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Clin Med I > Rheum I and II > Flashcards

Rheum I and II Flashcards

1
Q

cause of RA

A
  • autoimmune
  • triggered by T cell activation
  • causes deformities and disability
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2
Q

synovitis and RA

A
  • swollen, warm, stiff joints
  • ALWAYS multiple joints
  • symmetrical
  • low back NOT involved
  • tethering of tissues -> decreased ROM and erosion of joints -> deformity and loss of function
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3
Q

rheumatoid nodules

A
  • usually found on pressure points
  • elbow, heel, MCP joint
  • nodule has central area of fibroid necrosis
  • less fluid filled than cysts
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4
Q

common joints involved in RA

A
  • c spine
  • shoulders
  • elbows
  • hands and wrists (DIP spared)
  • hip (later in disease)
  • knee
  • foot and ankle
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5
Q

boutonniere deformity

A
  • assoc with RA
  • flexion of PIP
  • hyperextension of DIP
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6
Q

swan neck deformity

A
  • assoc with RA
  • hyperextension of PIP
  • flexion of DIP
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7
Q

other organs impacted by RA

A
  • lungs
  • eyes
  • skin
  • heart
  • NS
  • blood
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8
Q

heart complications of RA

A
  • often see pericardial effusions
  • MI
  • stroke
  • atherosclerosis
  • pericarditis
  • endocarditis
  • LVHF
  • vasculitis
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9
Q

what causes NS issues with RA

A
  • c spine instability (usually at C1-2)

- causes peripheral nerve entrapment and vasculitis -> mononeuritis multiplex

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10
Q

blood sx associated with RA

A
  • hypochromatic microcytic anemia
  • also have low serum ferratin or normal Fe binding capacity
  • seen in almost all RA pts
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11
Q

common PE findings in RA

A
  • warm, erythematous joints
  • commonly involves hands and wrists
  • DIP excluded
  • ulnar deviation of digits
  • nodules
  • baker cysts
  • general decreased ROM
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12
Q

serology for RA

A
  • ANA- not diagnostic and doesnt follow disease activity
  • RF- often seroneg in first year of disease
  • anti-CCP- highly specific, associated with shared epitope
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13
Q

diagnostic criteria for RA

A
  • joint involvement (5 pt max)
  • serology (3 pt max)
  • duration (1 pt max)
  • acute phase reactants (1 pt max)
  • need 6 points for definitive RA dx
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14
Q

other considerations for RA dx

A
  • family hx
  • joint tap for synovial fluid
  • x ray
  • MRI or bone scan
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15
Q

clinical course of RA

A
  • damage occurs early in most pts
  • 50% show joint space narrowing in first 2 years
  • 50% disabled after 10 years
  • early death
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16
Q

what is the DOC for RA?

A
  • methotrexate
  • works by inhibiting DNA synthesis through inhibition of dihydrofolate reductase
  • requires monitoring of blood, liver, lungs, kidneys
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17
Q

treatment of RA

A
  • NSAIDS
  • steroids
  • mtx/ DMARDS
  • tumor necrosis inhibitors
  • if newly dx use steroids until mtx takes effect
  • steroids for flares
  • intra-articular triamcinolone
  • hydroxychloroquine and sulfasalazine often in combo with mtx
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18
Q

felty’s syndrome

A
  • RA + neutropenia + splenomegaly
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19
Q

polymyalgia rheumatica (PMR)

A
  • idiopathic inflammatory disorder
  • proximal muscle pain
  • abrupt onset, self limited
  • sx worse in AM
  • “trouble getting dressed”
  • highly associated with temporal arteritis
  • dx of exclusion, get ESR
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20
Q

treatment of PMR

A
  • PO steroids
  • app pts should be biopsied for temporal arteritis or consult optho
  • no imaging
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21
Q

reactive arthritis

A
  • autoimmune reaction after infections (GI or GU)
  • associated with HLA- B27 halotype
  • triad of urethritis, arthritis, conjunctivitis
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22
Q

common infections associated with reactive arthritis

A
  • chlamydia
  • campylobacter
  • salmonella
  • shigella
  • yersinia
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23
Q

diagnosis of reactive arthritis

A
  • based on hx/ PE
  • cultures to det infection
  • CBC, CRP, UA, urine culture
  • echo
  • HIV pts higher risk
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24
Q

