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Systems Exam 1 > Rheumatologic and CT disorders: Medical Management > Flashcards

Rheumatologic and CT disorders: Medical Management Flashcards

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1
Q

what are the main characteristics of Rheumatoid Arthritis?

A
  • autoimmune disease
  • symmetric inflammation
  • more prevalent in woman 3:1
  • effects the synovial membranes
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2
Q

what are the important clinical features of Rheumatoid Arthritis?

A
  • systemic polyarthritis involving SMALL joints of hands, feet, wrists and ankles
  • prolonged morning stiffness (>1 hour)
  • 75% of RA patients have TMJ that is BILATERAL
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3
Q

How do you diagnosis RA and what are the criteria?

A

must have symptoms for 6 or more weeks and 4 out of 7 criteria must be met:
* Morning stiffness
* Arthritis of three of more joints
* Arthritis of hand joints
* Symmetric arthritis
* Rheumatoid nodules
* Serum rheumatoid factor
* Radiographic changes

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4
Q

what are the important laboratory findings for RA?

A
  • RHEUMATOID FACTOR: positive in 85% of patients
  • elevated ESR
  • C reactive proteins
  • Antibodies to cyclic citrullinated proteins (CCPs)-70-80%
  • Hypochromic, microcytic anemia
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5
Q

what are two main extra-articular manifestations for RA?

A
  • subcutaneous nodules
  • Sjogren Syndrome
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6
Q

How do you approach treatment for RA?

A

No cure so you try to
- control the disease
- preserve function
- improve outcome

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7
Q

What are the treatment options for RA?

A
  • NSAIDS/Aspirin
  • glucocorticoids
  • DMARDS
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8
Q

why are DMARDS important for RA progression?

A

can be helpful in slowing down the damaging component of the disease process

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9
Q

what are the main characteristics of Osteoarthritis?

A
  • degenerative disorder without systemic manifestations
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10
Q

what are the important clinical features of osteoarthritis?

A
  • morning stiffness is brief
  • minimal inflammation
  • MORE FAVORABLE prognosis and less severe complications
  • PAIN and DISABILITY are main complications
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11
Q

how is osteoarthritis diagnosed?

A
  • history, signs, symptoms
  • radiographs (joint space narrowing)
  • lab tests are unremarkable
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12
Q

what are the treatment options for osteoarthritis?

A
  • analgesics
  • Intra-articular injections (steroids)
  • physical therapy
  • SURGERY is an option
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13
Q

what are the two types of Lupus Erythematous and the main characteristics of Lupus Erythematous?

A
  • Discoid (can be confused with psoriasis)
  • Systemic (main)
  • chronic idiopathic inflammatory autoimmune disease
  • more common in woman, AA and hispanics
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14
Q

what are the main clinical features of Systemic Lupus Erythematous?

A
  • poor prognosis with renal involvement
  • classic BUTTERFLY RASH (SLE) - 90% of patients
  • always relapses
  • thromboembolism’s associated with antiphospholipid antibodies
  • Libman-Sacks endocarditis - 50% of patients
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15
Q

what are the laboratory findings for Systemic Lupus Erythematous?

A

Antinuclear antibody (ANA): best screening test
* Positive in 95% (sensitive but not specific)
* Also positive in other rheumatologic disease

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16
Q

what are the treatments for Systemic Lupus Erythematous?

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A
  • No cure; treatment is symptomatic or palliative
  • Avoid sun exposure: may trigger disease
  • NSAIDS - synovitis and mild systemic illness
  • Antimalarials - synovitis and cutaneous disease
  • Corticosteroids – moderate to severe systemic disease
  • Immunosuppressives - severe disease
17
Q

what are the 3 stages of Lyme disease?

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A
  1. Early Localized: erythema migrans
  2. Early Disseminated: cannot be detectible bc antibodies not made yet
  3. Late Disease: May not be preceded by earlier manifestations
    * Musculoskeletal problems
    * Neurologic manifestations: tertiary neuroborreliosis
18
Q

how is Lyme Disease diagnosed?

Study These Flashcards
A
  • Clinical findings
  • Serologic testing
  • Enzyme-linked immunosorbent assay (ELISA)
  • Confirm with Western blot analysis
19
Q

What are the treatments for Lyme Disease?

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A

Antibiotic therapy is effective
* Treatment with early symptoms usually prevents progression
* Oral doxycycline 100 mg BID for 3 to 4 weeks (adults)
* Tetracycline or amoxicillin (250 to 500 mg QID) alternatives (kids)

20
Q

what is scleroderma?

Study These Flashcards
A
  • also called systemic sclerosis
  • rare, chronic autoimmune disease
  • causes inflammation & tissue changes like skin tightening
21
Q

what are the two types of systemic scleroderma?

Study These Flashcards
A
  • Limited: CREST Syndrome
  • Diffuse
22
Q

what are the clinical presentations of CREST syndrome from limited systemic scleroderma?

