Rheum Medical Management

Question 1

Is rheumatoid arthritis autoimmune?

Answer 1

Yes

Question 2

RA is characterized by

Answer 2

Symmetric inflam of joints, especially hands, feet and knees

Question 3

What membranes are affected by RA?

Answer 3

Synovial membranes of joints

Question 4

What are the clinical features of RA?

Answer 4

• Insidious onset
• Symmetric polyarthritis involving small joints
• Prolonged stiffness
• Joint damage progresses to immobility, contractures, etc
• TMJ involved in many cases
  -Ulnar deviation and swan neck deformity

Question 5

RA diagnosis

Answer 5

4 of 7 criteria met:

• Morning stiffness
• Arthritis of 3+ joints
• Arthritis of hands
• Symmetric arthritis
• Rheumatoid nodules
• Serum rheumatoid factor
• Radiographic changes

Question 6

Lab findings of RA

Answer 6

• Rheumatoid factor
• Elevated ESR
• C reactive protein
• Hypochromic, microcytic
• Antibodies to cyclic citrullinated proteins

Question 7

RA can radiographically show

Answer 7

erosions

Question 8

Treatment approach for RA

Answer 8

• Control disease to reduce pain and inflam
• Preserve function
• Improve outcome and prevent deformity

Question 9

DMARDs can be helpful in

Answer 9

slowing down the damaging component of RA

Question 10

DMARDS help change

Answer 10

the natural histroy of disease

Question 11

What is osteoarthritis?

Answer 11

Degenerative disorderwithout systemic manifestations

Question 12

Is there morning stiffness in osteoarthritis?

Answer 12

Very brief (pain relieved by rest)

Question 13

Is there inflammation in osteoarthritis?

Answer 13

Minimal

Question 14

Which has more favorable prognosis, RA or OA?

Answer 14

OA

Question 15

Common presentations of OA include

Answer 15

Heberden’s nodes and Bouchard’s nodes

Question 16

Lab testing for OA

Answer 16

ESR is usually normal

Unremarkable

Question 17

OA radiographs

Answer 17

• Joint space narrowing
• Articular surface irregularities
• Remodeling: osteophytes, spurs
• Subchondral sclerosis
• Ankylosis

Question 18

Treatment options for OA

Answer 18

• Analgesics (Acetaminophen)
• Intra-articular injections (steroids and viscosupplements)
• PT
• Surgery (joint replacement)

Question 19

Discoid lupus predominantly affects what?

Answer 19

the skin

Question 20

Is SLE autoimmune?

Answer 20

Yes

Question 21

In SLE, antibodies are directed against what?

Answer 21

Cell nuclei

(pathogenic antibodies and immune complexes result in inflam and vasculopathy)

Question 22

Clinical presentation of SLE

Answer 22

• Butterfly rash
• Malaise, overwhelming fatigue, fever, weight loss, polyarthritis
• Ulcerations of buccal mucosa

Question 23

Other manifestations of SLE

Answer 23

• Recurrent noninfectious pharyngitis, oral ulcers
• Renal abnormalities
• Neuropsychiatric symtpoms (Thromboembolism associated with antiphospholipid antibody)
• Pulmonary manifestations (pleuritis, edema)
  -libman-Sacks endocarditis

Question 24

What is the best screening test for SLE?

Answer 24

Antinuclear antibody (ANA)

Question 25

SLE: Antiphospholipid antibdoies can cause

Answer 25

thrombosis and fetal loss

Question 26

Medical management of SLE

Answer 26

- No cure - Avoid sun exposure - NSAIDs (synovitis and mild systemic illness) - Antimalarials (synovitis and cutaneous illness) - Corticosteroids - Immunosuppressives

Question 27

Classical pattern of lyme disease

Answer 27

macular skin rash (erythema migrans)

Question 28

Late disease of Lyme inslcudes what types of problems?

Answer 28

- Musculoskeletal problems (intermittent, migratory poly arthritis) - Neurologic (tertiary neuroborreliosis)

Question 29

Lyme Dz treatments include

Answer 29

- Antibiotics (doxy for adults, amoxicillin for children)

Question 30

What does scleroderma cause?

Answer 30

Skin tightening and weakening, can affect joints, muscles, heart, lungs, kidneys, BVs or intestines

Question 31

What is the limited scleroderma type?

Answer 31

CREST syndrome Calcinosis Raynaud's Esophageal dysfunction Sclerodactyly Telangiectasia

Question 32

What does Sjogren syndrome affect?

Answer 32

Salicary and lacrimal glands

Question 33

Sjogren syndrome is characterized by

Answer 33

a triad of clinical conditions (keratoconjunctivitis sicca, xerostomia and CT disease)

Question 34

What is Sicca complex?

Answer 34

Dry eyes and dry mouth

Question 35

What is the second most common rheumatoid disorder?

Answer 35

Sjogren syndrome

Question 36

Clinical presentation of Sjogren Syndrome

Answer 36

Dry eyes, hyposalivation and enlargement of parotid glands

Question 37

Sjogren syndrome laboratory findings

Answer 37

- Hypergammaglobulinemia - Increased RF - Increased ANA - Elevated ESR, mild anemia

Question 38

What are the 3 categories of managing the oral symptoms of Sjogren syndrome?

Answer 38

1. Provision of moisture and lubrication 2. Tx of secondary mucosal conditions 3. Prevention of oral disease

Question 39

Mr. Jones presents with an abnormally high number of dental carries. He reports having increasingly dry eyes and mouth. He was recently diagnosed with rheumatoid arthritis. What is the most likely cause of his dental carries?

Answer 39

Sjogren syndrome

Question 40

What is fibromyalgia?

Answer 40

Chronic diffuse muscle pain accompanied by fatigue, sleep distrubrance and neuropathies

Question 41

What is amyloidosis?

Answer 41

Group of diseases in which abnormal protein called amyloid fibrils, build up in tissue

Question 42

What are symptoms of amyloidosis?

Answer 42

Diarrhea, weight loss, feeling tired, enlargement of tongue, bleeding, numbness, feeling faint with standing, swelling of leds or enlargement of the spleen

Question 43

Diagnosis of amyoidosis requires

Answer 43

tissue biopsy

Question 44

Amyloidosis treatment is geared towards

Answer 44

decreasing the amount of the involved protein (high doses of chemo or stem cell transplant or steroids)

Question 45

What is ankylosing spondylitis?

Answer 45

Inflammatory arthritis that causes pain in joints and ligaments

Question 46

Symptoms of ankylosing spondylitis

Answer 46

Chronic pain and stiffness in lower back, buttocks and hips

Question 47

Who does ankylosing spondylitis affect the most?

Answer 47

Young males

Question 48

Treatments for ankylosing spondylitis

Answer 48

Medication, exercise and surgery (NSAIDs, steroids, DMARDs)

Question 49

What is the antigen involved in ankylosing spondylitis?

Answer 49

HLA-B27