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Rheumatological 2 Flashcards

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1
Q

Infectious arthritis

- pathophys

A
  • bacterial or fungal infection of joint
  • Hematogenous seeding (MC), direct inoculation, contiguous spread from osteomyelitis, cellulitis, or septic bursitis
  • bacteria trigger inflammatory response of neutrophilic infiltration into joint space
  • can rapidly progress to joint damage
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2
Q

Infectious arthritis

- dx

A
  • joint aspiration: gram stain, fungal stain, culture, acid fast stain (TB), crystal analysis
  • If suspect GC, gram stain and culture anus, urethra, cervix, and pharynx also
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3
Q

Risk factors for infectious arthritis (10)

A
  • age
  • alcoholism
  • cutaneous lesions
  • dm
  • ESRD
  • hx steroid injections
  • IVDU
  • immunosuppresant
  • sickle cell
  • malignancy
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4
Q

Infectious arthritis

- common bugs

A
  • staph aureus (MC)
  • strep pneumo
  • gonococcal (MC female)
  • non-gonococcal gram negs (MC in immunosuppressed)
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5
Q

Why is gonococcal infection in joint more common in females

A
  • males with GC have dysuria = treatment
  • females dont’ have obvious sx, infection travels from vagina to cervix to uterus to fallopian tubes without obv sx, longer time to get in blood
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6
Q

What is presentation of GC infectious arthritis

A
  • acute arthritis
  • fever
  • skin lesions (vesiculopustular, hemorrhagic macules)
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7
Q

5 MC fungus in infectious arthritis

A
  1. coccidiodes
  2. sporothrix
  3. cyptococcus
  4. blastomyces
  5. candida
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8
Q

Viral infections associated with infectious arthritis

A
  1. HBV
  2. HCV
  3. Parvovirus B19 (Fifth disease)
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9
Q

What can both HBV and HCV cause in addition to infectious arthritis

A

polyarthritis in the prodromal phase of the hep virus

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10
Q

Describe presentation of Fifth disease infectious arthritis

A
  • aka erythema infectiosum
  • acute arthritis
  • usually young people
  • resembles acute RA without the antibodies
  • fever
  • slapped cheek erythematous rash
  • tx: supportive care
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11
Q

Chikungunya

- describe pathogen

A
  • type of infectious arthritis
  • virus endemic to asia/africa
  • transmitted via mosquitos
  • in US from travelers
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12
Q

Chikungunya

- sx

A
  • fever
  • myalgia
  • thrombocytopenia
  • leukopenia
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13
Q

Chikungunya

- dx

A
  • travel hx

- IgM anti-chikungunya antibodies

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14
Q

Idiopathic inflammatory myopathies (IIMs)

- describe

A
  • autoimmunity and inflammatory involvement of muscle fibers

- result in muscle weakness

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15
Q

What are the three Idiopathic inflammatory myopathies (IIMs)

A
  1. Polymyositis (PM)
  2. Dermatomyositis (DM)
  3. Inclusion body myositis (IBM)
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16
Q

Idiopathic inflammatory myopathies (IIMs)

- pathophysiology of each subtype

A
  1. PM: CD8-positive T cell mediated immune disease = direct myocyte injury
  2. DM: immune complex dz with vascular inflammation, cutaneous findings
  3. IBM: mho-degenerative dz with vacuoles in muscle cells and related t-cell response
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17
Q

Idiopathic inflammatory myopathies (IIMs)

  • common sx
  • antibodies
A
  • fatigue, wt. loss, fever

- Anti-jo-1 antibodies (acute onset)

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18
Q

What is antisynthetase syndrome?

