
which anti suppresive medication can cuase hyperlipidemia + GI perforation?
A
Tocilizumab
toci li ze m-abdomnial
8
Q
Mepolizumab can be use in which type of vasculitis?
A
EGPA
also for asthma
*remember- EGPA present with weird asthma
9
Q
when we should give folate after tx with MTX?
A
a day after treatment
10
Q
Granulomatosis With Polyangiitis (GPA)
What is the clinical presentation (triad)
A
Sinusitis, Otitis media, hemoptysis (think URI, LRI)
+
nephritic syndrome- hematuria + RBC casts
Upper resp. involv - 95%
lower- 85-90%
kidney - 77%
11
Q
What we will see in CXR of Granulomatosis With Polyangiitis?
A
bi-lateral nodular infiltrate - to cavitations
in biopsy- necrotic vasculitis w/ granulamotosis
12
Q
In which types of Vasculitis we will see pauci-immune?
A
all ANCA diseases:
GPA
EGPA
MPA
except- goodpasture syndrome (not a vasculitis)
13
Q
Granulomatosis With Polyangiitis how we diagnose?
A
Biopsy- mainly from the lung
DDx for GPA- use of cocaine
C-ANCA
14
Q
Which type of def. and substacne exposure will increase the risk for GPA
A
a1-AT and selica exposure
15
Q
Tx for GPA + MPA
A
induction steroids + cyclophospamide (PO) (3-6month)
RTX- good as cyclo, given to pt with relapse
maintance- RTX (most effective )/ AZA/ MTX/ MMF (less effective) - at least for 2 years
50-70% יחוו הישנות
16
Q
what is the different between
GPA to MPA
A
- MPA- w/o Upper respiratory tract involvment
- P-ANCA (and no C)
- No granulomas
could also be- mononeuritis multiplex (also in GPA)
almost the same disease
17
Q
Clinical presentation of EGPA (Chaug strauss)
A
- late onset of weird asthma - rsistant to therapy,
- sinusitis
- neuropathy- Mononeuritis multiplex- second most common finding
- eosinophilis in labs, P-anca
18
Q
Why should we perform echocardiography for every pt with EGPA?
A
will determine the prognosis and the aggresive to tx
19
Q
What is the most significant cause of death in EGPA
A
cardiac disease
20
Q
What is the prognosis of EGPA w/o Tx?
A
25% for 5 year survival
21
Q
What is the Tx of EGPA?
A
mild disease- steroids, consider Mepolizumab
severe- like GPA and MPA
22
Q
Which type of infection is associate with Polyarthritis nodusa (PAN)
A
HBV+
*check also for HBC
23
Q
Which leukemia is a/w PAN?
A
hairy cell leukemia
24
Q
Why kidney biopsy is not a good way to Dgx PAN?
A
beacuse this disease damage medium size blood vessels.
which mean »_space; the injury will be ischemic and will not see GN.
25
what is common sign in blood vessels in PAN?
and which Blood vessels are the most common?
**Rosary sign-** beads on string
look for this **anurysms** at the kidney, liver, mesenteric arteris.
on biopsy- transmural inflammation
26
Whats the Tx for PAN
Steroids + cyclophospamid
27
Clinical findings of GCA (Temporal)
headace
pain while eating
high ESR
pt > 50 can present with polymealgia rheumatica
28
major severe complication of GCA
Blindless >> due to obstruction of the ophtalmic artery **ischemic optic neuropathy**
## Footnote
1/3 of pt can present with **disease involving the aorta -mainly thoracic** leads to dicecction and anyrusms
29
how to Dgx PMR (polymaglia rheumatica)
Clinical:
high ESR
classic complains
rapid repsonse to low dose presnisone
with no symptoms related to GCA- no need to check
## Footnote
Aspirin- PPX for ischemic injury to coronary arteris
Tocilizumab- also effective in indution and remmision
30
Tx for GCA
* for "regular" disease
* for involvment of the eye
**for regular disease-**High dose Prednisone (40-60) for 1 month >> given low dose for around 2 yrs
**for eye involvment-** steroid palse 1 gr/day solmedrol X 3 days
31
Tx for PMR?
| פולימיאלגיה ראומטיקה
prednisone- 10-20mg
32
IgA vasculitis (Henoch s.purpra)
Clinical menefistaion
Always after URI
Palpable purpura on butt and legs
GI- abdminal pain, malena
Kidenys- GN RBC + protein in urine
| mainly a kids disease
## Footnote
Cardio involvment- not in kids!!
