Rheumatology Flashcards by Chris James

Rheumatoid Arthritis is defined as?

Having 4 or more of the following….
morning stiffness lasting >1 hour, wrist/finger involvement, swelling of at least 3 joints, symmetric, rheumatoid nodules, x-ray abnormalities(erosions), positive anti-CCP, CRP/ESR elevated
- must last for at least 6 weeks

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What is the single most accurate test for RA?

anti-CCP

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What is the treatment for RA?

NSAIDs combined with DMARDs

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What is the best initial DMARD?

Methotrexate (causes bone marrow supression, pneumonitis, liver disease)

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What additional tests need to be ordered if hydroxychloroquine is started for RA?

Regular eye exams for retinopathy

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What role do steroids have in RA?

Serve as a bridge to DMARD therapy to control acutely ill patients with severe inflammation

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What characteristics do all of the seronegative spondyloarthropathies (AS, Reactive arthritis, Psoriatic arthritis, JRA) have in common?

Negative test for RH
Spine predilection
SI joint involvement
HLA-B27

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What are the characteristics of reactive arthritis(Reiter’s syndrome)?

asymmetric arthritis, urethritis, GI infection, conjunctivitis
Can’t pee, see, climb tree

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How do you treat reactive arthritis?

NSAIDs

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What are the characteristics of psoriatic arthritis?

joint arthritis, nail pitting, DIP joint involvement, sausage shaped digits, enthesitis

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What is the treatment for psoriatic arthritis?

NSAIDs

Methotrexate for resistant disease

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What are the characteristics of JRA?

fever, salmon colored rash, polyarthritis, lymphadenopathy, myalgias

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What lab tests are typical in setting of JRA?

high ferritin, negative ANA and RH, inceased WBC

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What is the treatment for JRA?

NSAIDs

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What should be ordered when a patient presents with osteoarthritis?

ANA, ESR, RH, Anti-CCP

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What is the best initial test for SLE?

ANA

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What is the most specific test for SLE?

Anti-DS DNA or Anti-Smith

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What is the best way to follow severity of SLE flares?

Complement levels(drop in flare-ups and anti-DS DNA(rises in flare-ups)

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What is the treatment for acute flares for SLE?

prednisone and other glucocorticoids

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What are the causes of drug induced lupus?

HIPP
Hydralazine
Isoniazid
Procainamide
Phenytoin

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What are the characteristics of Sjogrens syndrome?

woman, dry eyes, mouth, sensation of sand under eyelids, loss of taste and smell

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What is the most accurate test for Sjogrens?

lip biopsy

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What serologic tests are positive in Sjogrens?

Anti-Ro/SSA and Anti-La/SSB

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What is the treatment for Sjogren’s?

keep mouth/eyes moist

pilocarpine

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How does scleroderma present?

woman, tight/thick/fibrous skin, Raynauds phenomenon | can have lung fibrosis(pulmonary HTN), restrictive cardiomyopathy, renal involvement with HTN

What is the diagnostic test for scleroderma?

antitopoisomerase(anti-Scl 70)

How do you treat scleroderma?

``` Treat the symptoms.. HTN- ACEi Pulmonary HTN- bosentan Raynauds- CCB GERD- PPI Lung fibrosis- cyclophosphamide ```

How does eosinophilic fasciitis present?

Thickened skin that looks like scleroderma but with no hand involvement, Raynauds, heart/lung/kidney involvement

How does polymyositis present?

Patient can't get up out of seated position, proximal weakness, muscle inflammation

How does dermatomyositis present?

Patient can't get up out of a seated position, rashes, periorbital rash (Heliotrope rash), Shawl sign(shoulder and neck erythema), MCP papules (Grotton's)

What are the diagnostic tests for polymyositis and dermatomyositis?

Elevated CPK, aldolase, abmormal EMG, | Order liver function tests and ANA for CCS portion of exam

What is the most common complication of polymyositis/dermatomyositis?

malignancy

What is the treatment for PM/DM?

Steroids

How does fibromyalgia present?

woman, muscle aches and stiffness in certain trigger points

How to treat fibromyalgia?

exercise, milnacipran, duloxetine, pregabalin(best initial therapy), TCAs

How does polymyalgia rheumatica present?

pain/stiff proximal muscles(shoulders/pelvis), worse in morning, localized to muscles not joints, elevated ESR

What is the most accurate test for vasculitis?

biopsy

What is the best initial therapy for vasculitides?

prednisone, glucocorticoids

What is the best initial test for diagnosing polyarteritis nodosa?

angiography of abdominal vessels

What is the most accurate test for diagnosing PAN?

biopsy (skin, muscle)

What is the treatment for PAN?

prednisone and cyclophosphamide

How does Wegener's granulomatosis present?

upper and lower respiratory findings, positive c-ANCA

What is the treatment for Wegeners granulomatosis?

prednisone and cyclophosphamide

How does Churg-Strauss present?

Vasculitis, eosinophilia, asthma

If a patient presents with symptoms of temporal arteritis(headache, jaw pain, vision changes, tender scalp....) what is the first step?

Treat with steroids, more important than diagnosis

How does Takayasu's arteritis present?

usual vasculitis picture along with possibly stroke/TIA from vascular occlusions

How is Takayasu's arteritis diagnosed?

Aortic arteriography or MRA. NOT DIAGNOSED VIA BIOPSY

What disease is associated with cryoglobulinemia?

Hepatitis C, treat disease with interferon and ribavarin

What is the best initial test for septic joints?

Cell count on aspiration Normal < 2000 Inflammatory 2000-5000 Infectious > 50,000

What is the most accurate test for gout?

polarized light exam (negative birefringent needles)

Best initial test for gout?

arthrocentesis

What is the best initial treatment for acute gout attack?

NSAIDs, if no response(or contraindicated) after NSAIDs, use steroids

When is colchicine indicated for gout?

When NSAIDs are contraindicated and it is within 24 hours

What is given for gout prevention?

Allopurinol- lowers UA levels Weight loss/no booze febuxostat- xanthine oxidase inhibitor uricase- breaks down UA

How does CPPD present?

Knee and wrist involvement, slower onset than gout

What is seen on microscopy for CPPD?

positive birefringent crystals

What is the best initial therapy for CPPD?

NSAIDs

How does Paget's disease present?

Often symptomatic, pain, stiff, achy joints, fractures, sarcomas in 1% of patients

What is the best initial test for Paget's disease?

Alkaline phosphatase

What is the most accurate test for Paget's disease?

Xray

What should be ordered on the CCS portion of the exam for Paget's disease?

Urine hydroxyproline, serum Ca, serum P, bone scan

What is the treatment for Paget's?

Bisphosphonates, Calcitonin

What is the diagnostic test for Baker's cyst?

US, must r/o DVT

What is the treatment for Baker's cyst?

NSAIDs

Rheumatology Flashcards

(64 cards)