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Flashcards in Rheumatology Deck (25):
1

24F
fatigue
muscle and joint aches and fever over the past 2 months
PE: erythematous rash on her cheeks and oral ulcers
auscultation reveals a pericardial friction rub

diagnosis?

Systemic Lupus Erythematosus

2

Systemic Lupus Erythematosus:
pathology?

chronic multisystem autoimmune disease

3

Systemic Lupus Erythematosus:
type of hypersensitivity?

type III hypersensitivity

4

Systemic Lupus Erythematosus:
most sensitive and specific serologic tests for this condition?

most sensitive: ANA (ANA snout)

most specific: anti-dsDNA or anti-Smith (DNA Smith spin)

Note: anti-dsDNA is prognosticating for LUPUS NEPHRITIS

5

Systemic Lupus Erythematosus:
diagnostic criteria? DOPAMIN RASH?
how many criteria are required for diagnosis?
most common criterion present?

DOPAMIN RASH

Discoid rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immunologic
Neurophsychiatric

Renal problems
ANA
Serositis
Hematologic

4/11

hematologic changes (pancytopenia)

6

Systemic Lupus Erythematosus:
most common criterion present?
what drugs may cause asimilar presentation?
what autoimmune antibodies are associated?

hematologic changes (pancytopenia)

Hydralazine, Isoniazid, Procainamide, Penicillamine
(It's HIPP to have Lupus!)

anti-histone antibodies

7

Systemic Lupus Erythematosus:
why will she test false positive for syphilis?

anti cardiolipin antibodies
RPR is embedded in cardiolipin

8

Systemic Lupus Erythematosus:
what complication may develop if she becomes pregnant? pathogenesis?

recurrent abortions due to APAS (due to lupus anticoagulant and anticardiolipin antibodies)

9

Systemic Lupus Erythematosus:
what is the most appropriate treatment for acute flare ups of her condition?

corticosteroids

10

Systemic Lupus Erythematosus:
what is the most appropriate treatment for cutaneous lesions?

antimalarials +/- (low dose) corticosteroids
use of sunblock

11

Systemic Lupus Erythematosus:
what is the most appropriate treatment to induce disease remission?

immunosuppressives (cyclophosphamide) + corticosteroids

12

Systemic Lupus Erythematosus:
if she developed unexplained proteinuria and hematuria, what should be done?

renal biopsy

13

Systemic Lupus Erythematosus:
what is the most catastrophic organ involvement of this condition?

SLE nephritis

14

Systemic Lupus Erythematosus:
SLE nephritis
describe the various forms of renal involvement in this condition (I to V)
most common?
most severe form?
HP finding?

I: minimal mesangial (10 to 25%)
II: mesangial proliferative
III: focal proliferative (20 to 35%)
IV: diffuse proliferative (35 to 60%)
V: membranous (10 to 15%)

IV: diffuse proliferative (35 to 60%)---most common or severe form, HP: wire loop lesions

15

67F
pain in her knees and ankles that she claims are stiff in the morning for a short period of time
PE = crepitations of the involved joints as well as enlargement of her proximal and distal interphalangeal joints
all lab tests are normal

diagnosis?

Osteoarthritis

note: changes described---Heberden and Bouchard nodes

16

Osteoarthritis:
etiology?

chronic, slowly progressive, erosive damage to joint surfaces causing loss of articular cartilage

directly proportional to increasing age and trauma to the joint (most common cause of joint disease)

17

Osteoarthritis:
most appropriate diagnostic test?

xray of affected joints (joint space narrowing, osteophytes, bone cysts)

18

Osteoarthritis:
what is the most appropriate treatment?

weight loss, moderate exercise, acetaminophen (best initial analgesic), intraarticular steroids if there is no pain control, joint replacement for severe disease

19

Osteoarthritis:
how do you differentiate RA from OA?

bilateral, symmetrical joint involvement (usually MCP joints)
morning stiffness >30 min
autoimmune phenomena (rheumatoid nodules, episcleritis, vasculitis)

also, Swan neck deformities, Boutounneire deformities, ulnar deviation

20

42M
fever, sudden, excruciating pain, redness, and tenderness of his big toe at night after a binge drinking session
elevated uric acid
elevated ESR
leukocytosis

diagnosis?

Gout

note that it's also found in the knees!

21

Gout:
etiology?

defect in urate metabolism due to overproduction (idiopathic, increased turnover of cells, enzyme deficiency) or underexcretion (renal insufficiency, acidosis, thiazides, aspirin)

22

Gout:
most accurate diagnostic test?

Joint aspiration (needle shaped crystals with negative birefringence on polarized light microscopy)

birefringence = double refraction of light

23

Gout:
most appropriate treatment at the ER?

NSAIDS and colchicine

24

Gout:
which drug in chronic gout is safe in patients with renal insufficiency?

Allopurinol

25

Gout:
What is pseudogout? How to differentiate it from gout?

Calcium pyrophosphate deposition disease
joint aspiration --- positively birefringent rhomboid shaped crystals