A
  • Anti-jo-1 antibodies with m weakness, pain and 2+ of:
  • inflammatory myositis
  • interstitial lung dz
  • Raynaud
  • non-erosive inflammatory arthritis
  • mechanics hands
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19
Q

Dermatomyositis cutaneous manifestations

A
  • Gottron sign/papules: symmetric erythematous violaceous macules, patches on extensor surface of hand
  • Heliotrope rash on sun exposed surfaces (upper eyelid)
  • shawl sign on back (sun)
  • v sign on chest (sun)
  • mechanics hands
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20
Q

How to diagnose idiopathic inflammatory myopathies

A
  • Hx and exam
  • muscle enzymes: Ck, aldolase, AST
  • electromyography
  • auto-antibodies (lots)
  • MRI: active muscle inflammation
  • Muscle bx
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21
Q

4 meds that can cause idiopathic inflammatory myopathies

A
  • cochicine
  • hydroxychloriquine
  • glucocorticoids
  • statins
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22
Q

idiopathic inflammatory myopathies

- management

A
  • high dose glucocoricoids initially, then taper to low dose
  • immunosuppressants
  • Rheumatology referral
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23
Q

Systemic Vasculitis

- describe

A
  • inflammation of arteries, veins, capillaries
  • small, large, intermediate size vessels
  • r/o the many secondary causes
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24
Q