treatment of reactive arthritis

A
  • based on sx
  • treat infection
  • NSAIDs
  • steroids
  • DMARDS if NSAIDs and steroids are ineffective
  • 2/3 recover spontaneously
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25
anterior uveitis
- occurs in pts with reactive arthritis - one of leading causes of preventable vision loss - progresses over a few hours
26
si/sx of anterior uveitis
- red eye - pain worse with reading - blurred vision - photophobia - excessive tear production - abnormally shaped pupil
27
juvenile idiopathic arthritis (JIA)
- kids < 16 y/o - chronic inflammation of connective tissue - pain and swelling - can impact one or many joints - duration > 6 weeks
28
si/sx of JIA
- often have fever and rash that is similar to SLE - joint inflammation - contractures - joint damage - leads to decreased mobility, strength, endurace - episodic- go from sx free to extreme pain quickly
29
subtypes of JIA
- systemic onset arthritis - polyarticular arthritis - oligoarticular arthritis - enthesis
30
systemic onset arthritis
- subtype of JIA - arthritis and fever > 103 - fluctuating rash - inflammation of internal organs and joints - anemia and leukocytosis
31
polyarticular arthritis
- subset of JIA - arthritis in 5 or more joints - constant pain
32
oligoarticular arthritis
- subset of JIA - arthritis in 4 or fewer joints - if dx before 7 have best chance of disease subsiding - high risk uveitis
33
enthesis related arthritis
- subtyle of JIA - involves ligaments as well as spine - aka sondyloarthritis
34
treatment for JIA
- refer to rheum - sx control - intra-articular steroid injection if only a few joints involved - PO prednisone - DMARDS +/- biologics
35
polymyositis
- immune mediated - inflammation of muscles and associated tissues in response to cell damage - bilateral muscle weakness
36
associated diseases with polymyositis
- raynauds - RA - SLE - Sjorgens - CV disease - cancer
37
sx of polymyositis
- proximal muscle weakness - dysphagia - bloating, constipation - arrythmias and conduction defects - pulmonary and kidney involvement
38
diagnosis of polymyositis
- CBC, ESR, elevated CK and LDH - elevated liver enzymes - ANA - EMG - muscle biopsy
39
treatment of polymyositis
- steroids 4-8 weeks - monitor CK lev and muscle strenth - immunosuppressives if no response to steroids or extra-skel manifestations - IVIG - TNF inhibitors - consult
40
dermatomyositis
- heliotrope rash and grotton papules - muscle weakness - capillary loops at base of fingernails- "dirty look"
41
heliotrope rash
- sx of dermatomyositis - purple discoloration on upper eyelids - flat red rash on cheeks and trunk
42
gottron papules
- sx of dermatomyositis | - scaly rash on knuckles
43
muscle biopsy for dermatomyositis
- shows perivascular and perimysial inflammation
44
inclusion body myositis
- asymmetrical distal muscle weakness - more common in older men - falls common - facial muscle weakness - dysphagia and choking - progresses slowly so may be confused with MD
45
treatment of inclusion body myositis
- resistant to immunotherapy | - axathioprine + prednisone often tried for a few months
46
treatment of dermatomyositis
- same as polymyositis
47
livedo reticularis
- reticular/ lace like pattern on skin - cyanotic discoloration of skin - found mainly on arms and legs - d/t altered flow in BV feeding skin -> dilation of other vessels to compensate
48
giant cell arteritis
- aka temporal arteritis - large vessel disease - most common of systemic vasculitis - in older adults - strong association with PMR
49
clinical manifestations of giant cell arteritis
- new onset HA and temporal tenderness - jaw claudication - abrupt onset visual disturb - thoracic aortic aneurysm possible
50
classification criteria for giant cell arteritis
- need at least 3 of the following 5: - age > 50 - new onset localized HA - tenderness or decreased pulse of temporal artery - ESR > 50 (often >70) - biopsy of temporal artery with necrotizing arteritis and giant cells
51
diagnosis of giant cell arteritis
- gold standard= temporal a. biopsy - scheduling biopsy should not interfere with tx - color doppler US, CT, MRI
52
treatment of giant cell arteritis without vision loss
- prednisone as single dose - taper to d/c steroids- drop by 10% - treatment can last 12-16 months - also give low dose ASA
53
treatment of giant cell arteritis with vision loss
- methylprenisolone IV X 3 days then PO prednisone - taper to d/c steroids- drop by 10% - treatment can last 12-16 months - also give low dose ASA
54
Takayasu Arteritis
- large vessel disease - inflammation of aorta and its branches - mainly females, usually younger - classically asian woman in 40s
55
clinical presentation of takayasu arteritis
- look chronically ill with constitutional sx - pulselessness - extremities are cool, dev arm or leg claudication - subclavian steel syndrome - myalgias and lg joint synovitis - bruits - HTN - elevated ESR and CRP - HA and vision loss