33
How we Dgx Hanoch schonlein?
skin biopsy- IgA-C3 complexes
| high blood IgA- without any diagnostic of prognosis meanning
34
Tx for IgA vasculitis (hanoch)
Follow up.
steroids for relief of symptoms
35
Which vasculitis can present with RPGN
all small vessels vasculitis
GPA
MPA
EGPA
IgA vasculitis (hanoch)
36
Which artery is the most common injured in Takayasu?
Subclavian- 93% of cases
| arm claudication, raynauds phenomenan
37
How to Dgx Takayasu?
and TX
Arteriography or CT/MRI
Tx- steroids + surgery approche , if can't >> MTX
38
Cryoglobulinemic Vasculitis
what is the MOA
which type of nephropathy is common?
* MOA- Ab the sink in cold
* kidney- GN >> MPGN
39
Cryoglobulinemic Vasculitis
what is Type 1 vs Type 2
Type 1- monoclonal Ab, a/w monoclonal disease (MGUS, MM, WM)
Type2- can present with **HCV / HIV** immune complex (type III)
40
in Cryoglobulinemic Vasculitis
what will be the levels of
RF
C4
C3
ESR / CRP
and what we shold always look for?
* RF- eleveted
* C4- low
* C3- normal (rare)
* ESR/CRP- eleveted
**always look for HCV infection**
41
Behçet Syndrome
which type of HLA is found?
what is the systems involve / organs in this syndrome
HLA-B51
**Systems- for diagnosis you need mouth ulcers + 2 of the 4 below**
* mouth ulcers (not painful)- 98%
* reccurent genital ulcers- 80% **most specific**
* Skin lesions- acne like lesions, erythema nodosum, superfical thrombophlebitis,
* **pathrgi reaction- hyperactivity reaction of skin to trauma- like needle**
* eye lesions- pan-uveitis
and many more- CNS, GI, Thrombosis, anurysms of lung arteris
42
Which medication can be use in every one of the menefistations of Behçet Syndrome
Azathioporins
GI + EYE- combine with steroids
CNS- add Anti-TNF
43
When we will see deposition of Calcium oxalate in joints?
CKD
44
Which crystals are seen in Gout?
Monosodium Urate
uric acid > 6.85
45
Triggers for Gout attecks
everything that elevate uric acid levels:
1. red meat and seafood
2. alcohol
3. diuretics
4. Myeloproliferative disoder = high turnover (PV, ET, CML)
5. CKD (low GFR)
| also seen in obesity and males
46
most common presentation of gout attack
mainly 1 joint- most times is the 1st MTP (Podagra) = toe
pass after 1-2 wks
47
Which physical finding can be seen in chronic hyperurecemia (a lot of gout attack)
**Formation of tophi**
48
Cheracteristics of the crystals in gout
Negetive bi-refrigiants
needle shape
Yellow in parallel
blue in perpandicular
49
Which medications can be use for gout PPX
**Xhantine oxidase inhibitors**
alloperinol- 1st line, can cause Steven jhonson, TEN
fubuxostat
**must take with NSAIDS/ cholchicine in start-** until tophi disapper or uric acid in target (the later )
| Not during acute episode
## Footnote
the main use: Gout, PPX TLS
50
which 3 menefistations are a/w CPPD?
1. a-symptomatic
2. psuedo-gout
3. psauso- OA
51
common finding in X-ray of CPPD joint
**Chonsrocalcinosis**
linear calcification of the joint
52
What defines the crystals in CPPD?