Two types of large vessel vasculitis

A
  1. giant cell arteritis

2. takayasu arteritis

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25
Giant cell arteritis - incidence - M vs. F - age
- MC primary vasculitis - F > M - 70 av age of onset
26
Giant cell arteritis | - commonly affected
- MC temporal - carotids - ciliary ophthalmic
27
Giant cell arteritis | - pathyophysiology
- dendritic cells in vessel adventitia are activated & recruit T cells and monocytes to vessel wall - Macrophages coalesce and form giant cells - cells secrete metalloproteinases = disrupt vessel wall - Intimal proliferation = vessel closure, ischemia, dead tissue
28
Giant cell arteritis | - sx
- scalp pain - HA - tenderness over temporal artery - jaw claudication - temp blindness - diplopia
29
Giant cell arterities | - dx tests
- VERY high sed rate (>70) | - temporal artery bx
30
Giant cell arteritis | - tx
- glucocorticoids | - high dose at first, then taper down
31
What co-morbidity is often found with giant cell arteritis
- polymyalgia rheumatica
32
Takayasu arteritis - what vessels affected - who does it MC affect
- aorta and its main branches | - young women
33
Takayasu arteritis | - presentation
- s/s inflammatoin | - PE findings of vascular disease: decreased pulse, asymmetrical pulse, BP, bruits
34
Takayasu arteritis | - dx
- angiography: aneurysms and narrowing of affected arteries
35
Takayasu arteritis | - tx
- high dose steroids
36
3 medium sized vasculitis
- polyarteritis nodosa - primary angiitis of CNS - Kawasaki dz
37
Polyarteritis nodosa | - incident
- rare - m = f - 30% assoc. with past HBV infection
38
polyarteritis nodosa | - presentation
- aneurysm formation - ruptured aneurysms - organs: kidney, peripheral nerve, tests, ovaries, GI, coronaries
39
How most likely to pick up polyarteritis nodosa?
ROS - will get unusual sx such as mononeuritis multiplex (numbness comes and goes)
40
Polyarteritis nodosa | - tx
- high dose glucocorticoids - DMARDS sometimes - GET HELP
41
Primary angiitis of CNS - incidence - describe
- VERY rare - vasculitis limited to CNS - necrotizing granulamatous vasculitis
42
Primary angiitis of CNS | - presentation
- CNS issues - stroke - visual field defects - seizures
43
Primary angiitis of CNS | - Dx
brain biopsy (ahhh)
44
Primary angiitis of CNS | - management
- high dose steroids | - cyclophosphamide
45
Kawasaki disease | - incidence
- asian boys
46
Kawasaki disease | - presentation
- spiking fevers - conjunctivitis - mucusitis of lips and oral cavity - palmar/plantar erythema, induration, desquamation (like hand, foot, mouth dz)
47
Kawasaki disease | - tx
- IV immune globin | - ASA
48
Small vessel vasculitis - what affected - two major categories
- post-capillary venues, arterioles, capillaries - ANCA associated - immune complex-mediated (C3 & C4)
49
What are the three ANCA associated vasculitis diseases
- granulomatosis with polyangiitis (Wegener Granulomatosis) - Microscopic polyangitis - Eosiniphilic Granulomatosis (Churg-Strauss syndrome)
50
what does ANCA stand for
anti-neutrophil cytoplasmic antibody
51
ANCA associated vasculitis diseases | - pathophys
- when ANCA attacks neutrophil, neutrophil degranulates - enzymes attack endothelium of small blood vessels - neutrophils disintegrate: can find remnants in vessel walls on bx - dz d/t closure of small vessels
52
What do you order when suspect small cell vasculitis?
- c-ANCA antibodies - p-ANCA antibodies * helps determine which disease
53
Granulomatosis with polyangiitis | - presentation
- upper resp. tract, nose, upper airway - lungs: SOB, hemoptysis - Kidney: glomerulonephritis
54
Granulomatosis with polyangiitis | - Dx
- ANCA antibodies | - lung/kidney tissue bx
55
Granulomatosis with polyangiitis | - tx
- steroids | - cyclophosphamide
56
Microscopic polyangiitis | - presentation
- very similar to granulomatosis with polyangiitis
57
How differentiate microscopic polyangiitis from granulomatosis with polyangitis?
P-ANCA for microscopic
58
Eosinophilic Granulomatosis | - presentation
- allergic rhinitis - nasal polyps - asthma - lung dz - peripheral nerve dz (mono or multiple nerve numbness, permanent or come and go)
59
Eosinophilic Granulomatosis | - lab findings
- hypereosinophilia | - P-ANCA (but 40% negative...)
60
Eosinophilic Granulomatosis | - tx
- glucocorticoids
61
Immune complex vasculitis | - basic pathophys
- immune complex deposition in vessel walls | - fix complement and attract neutrophils
62
Immune complex vasculitis | - what organs affected?
- Any can be affected | - skin and joint MC
63
Three immune complex vasculitis diseases
1. Cryoglobulin vasculitis 2. Leukocytoclastic vasculitis 3. Henock-Schonlein Purpura
64
Cryoglobulin vasculitis | - antibodies
- antibodies precipitate in vitro at temp < body temp | - can precipitate in cooler areas of body
65
Cyroglobulin vasculitis | - lab
- cryoglobulins | - C3 and C4 low
66
Leukocytoclastic vasculitis | - presentation
- immune complex manifestation in skin | - palpable purpura
67
Leukocytoclastic vasculitis | - dx
- neutrophils in tissue bx
68
Henock-Schonlein purpura | - describe
- MC childhood vasculitis - rare in adults - tends to appear after URI - antigen unknown, antibody in IgA class
69
Henock-Schonlein purpura | - presentation
- abd pain - palpable purpura * vasculitis in abd and skin vessels
70
Henock-Schonlein purpura | - tx
- usually self limiting | - possibly steroids
71
Scleroderma - aka - describe
- aka systemic sclerosis - autoimmune dz - fibrosis = thickening and hardening of skin - internal organ involvement common - sig morbidity/mortality
72
Scleroderma | - Pathophysiology
- Excess deposition of structurally normal collagen - small artery endothelial damage/dysfunction - trigger unknown
73
Scleroderma | - dx
- mostly clinical dx - symmetric skin induration of hands, arms, face, torso - sclerodactyly (skin fibrosis of hands an fibers) - digital infarction - finger pitting - DOE - dysphagia
74
Scleroderma | - lab findings
- ANA in anti-centromere pattern **KNOW THIS ONE
75
Scleroderma | - treatment
- immunosuppressant drugs IF active lung dz
76
Behcet Syndrome | - describe
- vasculitis that affects small to large arterial vessels | - can affect veins
77
Behcet syndrome - presentation - lab
- recurrent, painful oral ulcerations, vagina also | - HLA-B51
78
Behcet Syndrome | - dx
Recurrent painful oral ulcers and 2+ of: - recurrent painful genital ulcerations - eye involvement - erythema nodosum - pathergy test (needle into skin = immediate inflammatory response)
79
Sarcoidosis | - describe
- multisystem dz characterized by noncaseating granuloma ** in tissues
80
Sarcoidosis - MC affects what organ - what other sx?
Lungs - bilateral hilar adenopathy - erythema nodosum
81
Sarcoidosis | - dx
- bilateral hilar lymphadenitis - erythema nodosum if have both = dx - if don't have both, bx showing noncaseating granulomas required for dx
82
Sarcoidosis | - tx
- symptomatic - NSAIDs, colchicine, low dose steroids - immunosuppressives - TNF alpha inhibitors

Musculoskeletal 1 (14 decks)

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