Rheumatologic conditions

Question 1

Who does CFS primarily affect

Answer 1

F>M
average age: 29-35
occurs more frequently among minority populations and those with a lower social-economical status and education level are at a higher risk

Question 2

what is the pathophysiology of CFS

Answer 2

unclear underling pathophysiology - diagnosis of exclusion

Question 3

what is fatigue

Answer 3

described as weakness, tiredness and lethargy

Question 4

what are the clinically concerning factors of fatigue

Answer 4

difficulty initiating activities
difficulty completing activities
memory and concentration difficulties

Question 5

how is CFS diagnosed

Answer 5

with exclusion criteria - there are no objective physical exam findings.

requires 6 months of fatigue and all self reported symptoms

Question 6

what are we ruling out when trying to determine CFS

Answer 6

ruling out medical or psychiatric conditions that might be causing fatigue

Question 7

what is the treatment of choice for CFS

Answer 7

cognitive behavioral therapy and graded exercise

Question 8

what is cognitive behavioral therapy (CBT)

Answer 8

psychotherapy technique aimed at changing throught/behavior

Question 9

what is Graded exercise therapy (GET)

Answer 9

home exercise program to improve conditioning and exercise tolerance

Question 10

what are alternative treatment options for CFS

Answer 10

remaining active, physically and socially.
treat any co-occurring anxiety or affective disorders (common)

Question 11

what is typically unhelpful in CFS treatment

Answer 11

medications

Question 12

What is the common patient presentation of fibromyalgia

Answer 12

affects 3-10% of the population
F>M
average age: 20-50

Question 13

what is the pathophysiology of Fibromyalgia

Answer 13

underling pathophysiology unknown
? abnormal pain perception, ? related to sleep disorder, ? depression, ? viral infectious etiology

Question 14

what is the typically fibromyalgia presentation

Answer 14

MSK pain and impairment in functioning

chronic, achy pain and stiffness that usually involves the neck, shoulder, low back and hips

associated with
fatigue, sleep disturbances, subjective numbness, headache, IBS

Question 15

How many tigger pints to diagnose fibromyalgia

Answer 15

11 of the 18 trigger points PLUS widespread chronic pain

Question 16

how is fibromyalgia diagnosed

Answer 16

symptoms for more than 3 months
there is no specific imaging or lab testing

rule out: amemia, thyroid abnormalities, electrolyte abnormalities

Question 17

what are the 5 approaches to the treatment of fibromyalgia

Answer 17

1. patient education
2. non-pharmacologic options
3. pharmacologic options
4. treat any co-morbid conditions
5. identify any available community resouces

Question 18

what falls under patient education for fibromyalgia treatment

Answer 18

treatments can improve the symptoms, disease is not progressive, ID most distressing symptoms, Set treatment expectations (not complete relief of symptoms)

Question 19

what falls under non-pharmacologic options for the treatment of fibromyalgia

Answer 19

mindfullness and meditation, exercise, sleep hygiene

managing their pain and function

Question 20

What are the pharmacologic options for treating fibromyalgia

Answer 20

amitriptyline for sleep, fatigue, and chronic pain
gabapentin/pregabalin for pain
muscle relaxants with one of the above for sleep and pain
tramadol and tylenol for pain

Question 21

what pharmacologic aids are unhelpful for fibromyalgia

Answer 21

NSAIDs and opioids

Question 22

What is polymyositis

Answer 22

chronic muscle inflammation and weakness

typically symmetric and proximal

Question 23

what is the typical patient presentation with polymyositis

Answer 23

F>M
average age: 50-60
african americans > caucasians

Question 24

what are patients diagnosed with polymyositis at an increased risk for

Answer 24

malignancy

Question 25

what is the typical presentation of polymyositis

Answer 25

progressive proximal muscle weakness that usually starts in the LE and moves to UE and neck NO facial or ocular weakness but may include myocarditis, lung and joint involvement

Question 26

what can polymyositis be coupled with

Answer 26

a dermatomyositis - rash that is dusky red in color and commonly involves one or more of the following: face, upper chest, back, neck and shoulders

Question 27

what are other skin findings in dermatomyositis

Answer 27

heliotrope rash - periorbital edema and rash over eyelids Gottron papules - raised violaceous lesions on extensor surfaces of DIP, PIP and MCP joints Gotton sign - erythematous rash on the extensor surface of fingers, elbows and knees

Question 28

What is the most specific lab test for polymyositis

Answer 28

Creatinine kinase (CK) - elevated in all patients

Question 29

What is the gold standard for diagnosis of polymyositis

Answer 29

muscle biopsy - endomysial and perivascular inflammation

Question 30

What is the mainstay treatment for polymyositis

Answer 30

oral corticosteroids at a high dose (prednisone) and then taper down if symptoms persist - MTX hydroxychloroquine for the dermatomyositis rash and avoid the sun

Question 31

What is the patient population for polymyalgia rheumatica

Answer 31

disease of older adults - most common rheum disease diagnosed in older adults over 50 F>M predilection for patients of scandinavian descent

Question 32

what is the pathophysiology of polymyalgia rheumatica

Answer 32

a vasculitis - inflammation of the vessel walls that predominately affects the medium sized vessels that is believed to be autoimmune associated with HLA gene

Question 33

what is the presentation of PMR

Answer 33

muscular pain and stiffness that is typically present int he shoulder and pelvic girdle NO MUSCLE WEAKNESS often associated with fever, malaise and weight loss in the early presentation

Question 34

How is PMR diagnosed

Answer 34

primarily clinical and no imaging is necessary labs can be supportive with elevated ESR, CPR and most patient have associated anemia

Question 35

how do we treat PMR

Answer 35

corticosteroids - low dose - should see affect within 72 hours - if not reconsider diagnosis

Question 36

What is giant cell arterities

Answer 36

also known as temporal arteritis throught to be part of the same disease spectrum as PMR and is also a vasculitis but affects medium AND LARGE vessels

Question 37

What is associated with giant cell arterities

Answer 37

unclear association with varicella zoster antigen

Question 38

how does Giant cell arteritis present

Answer 38

headache, scalp tenderness, visual disturbances (amaurosis fugax), throat pain, JAW CLAUDICATION and associated fever

Question 39

what is Amaurosis fugax

Answer 39

sudden monocular vision loss, partial or complete CURTAIN COMING DOWN - can lead to blindness

Question 40

What is the presentation of giant cell ateritis

Answer 40

temporal artery usually normal to palpation but nodular, enlarged, tender and pulseless

Question 41

what are patients with GCA at greater risk for

Answer 41

17x their risk of thoracic aortic aneurysm

Question 42

what is the gold standard for GCA

Answer 42

temporal artery biopsy

Question 43

how is GCA treated?

Answer 43

corticosteroids are first line (high dose) but urgent biopsy necessary if vision loss - IV methypred.

Question 44

What is the difference between Raynauds phenomenon and raynauds disease

Answer 44

raynauds phenomenon tends to be more severe and associated with CT diseases, unilateral (asymmetric), quicker progression, skin changes (ulcerations/gangrene), abnormal allens test Raynauds disease is idiopathic and the more common form, symmetric bilaterally, slower progression, no skin changes, peripheral pulses present, negative allens test

Question 45

What is the progression of Raynauds

Answer 45

White, blue, red Vasospasm - lack of blood flow (white) lack of arterial flow - cyanosis (blue) resolution of vasopasm and reprofusion - rebound hyperemia (Pink/red)

Question 46

What is the treatment for raynauds

Answer 46

lifestyle modifications prevention of attacks, avoiding cold exposure, warm clothing, avoid smoking and vasoconstrictive drugs and injuries to your hands