Rhomboids
positive Bi-regrignes
Blue in parallel
## Footnote
gout- needle shape, negitive, yellow in parallel
53
ESRD + vitamin C supplaments are major risk for which type of crystal deposition
Ca-Oxalata
54
Main cuase of death in SLE?
Cardio-vascular
55
Which Ab we might see in SLE?
* ANA-95%
* Anti-dsDNA
* anti-smith
drug induce SLE:
* Anti-histone
56
Which Ab are in correlation of neonatal SLE?
and which other disease is a/w this menefistation
Anti SSA- anti ro
Anti SSB- anti la
more common in womens with Sjoren Syndrome (this is the Ab a/w the disease)
57
Main menefistation of SLE:
* Musculoskeletal- Arthralgia/ polyarthritis
* cutaneous- photosensetivity, malar rash, discoid
* Hematologic- anemia of chronic disease. could be penia's
* Cardio- Pericarditis, libman sack
* Renal- nephrotic syndtome
58
The difference between Sica syndrome to sjoren
Sica syndrome- dryness of eye and mouth. not present with anti-ro or anti-la (SSA + SSB)
59
most common presentation of SLE in lung
pleuralitis
60
what are the 4 main kideny menefistation of SLE
* Minimal mesangial LN (class I)
* Mesangial proliferative LN (class II)
* Focal LN (class III)
* Diffuse LN (class IV)
* Lupus membranous nephropathy (class V)
* Advanced sclerosing LN (class VI)
61
What is the indication of Hydroxychloroquine in SLE?
**Recommended to all SLE pt**
prolong life + reduce tissue damage
| rq eye test once a year
62
Tx in non life thrething SLE?
* low dose sterodis
* AniFrolumab
* Belimumab
## Footnote
Faru and Bella - SLE is a women disease
63
Tx in SLE with organ damage?
* Steroids
* **induction-** Cyclophophamid / MMF
* **maintancne-** MMF / AZA
| pregnency only AZA
64
when we will give ACEi / ARBS in SLE
lupus nephritis with protinura > 500
65
main risk in neonatal lupus
**Complete Heart block**
will need ICD
66
Pregnancy with Anti-phospholipid syndrome Tx
Enoxaparin - LMWH
+
Aspirin
| קלקסן
67
Ab positive in Drug induce lupus
| and which drugs
**Anti-histone
**
**Drugs:**
SHIPPP
Sulfa
hydralazyne
isoniazid
Procinamide
Phyntoin
PTU
anti- TNF
| ANA can be also positive
68
Drugs associate with drug induce vasculitis
PTU
Hydralazine
69
Antiphospholipid syndrome (APS)
Which type of thrombus?
what are the Ab?
**Vein + artery**
Ab:
1. Anti-cardiolipin
2. lupus anticoagulant
3. anti b2-glycoprotein
70
What is catasthropic Antiphospholipid syndrome (APS)
Thromboembolic disease which involve 3 or more organs at the same time
71
What are the criteria for Dgx of Antiphospholipid syndrome (APS)
**lab-**at leat one of the Ab to be positive in 2 test with gap of at least 12 wks
**Clinical criteria**- one or more thromboembolic event
or
Pregnancy realted- IUD of normal fetus > 10wks, 3 or more abortion < 10wks, preterm labor < 34
| **one lab criteria and one clinical critera**
72
Tx for Antiphospholipid syndrome (APS)
in pregnency and not
**No pregnency-** warfarin (comidin) for life. INR 2-3 after venous event, 3-4 after arterial event. or 2-3 + aspirin
**Pregnant womens-** Aspirin + LMWH (ppx dose), if event on Tx- LMWH thrapoetic dose / hydroxycholoquine / IVIG 5 days
73
Why we should be careful in given DOAC to pt with Antiphospholipid syndrome (APS)?
Found to increase the risk of Aterioemblic events
74
what are the Ab associated with both types of Scleroderma?
