Rheumatology 3 Flashcards
(131 cards)
1
Q
juvenile idiopathic arthritis (JIA) is an umbrella term for chronic arthritides in patients __ years old or less
A
16
2
Q
JIA must involve at least __ joint and last for
__ weeks
A
1 joint
6 weeks
3
Q
what are the subtypes of JIA (6)
A
- oligoarticular 2. polyarticular (sero pos, sero neg) 3. systemic onset 4. psoriatic 5. enthesitis-related 6. undifferentiated
4
Q
JIA is likely caused by __ increase with __ cells and formation of __
A
synovial fluid increase with inflammatory cells and formation of panes
5
Q
what is another name for oligoarticular JIA
A
pauciarticular JRA
6
Q
oligoarticular haș __ joint involvement and must involve fewer than __ joints
A
asymmetric 4
7
Q
în oligoarticular JIA, ESR/CRP might be slightly elevated, but __ is positive in 60% of pt’s
A
ANA
8
Q
oligoarticular JIA increases risk for __, so regular __ exams must be done
A
uveitis slit-lamp
9
Q
polyarticular JIA must involve at least __ joints
A
5
10
Q
in polyarticular JIA, CRP may be normal, but __ is usually very elevated
A
ESR
11
Q
what does seropositive polyarticular JIA mean
A
positive RF
12
Q
seropositive polyarticular JIA resembles adult __; seronegative polyarticular JIA will not have any __ features
A
RA extraarticular
13
Q
systemic onset JIA (SOJI) is also called
A
Still’s Dz
14
Q
2 common clinical manifestations of SOJIA/Still’s
A
- quotidian fever 2. salmon-colored evanescent macular rash
15
Q
SOJI/Stills mc affects
A
trunk, extremities
16
Q
what can be a fatal complication of SOJIA/Still’s
A
pericarditis or MAS (macrophage activation syndrome)
17
Q
what might labs show for SOJIA/Stills
A
leukocytosis very high ESR elevated ferritin
18
Q
macrophage activation syndrome (MAS) is a complication of SOJI and can cause
A
fevers coma shock DIC -> immune system going crazy -> up to 50% mortality
19
Q
psoriatic arthritis is associated w. what 5 clinical manifestations
A
DIP synovitis dactylitis nail pitting psoriatic rash acute anterior uveitis
20
Q
what 3 JIA conditions increase risk for uveitis
A
oligoarticular psoriatic enthesitis-related
21
Q
psoriatic arthritis increases risk for
A
uveitis
22
Q
enthesitis-related JIA is characterized by __ tenderness
A
sacroiliac
23
Q
what genetic factor is associated w. enthesitis related JIA
A
HLA-B27
24
Q
enthesitis ininflammation of the
A
tendons or ligaments -> ex kid w. swollen achilles tendon
25
enthesitis-related JIA includes pt's w.
juvenile-onset spondylitis reactive arthritis IBD arthritis
26
enthesitis-related JIA is a __ diagnosis
clinical
27
JIA are all __ diagnosis
clinical
*labs can be supportive*
28
first step in all JIA is
pediatric rheum referral
29
what are the 2 mainstays of therapy in JIA
NSAIDS
intraarticular joint injxn
30
SOJI pt's need __ initially for symptom control
steroid
31
in addition to NSAIDs and intraarticular joint injxns, __ might also be a drug used in JIA tx
DMARDs → MTX
32
what JIA condition needs aggressive tx w. DMARD
seropositive polyarticular JIA
33
which JIA has the highest mortality rate
SOJIA
34
what are the two forms of systemic sclerosis (scleroderma)
limited
diffuse
35
systemic sclerosis/scleroderma is caused by
fibrosis of the skin and other organs
36
CREST syndrome is a type of __ scleroderma
limited
37
what does CREST stand for
**c**alcinosis cutis
**r**aynaud phenomenon
**e**esophageal dysmotility
**s**clerodactylyl
**t**elangiectasia
37
what does CREST stand for
**c**alcinosis cutis
**r**aynaud phenomenon
**e**esophageal dysmotility
**s**clerodactylyl
**t**elangiectasia
38
what 2 groups are esp at risk for scleroderma
aa
choctaw Native American
39
what does this make you think of: widespread proliferative/obliterative vasculopathy of small and medium arteries and capillary refraction
scleroderma
40
what is the first sign of scleroderma
Raynaud phenomenon
41
initial skin manifestations of scleroderma
edema
pruritus
42
late skin manifestations of scleroderma
thick, hide like skin
**tight skin**
hyperpigmentation/depigmentation
ulcers
telangiectasis
43
what is watermelon stomach
GI manifestation of scleroderma
44
pulmonary manifestation of scleroderma
fibrosis → pHTN
45
cardiac manifestations of scleroderma
pericarditis
diastolic hf
46
what do calcinosis cutis and siccca syndrome make you think of
scleroderma
47
what is scleroderma renal crisis
sudden onset of malignant HTN → renal failure → death
48
up to 80% of scleroderma pt's have
pericardial involvement
49
can scleroderma also cause thromboembolic dz and affect MSK, neuromuscular, and GU systems?