Study These Flashcards
A
  • Calcinosis
  • Calcium salts form nodules
  • Raynaud’s phenomenon
  • Lack of blood flow to parts of your body such as your fingers, toes, or nose, usually because of cold
  • Esophageal dysfunction
  • Sclerodactyly
  • Thickening of the skin
  • Telangiectasia
  • Small blood vessels grow near the surface of your skin
23
Q

what is Sjögren Syndrome (SS)?

Study These Flashcards
A

Chronic autoimmune inflammatory disorder that affects salivary and lacrimal glands
** second most common rheumatoid disorder
** “Sicca complex”: dry eyes and dry mouth

24
Q

what is the triad of clinical conditions for Sjögren Syndrome (SS)?

Study These Flashcards
A

keratoconjunctivitis sicca, xerostomia & a connective tissue disease (usually RA)
- Eye dryness, hyposalivation, and enlargement of parotid glands

25
how is Sjögren Syndrome (SS) diagnosed?
no single test - lab findings - sialometry - imaging
26
what are the treatment options for Sjögren Syndrome (SS)?
no known cure, therapy for oral component of SS may be classified into three major categories: 1. Provision of moisture and lubrication by stimulation or simulation 2. Treatment of secondary mucosal conditions (such as mucositis or candidiasis) 3. Prevention of oral disease, provision of maintenance and general support (such as nutrition)
27
what is fibromyalgia?
most common cause of chronic pain in US that affects up to 4% of population, primarily women * Chronic (several years) diffuse (muscle) pain accompanied by fatigue, sleep disturbance, and neuropathies
28
what are the symptoms of fibromyalgia?
* Body aches * Chronic facial muscle pain or aching * Fatigue * Irritable bowel syndrome * Memory difficulties and cognitive difficulties * Multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hips, shins, elbows, knees * Numbness and tingling * Palpitations * Reduced exercise tolerance * Sleep disturbances * Tension or migraine headaches **** must have 11 out of 18
29
what are the treatment options for fibromyalgia?
* Medications-amitriptyline, trazodone, or nortriptyline * SSRIs such as fluoxetine exhibit a modest pain benefit * Anticonvulsant medications such as gabapentin, topiramate, or pregabalin are effective and are being utilized more frequently * Opioids
30
What is Ehlers-Danlos Syndrome (EDS)?
- Ehlers-Danlos Syndrome (EDS) is a group of 13 connective tissue disorders affecting 1 in 5000 people - has a 50% inheritance rate but can also occur spontaneously - involves mutations in COL genes and lysyl hydroxylase
31
what are its key features of Ehlers-Danlos Syndrome (EDS)?
- common symptoms include loose skin, joint dislocations, poor wound healing, vascular fragility, and easy bruising.
32
What is the Beighton Scoring System and how is it used?
a method to measure joint hypermobility in EDS It consists of 5 tests: - 5th Finger: Can it bend beyond 90°? - Thumb: Can it touch the forearm? - Elbows: Can they hyperextend more than 10°? - Knees: Can they bend backwards? - Spine: Can you place palms on the floor without bending knees? ***A score of 4 or more indicates significant hypermobility.
33
What are the types of pain and the role of opioids in Ehlers-Danlos Syndrome (EDS) management?
- Nociceptive Pain: Soft tissue injuries, dislocations, arthralgia, myalgias, myofascial pain. - Neuropathic Pain: Compression and peripheral neuropathy. - Dysfunctional Pain: Regional pain syndromes, abdominal pain, dysmenorrhea, dyspareunia ***Opioids: Recommended only for moderate to severe pain and should be used for a short duration due to risks of dependency.
34
What is Amyloidosis, and what are its key features?
a group of diseases where abnormal protein called amyloid fibrils build up in tissues - Common symptoms include diarrhea, weight loss, fatigue, tongue enlargement, bleeding, numbness, leg swelling, and spleen enlargement
35
What are the four main types of Amyloidosis?
- AL (Light Chain) - Associated with plasma cell disorders - AA (Inflammatory) - Linked to chronic inflammation - Aβ₂M (Dialysis) - Occurs with long-term dialysis - ATTR (Hereditary and Age-Related)
36
How is Amyloidosis diagnosed and treated?
- requires a tissue biopsy - Treatment focuses on reducing amyloid production through chemotherapy, stem cell transplantation, and steroids. **Without treatment, life expectancy ranges from 6 months to 4 years.
37
What is Ankylosing Spondylitis and who is most commonly affected?
- an inflammatory arthritis that causes pain and stiffness in the lower back, buttocks, and hips - It develops slowly over weeks or months, primarily affecting young adults, with males being more commonly affected than females
38
What genetic marker is associated with Ankylosing Spondylitis, and how is it diagnosed?
- 90% of those with Ankylosing Spondylitis carry the HLA-B27 antigen - Diagnosis is based on symptoms, imaging, and blood tests - It is classified as a seronegative spondyloarthropathy, which means there is no rheumatoid factor (RF) present
39
What are the main treatments for Ankylosing Spondylitis?
there is no cure, treatment focuses on medication, exercise, and surgery. - Medications include NSAIDs, steroids, DMARDs (like sulfasalazine), and biologic agents such as infliximab to manage symptoms and prevent progression

Systems Exam 1 (20 decks)

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