**Diffuse-** SCL-70 (anti-toposiomerase) + Anti-RNA polymerase III
**Limited-** Anti centromere
75
What is the main clinical features of RA?
* symmetrical polyarthritis
* Morning stifness > 1 hr
* Can present as a systemic disease - fever and ect.
## Footnote
Osteoarthritis is different in all of that
76
Which joint are typically effect in RA?
MCP + PIP
**DIP is spare**
| in OA- DIP will be involve
77
Most common cause of death in RA
CV disease
78
all of the following are related to which type of autoimmune disease:
1. Baker cyst
2. Serositis- pleurolitis, pericarditis
3. Subcutneous nodules
4. eye involvment
**RA**
79
What is felthy syndrome?
Traid of RA + splenomegaly + neutropaenia
80
Eleveted fever in RA pt should raise a suspect for?
rheumatoid vasculitis
or
infection (septic arthritis)
81
Which Ab can present in RA?
which one is more specific
RF- in 75%
Anti-centrulline peptide (ACPA = Anti-CCP)- 75% pt **but specifity of 95%**
82
which Ab that present in RA is in correlation to worsen prognosis in extra-joints menefistatoin?
Anti-CCP
83
Which serious toxocity can cause hydroxycholoquine?
Retinal demege- irreversible (rq eye exmination pt > 40 yrs)
84
Which serious toxicity can cause sulfasalazine ?
Granulocytopenia
G6PD hemolytic
85
MTX affect on lung, liver, BM?
lung- intestitial pneumonitis
Liver hepatotoxicity
BM- myelodepresson (penia)
86
Which medication can reverse the affect of MTX?
Levcovorin
87
Side effects of Cyclophosphamid?
* Cystitis hemmorhagic
* SIADH- hyponathremia
* risk for bladder cancer
* infartility
88
Which immunosupressive medication should be screen first to PDD (TB)?
**Infliximab (TNF-a inhibitors)**
89
What is the only bilogic medication that not rq TBB test prior to administation
RTX
90
Which 4 medication rq serologic testing for viral hepatitis
* Anti=TNF
* RTX
* MTX
* ARAVA (leflunomide)
91
What is the most common medication for the use of RA (DMARDS)
MTX
92
C/I for MTX?
pregnanct
Cr > 2
ILD
93
Side effect of MTX
* Somatomatitis / mucositis
* BM depression- pancytopenia
* pneumonitis ~ PF
## Footnote
ARAVA (Leflunomide) similar to MTX
94
C/I for anti-TNF (infliximab)
HBV
CKD III/IV
might cause a reactivation of TB
95
in which case of RA we will use in RTX?
Refactory RA
96
What is the approch of Tx with RA?
1. mild-severe disease- MTX
if after 3-6 month theres no desire outcome - move to combination therapy
1. **Oral triple therapy-** MTX + sulfasalizne + Hysroxycholoquine
2. MTX + Leflunomife
3. MTX + anti-TNF
**Tx of ILD-** high dose steroids + more immunosuppresent therapy
97
Axial spondyloarthitis with finding in imaging will be called:
Ankylosing spondylitis (AS)
98
Which HLA is prevelance in Ankylosing spondiloarthritis?
**HLA-B27**
90% in AS
| 50% in psoriatic arthritis
99
What are the 4 seronegetive spondyloarthritis?