56
dx of takayasu arteritis
- elevated ESR and CRP - MRI, CT, angiogram - normochromic normocytic anemia
57
treatment of takayasu arteritis
- acute- steroids | - chronic- surgical bypass once arterial stenosis has occured
58
polyarteritis nodosa (PAN)
- necrotizing vasculitis of medium +/- sm vessels - systemic sx: kidneys*, skin, joints, muscles, nerves, GIT - NO lung involvement* - not associated with ANCA - middle aged/ older men - associated with HBV and HCV
59
clinical manifestations of PAN
- nonspecific constitutional sx - often have HTN d/t renal disease - skin rash/ ulcers: purpura, livedo reticularis - peripheral neuropathies - renal sx - GIT sx
60
diagnosis of PAN
- elevated ESR - UA shows proteinuria - biopsy if skin, muscle, or nerve involvement - nerve conduction study if nerve involvement
61
classification criteria for PAN
- need at least 3 of the following: - unexplained wt loss > 4 kg - myalgias/ weakness - mono or polyneuropathy - new onset diastolic > 90 mmHg - elevated BUN
62
treatment for mild PAN
- prednisone PO X 4 weeks | - taper to d/c
63
treatment for mod-severe PAN
- prednisone PO plus cyclophosphamide Q 2 weeks for three doses
64
treatment for severe PAN
- methylprednisolone IV X 3 days then PO steroids
65
kawasaki disease
- medium vessel disease - most common in kids* - fever > 5 days* - coronary artery involvement -> aneurysm if untreated
66
clinical presentation of kawasaki disease
- fever > 5 days - bilat bulbar conjuctival injection - oral mucous membrane changes - polymorphous rash - cervical LD - peripheral extremity changes - need at least four of five listed plus fever to dx
67
diagnosis of kawasaki
- fever plus 4/5 of sx - get baseline echo + every 2-6 weeks - no labs
68
treatment of kawasaki
- IVIG single infusion over 8-12 hours - ASA 30-50 mg/kg X 4 doses until fever is gone for 48 hours - continue with low dose ASA - postpone live vaccines for at least 11 mo if pt has had IVIG
69
microscopic polyangiitis
- small vessel disease - necrotizing vasculitis with few/no immune deposits - +/- medium vessels - most common cause of pulmonary renal syndrome
70
clinical presentation of microscopic polyangiitis
- purpura - pulmonary hemorrhage* - interstitial lung fibrosis - ulcers - splinter hemorrhages
71
diagnosis of microscopic polyangiitis
- elevated ESR - positive ANCA - UA- hematuria, proteinura, RBC casts - CT
72
treatment of microscopic polyangiitis
- cyclophosphamide PO plus prednisone for 3-6 mo - key to good outcome is early dx - recurrence possible
73
granulomatosis with polyangiitis
- aka wegner's disease - necrotizing vasculitis of small vessels - +/- medium vessels - common in 40s/50s - ANCA associated
74
clinical presentation of granulomatosis with polyangiitis
- triad of upper and lower respiratory sx and glomerulonephritis - constitutional sx - crusting, ulceration, bleeding, and perf of nasal septum - proptosis, ptosis, opthalmoplegia - scleritis
75
upper RT sx associated with granulomatosis with polyangiitis
- nasal congestion - sinusitis - otitis media - mastoiditis
76
lower RT sx associated with granulomatosis with polyangiitis
- cough - dyspnea - hemoptysis
77
diagnosis of granulomatosis with polyangiitis
- elevated ESR and CRP - slight anemia and leukocytosis - UA shows proteinura and red cell casts - CXR followed by chest CT
78
treatment of granulomatosis with polyangiitis
- cyclophosphamide plus prednisone | - continue for 3-6 mo
79
IgA vasculitis
- aka Henoch-Schonlein - small vessel disease - affects skin, GIT, kidneys - found in kids** - generally self limited, cause unknown
80
clinical presentation of IgA vasculitis
- purpura (all) - arthralgia/arthritis in lower extremity large joints - abdominal pain- possible intussusception - renal disease- hematuria without RBC
81
classification of IgA vasculitis
- MUST have purpura and at least one of the following: - abdominal pain - arthritis - renal involvement - leukocytoclastic vasculitis or proliferative glomerulonephritis with IgA deposition
82
diagnosis of IgA vasculitis
- clinical | - based on purpura plus at least one other cardinal sx
83
treatment of IgA vasculitis
- supportive/ symptomatic - oral hydration - NSAIDs (naproxen) for joint/ abdominal pain - if severe abdominal pain and decreased PO intake give them prednisone
84
behcet disease
- variable vessel disease - triad of aphthous ulcers, genital ulcers, recurrent eye inflammation - HLA-B51 risk factor
85
clinical presentation of behcet disease
- aphthous ulcers- numerous, frequent, more painful - genital ulcers - anterior and/or posterior uveitis - lungs- aneurysms - GIT ulcers
86
treatment of behcet disease
- steroids - colchicine and thalidomide for mucocutaneous findings - cyclophosphamide if severe ocular or CNS sx

Clin Med I (16 decks)

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