yes
50
2 GU manifestations of scleroderma
ED
dysperiunia in women → fibrotic vaginal opening
51
over 95% of scleroderma pt's have (+) ANA
52
what (+) lab value is related to poor prognosis w. scleroderma
anti-SCL-70
53
imaging for lung involvement in scleroderma
high resolution CT
baseline PFTs
54
what test to order for cardiac involvement in scleroderma
ECHO
55
why would you order EGD in scleroderma
Barrett's esophagus
56
score of __ or above is diagnostic for criteria for scleroderma
9
57
can scleroderma be dx'ed w.o the criteria
yes
58
tx for scleroderma targets
affected organs
59
tx for skin sx in scleroderma
glucocorticoids, MTX, cyclophosphamide, IVIG
60
tx for raunaud phenomenon in scleroderma
CCB → nifedipine
61
\_\_ agents are used for GI symptoms in scleroderma
pro kinetic agents → reglan or erythromycin
62
tx for lung sx in scleroderma
diuretics
+/- digoxin
63
tx for renal sx in scleroderma
ACEI
64
tx for ED in scleroderma
long acting Cialis (tadalafil)
65
leading cause of mortality in scleroderma
pulmonary fibrosis
66
what do you think when you see inflammatory dz w. autoabs affecting every organ
systemic lupus erythematosis (SLE)
67
lupus incidence is highest in
child bearing females
68
rf for SLE
estrogen!
smoking
69
constitutional SLE sx (5)
fever
fatigue
anorexia
malaise
wt loss
70
skin manifestations of SLE
acute cutaneous lupus erythematosis (ACLE)
71
ACLE looks like
butterfly rash
72
ACLE spares \_\_
and is triggered by \_\_
nasolabial folds
sun
73
what do you think when you see maculopapular lesions in a photosensitive distribution on any part of the body
ACLE
74
what is SCLE
subacute cutaneous lupus erythematosis (SCLE)
75
what do you think when you see scaly erythematous papule
SCLE
76
most photosensitive SLE rash
SCLE
77
what is CCLE
chronic cutaneous lupus erythematosis
78
mc subtype of CCLE
discoid lupus
79
what do you think when you see raise, erythematous plaques w. a scale or ring around the lesion
CCLE
80
what MSK sx is common in SLE
arthralgia
81
what is renal involvement of SLE called
lupus glomerulonephritis
82
vascular sx of SLE
raynaud
vasculitis
83
what does palpable purple petechiae make you think of
vasculitis in SLE
84
mc cardiac manifestation of SLE
pericarditis
85
what does “wart-like” pericardial lesions make you think of
cardiac symptom of SLE
86
what ocular sx is very common in SLE
dry eye (keratoconjunctivitis sica) → secondary Sjorgen's
87
what lab value is always positive in SLE
ANA
88
besides ANA, what other lab values are associated w. SLE
anti-dsDNA
anti-SM
89
antiphospholipid abs in SLE can cause false positive for
syphilis
90
what organ involvement do you not see in drug induced lupus
renal
CNS
91
T/F drug induced lupus is just in common in women as men
T
92
name 3 drugs that are associated w drug induced lupus
procainamide
hydralazine
isoniazid
→ *lots more*
93
do lab abnormalities and sx go away when drug is removed in drug-induced lupus
yes
94
tx considerations for SLE
exercise
smoking cessation
sun protection
healthy diet
prevention of glucocorticoid-induced osteoporosis