1. Ankylosing spondylitis
2. Psoritatic arthritis
3. IBD
4. Reactive arthritis
| they can also menifest toghter for exp- AS with IBD/ psoriasis
100
What is the most common symptom of Ankylosing spondylitis
**lower back pain - 75%**
inflammtory pain- night pain, pain in rest, improve in movment
| pain in lumber region/ butt/ sacroiliac
101
Which cheracterisitc are present in **all** of the seronegetvie spondyloarthritis
1. oligoarthritis - 2-4 joints
2. a-symmetrical (mainly in lowe extremity)
3. Dactilytis- sausage fingers
4. enthersitis- ligament inflame in the insertion to the bone
5. involve the axial spine
| in RA: symmetrical, polyarthritis, mainly hands
## Footnote
1. Ankylosing spondylitis
2. Psoritatic arthritis
3. IBD
4. Reactive arthritis
102
Which Eye menefistation is the most common on AS (AxSPA)
**Ant. uveitis** ~40%, mainlt unilateral
103
Which extra skeletal menefistation can be present in Ankylosing spondylitis (AxSPA)
uveitis
Aortitis >> AR
Restrictive lung disease
104
How to Diagnose AxSPA
| ankylosing spondlyartritis
**Pt with back pain >3 month ang age < 45**
**criteria:**
Sacroilitis on imaging + 1 < SpA features
**or**
HLA-B27 + 2 < SpA features
## Footnote
the features:
* inflammatory back pain
* Arthritis
* Enthensitis- heel pain
* ant. uvietits
* dactylitis
* psoriasis
* IBD realted
* HLA-b27
* elevete CRP
* family Hx of SpA
* good respond to NSAIDS
105
What test is the imaging when AxSpA is suspected?
MRI
106
What is the 1st line medication in AxSpA
NSAIDS - high dose long term
| sendongf line - Anti- TNF (could cause secondary psoriasis due to tx)
107
Which bacteria can cause Reactive Arthritis?
**Enteric or urogenital:**
Entreric- Shigella, Salmonela, Yersina, Combylobacter jejuni
Urogenital- Clamydia throchomanis
| mainly 1-4 weeks prior the symptoms
108
What is Rieter syndrome?
When reactive Arthritis present with Ant. uveitis + and dysurea
**Can't See Can't Pee, Can't Climb a Tree**
109
Clinical features of Reactive arthritis?
after infection
can present with:
* oligo-a-symmetrial arthritis
* dactylitis
* enthritis
* oral ulcers
## Footnote
**Keratoderma blennhorragica-** vasicular rash with crust in hands and feets
110
Tx for Reactive Arthritis?
High dose NSAIDS
(arthritis last for 3-5 months)
111
Which seronegetive disease present with only the involvment of DIP (in hands)
Psoriasis arthritis
112
How many cases of psoriasis arthritis can present as symmetrical arthritis like RA
40%
113
a pt with psoriasis anf chenge in the nails will most likely will also have
Arthritis.
(psoriasitc arthritis)
90% of pt.
114
In which disease we will see "pencil in a cup"
Psoriasis arthritis
115
Which viral disease can cuse psoriasis arthritis?
HIV
116
what are the 3 best choice of Tx for psoriatic arthritis
* Anti-TNF- improve both skin and joint disease (check TB)
* Anti-IL17 (Sekucicnumab)- could make IBD worsen
* Anti-IL23
117
Which type of IBD is relates to AxSpA?
* Type I- joints < 5, comes with wosresning of the IBD
* **type II-** joints > 5, w/o correlation to the severity of the IBD disease/ flares
118
what is the Tx for IBD associated arthritis?
Anti-TNF
**except ETNACEPT- only for RA or SpA**
119
Which type of histological feature we will see in sarcoidosis?
**Non- ceasting granulomas**
TB- ceating granulo,as
120
How many pt will recover for sarcoidosis?
more then 50%
after 2-5 years
121
Which electrolyte disbalance sen in sarcoidosis?
**Hypercalcemia-** due to realese of a-1 hydroxylase from macrophages in alveoli >> more vitamin D active
122
What we will see in CXR of sarcoidosis?
and what is the most common fiding (in presentation)
1. Hilar lymphadenopathy
2. interstitial infiltrates
might progess to pulmonary fibrosis
**most common findings- pt with cough and dyspnea and on CXR with lymphadenopathy**
123
What are the 4 stages of sarcoidosis?
Stage 1- hilar LAD
stage 2- Adenopathy + infiltrates
Stage 3- infiltrates alone
stage- PF
124
What is the most sensitive test for interstitial disease?
in lung
DCLO
125
What is the extra-lung menefistation of sarcoidosis
1. **skin-** Erythema nodosum- on shins
2. **eyes-** Ant. uveitis (could also be post)
3. **Heart-** heart block, cardiomyopathy
4.** CNS-** bells palsy, motor deficit
4. **liver** involve in biopst ~50%
5. **kidney- **CKD (hypercalcemia)
126
how to Dgx sarcoidosis?
1. typical clinical presentation
2. imaging
3. biopsy of non-ceating granulomas
127
which test can support sarcoidosis if biopsy is negetive
1. high ACE levels- not senstive nor specific
2. PET scan- if many organs are involve
3. BAL- lymp > X2 (sensetive), ratio CD4:CD8 > 3.5 - higly specific
## Footnote
Sarcoidosis is a **CD4 cells disease** which secrete >> **IL2 **>> TH1 prolifration +CD4 secrete ** INF-y** >> activate of macrophages
and granuloma formation
128
Tx of choice in sarcoidosis?
| in acute flate and also in chronic
**Steroids**
mild or a-symptomatic disease- just follow up
one organ invilve- topical steords
multi organ disease or /Brain, heart, eyes , hypercalcemia- systemic steorids
129
Which steroid sparing can be use in sacroidosis?
| in acute flare + chronic disease
**for acute flare**
skin- minucyclin or hydroxycholoqine
MTX- affective in ~ 2/3 of cases
AZA- as MTX but more toxic
**for chronic disease**
Infliximab- effective in lung dsease. risk for TB reactivation
130
What is the CREST in limited scleroderma
**CREST**
Calcinosis
Rauneyds
Esophageal dysmotility
Sclerodactyly
Telangiecatia
| Anti-centromere Ab
131
Which feature can be distinguish between a primary renualds to secondary
on capiloscopia abnormality of the nail bad- **in secondary**
132
How is the skin of a person with Scleroderma will look?
* face mask, fish mouth
* tight and thick skin
* Telangiectasia- mainly on the dace
* sclerodactulity- swollen fingers
133
What will be the lung function test in a pt with Systemic scleroderma
low volumes + DLCO
**Pulmonary fibrosis**
134
What is the test of choice for diagnosis of PF or ILD in scleroderma
Hgh resulotion CT
(HRCT)
135
Renal crisis and scleroderma:
* which type is more commen?
* Risk factors?
* what is a protective factor?
1. more common in the diffuse type
2. risk factors- anti-RNA pol III (Ab in diffuse with SCL-70), use of steroids, afroamericans, penia (of blood)
3. protective factors- Anti-centromere
136
A pt with Scleroderma present to the ER with severe headace and visual disturbacne, BP 210/120. on CBC Thrombocytopenia with schistocytes with sings of AKI.
what is the Dgx?
what is the Tx?
**Renal crisis**
Malignant HTN (in 10% BP is no eleveted)
MAHA- with schystocyts
AKI
Thrombocytopenia
**Tx**
ACEi
137
Which disease are in correlation with PBC (primary billiary chirossis)
* Limited Scleroderma- 5-15%
* Hasimoto
* RA, SLE, Sjoren
138
Tx in Renal crisis in scleroderma
Short T1/2 ACEi- **Captopril**
If HTN persist- CCB, ARBS
consider- Eculizumab (against Complement system)
2/3 of pt will need dialysis later
90% mortality w/o treatment
139
Which Scleroderma Pt are at high risk for **Renal crisis**
| 4
* Early disease
* large skin involvment
* Tendon friciton rab
* Anti-RNA polymerase III
| Avoid Steroids
140
What is the Tx of choice in PAH in scelroderma
Endothilin 1 receptor antagonist (Bisentan) / PDE-5 inhibitor (dildenafil)
141
Wha is the Tx of coice in Raynaud?