utd on vaccines
+/- antimalarials (hydroxychloroquine)
95
tx for cutaneous lupus
topical corticoids
+/- systemic meds → hydroxychloriquine
96
tx for MSK SLE
NSAIDs/Tylenol
+/- hydroxychloriquine
97
tx for serositis SLE
NSAIDs
+/-steroids and hydroxychloriquine
98
test to order before tx of renal manifestation of SLE
renal bx
99
4 important drugs in SLE
glucocorticoids
hydroxychloriquine
MTX
99
4 important drugs in SLE
glucocorticoids
hydroxychloriquine
MTX
100
what do you think of when you see ai myopathy characterized by proximal muscle weakness
polymyositis
101
in SLE, pt's w. __ involvement have the poorest prognosis
renal
102
polymyositis pt's have __ abs
anti muscle:
MSAs
MAAs
103
muscle weakness in polymyositis is \_\_,
\_\_,
and \_\_
gradual
progressive
symmetric
104
weakness in polymyositis affects __ first
legs
105
most pt's w. polymyositis will have elevated \_\_;
\_\_ may also be (+)
CK
ANA
106
gold standard for polymyositis dx
muscle bx
107
what do you think of when you see inflammatory infiltrate on muscle bx
polymyositis
108
how can EMG be helpful in polymyositis
shows early muscle involvement → show you where to bx
109
how can MRI be helpful in polymyositis
areas of muscle inflammation → help decide where to bx
110
can you dx polymyositis w.o muscle bx
yes
111
what clinical symptoms can be diagnostic of polymyositis
proximal muscle weakness → *can be more helpful/used more than enzymes*
abnormal muscle enzyme labs
no better explanation
112
initial tx for polymyositis
steroids
→ usually combined w. another immunosuppressant
113
do pt's w. polymyositis need to avoid exercise
no! it helps → PT recommended
114
5 clinical domains of psoriatic arthritis
peripheral
axial
enthesitis
dactylitis
skin and nail
115
psoriatic arthritis usually develops
after or at same time as psoriasis
116
genetic component of psoriasis
HLA
117
psoriatic arthritis pt's will have morning pain/stiffness __ min
more than 30
118
polyarhtritis can be \_\_
or \_\_, but
\_\_ is mc
symmetric or asymmetric mc: symmetric
119
4 clinical presentations of psoriatic arthritis
symmetric vs asymmetric
distal → DIP
arthritis mutilans
spondyloarthritis → C-spine involvement
120
3 periarticular manifestations of psoriatic arthritis
enthesitis
tenosynovitis
dactylics
121
what is dactylics
sausage digit
122
in psoriatic arthritis, nails can show
pitting
ridging
oncholysis
123
psoriasis can be \_\_, so it is important to do through exam in pt's you suspect psoriatic arthritis
hidden
124
what do you think of when you see “pencil-in-cup”deformity
psoriatic arthritis → damage to DIP and PIP
125
what criteria is used for psoriatic arthritis
CASPAR
126
tx for mild psoriatic arthritis
NSAIDs → naproxen, Celebrex
127
tx for severe/unresponseive to NSAIDs psoriatic arthritis
DMARDs → MTX, sulfasalazine
TNF inhibitors → Etanercept
128
what do you have to screen for before prescribing immunosuppressing drugs in psoriatic arthritis (or any rheum condition)
latent TB
129
what drug to avoid in psoriatic arthritis
PO steroids → can cause flare of pustular psoriasis