**CCB**- Dhydro / dilitazam
another option: **ARBS**
| for refactory cases- PDE-5 inhibitors, a1 blockers, prostaglidins
## Footnote
ACEi- not effevtive in Renuyad
142
How the following conditions in scleroderma treated:
1. GAVE- watermelon stomach
2. GERD
3. Bacterial overgrowth- low B12 with high Folate
1. צריבה באנדוסקופיה
2. PPI
3. Broad spectrum Abx- like Flagyl
143
Sjoren Syndrome clinical menefistation
Sicca- dry eyes
Dry mouth
Extranodular- only 30%, Arthritis/ arthralfia/ every organ.
hyperavtivity of B cells
144
Sjoren syndrome is a/w high risk of ------------ lymphoma
MALT
145
Dgx of Sjoren syndrome
Anti-Ro (SSA
Anti LA (SSB)
if dgx is not clear >> biopsy with lymphocytes
## Footnote
must rule HCV
146
Which are the most common joints damage in Osteoarthritis?
Knee > hip > hands- DIP, PIP, 1st MCP (base of thumb) > cervical spine > lumbuscaral
| in RA- no DIP involvment
147
Haberden's nodes and bouchards nodes are clinical finding which we can see in -------------
osteoarthritis
DIP, PIP
148
היצרות הסדק המפרקי, סקלרוזיס וציסטות של עצם סאב-כונדרלית בהדמייה עם אוסאופיטים בקצוות העצם מכוון אותנו לאיזו מחלה?
OS
149
What finding will rule out Osteoarthritis in pancutre of the synovial fluid?
WBC > 10000
think of a different Dgx
150
Tx for OA
life changing, less stress on the joints
NSAIDS
steroids injections
151
What is IgG-4 related disease, what is the pathophysiology and which type of pt is most common in?
גבריפ בגיל העמידה
Tendency to create tumor like lesions with atophic clinical presenation. **every part in the body can be involve.**
**also called type 1 autoimmune pancreatitis**
152
What we will find in biopsy of IgG4 related disease
lympocytes and plasma cells which are positive for IgG4 + esoinophilia
153
Tx for IgG related disease
1st line- Steroids
refoctory / steroids not good enough- RTX
154
what are the 2 clinical signs patognemonic for Dermatomyositis?
Heliotrope rash- purple color and a bit adema in upper eyelid
Gottorn sign- red rash on hands joints and chunkles
## Footnote
Shawl and V sign- בחשיפה לשמש תיהיה פריחה אדומה סגלגלה, נראה כמו שאל / סימן וי של שיזוף
155
Which test rq for defenitive Dgx of Inflammatroy myopathies
## Footnote
Derma to + polymyositis
**Muscle biopsy
**
Dermatomyositic- inf. in perimysium. CD4 +
Polymyositis- inf. in endomysium. CD8+
156
What is the main different between polymyalgia reumatica to inflammatory myopathis?
in polymyalgia reumathica **theres no muscle weakness- they will complain on stiff joints**
157
How can er describe the pattern of muscle involvment in poly + Dermatomyositis
**proximal + symmetrical** muscle weakness
| קושי לעלות במדרגות, להרים רגליים, להסתרק, לעמוד מתנוחת ישיבה
158
Which type of cancer is associated with Polymyositis and dermatomyositis
**Adenocarcinoma**
| mainly dermatomyositis
159
Tx for Inflammatory myopathies
1. Steroids
2. MTX/ AZA
3. IVIG- in severe cases / refactory cases
| MMF instead of MTX if- CKD,liver induff. or ILD)
160
Cheracteristics of Inclusion body myopathy
* muscles invovle
* symmetric vs a-symmetric
* tx
* age
* muscles invovle- proximal and distal + muscle of the face and swallowing but not the eyes
* a-symmetric
* tx- steroids + AZA/ MTX
* age- males > 50
161
Which type of Vasculiitis can be seen in FMF?
**Polyarthritis nodusa** and HSP
161
Which type of Amyloidosis can be seen in FMF?
AA- mainly kidney involvment
| Protenuria between FMF episodes
162
Tx for FMF?
**daily Cholcince PO** (1.2-1.8 mg)
can raise risk for trisomy 21
but overall - can take in pregnancy
**2nd line-** IL-1 inhibitors (Canakinumab)
