Rheumatology Flashcards Preview

Blood and Lymph Section III > Rheumatology > Flashcards

Flashcards in Rheumatology Deck (30)
Loading flashcards...

What is the etiology of osteoarthritis?

Mechanical - Joint wear and tear destroys articular cartilage


What are the joint findings in osteoarthritis?

Subchondral cysts, sclerosis, osteophytes, eburnation, Heberden nodes, Bouchard nodes, no MCP involvement.


What are the predisposing factors for osteoarthritis?

Age, obesity, joint deformity, trauma


What is the classic presentation of osteoarthritis?

Pain in weight bearing joints after use (e.g. at end of day) improves with rest. Knee cartilage loss begins medially (bowlegged), Noninflammatory, no systemic symptoms.


What is the treatment for osteoarthritis?

NSAIDs, Glucocorticoids.


What is the etiology of Rheumatoid arthritis?

Autoimmune - inflammatory destruction of synovial joints. Mediated by cytokines and Type III and Type IV hypersensitivity reactions.


What are the joint findings of Rheumatoid arthritis?

Pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules (fibrinoid necrosis), ulnar deviation of fingers, subluxation, Baker cyst (in popliteal fossa), no DIP involvement.


What are the predisposing factors for Rheumatoid arthritis?

Females > males, 80% have RF, anti-cyclic citrullinated peptide antibody is more specific, Strong association with HLA-DR4.


What is the classic presentation of Rheumatoid arthritis?

Morning stiffness lasting > 30 minutes and improving with use, symmetric joint involvement, systemic symptoms (fever, fatigue, pleuritis, pericarditis).


What is the treatment for Rheumatoid arthritis?

NSAIDs, glucocorticoids, disease modifying agents (DMARDs - methotrexate, sulfasalazine, TNF-a inhibitors)


What is the etiology of Sjogren syndrome?

Autoimmune disorder, characterized by destruction of exocrine glands (esp. lacrimal and salivary), Predominantly affects women 40-60 years old.


What are the signs and symptoms of Sjogren syndrome?

Xerophthalmia (dec. tear production and corneal damage), Xerostomia (Dec. saliva production), Antinuclear antibodies (SS-A, SS-B), Bilateral parotid enlargement.


What are the predisposing factors for Sjogren syndrome?

Can be primary disorder or secondary to other autoimmune disorders (e.g. RA) Complications include dental caries, and MALT lymphoma.


What is gout?

An acute inflammatory monoarthritis caused by precipitation of monosodium rate crystals in joints. Crystals are needle shaped and not "birefringent" (yellow under parallel light, blue under perpendicular light)


What condition is gout associated with and what causes this condition?

Gout is associated with hyperuricemia, which can be caused by: Underexcretion of uric acid (90% of cases) which is idiopathic or exacerbated by thiazide diuretics; or by Overproduction of uric acid (10% of cases) as in Lesch-Nyhan syndrome, tumor lysis syndrome (inc cell turnover) PRPP excess.


What are the symptoms of gout?

Asymmetric joint distribution. Joint is swollen, red, and painful. Classically MTP joint of big toe, Tophus formation, acute attack tends to occur after big meal or alcohol intake.


What is the treatment for gout?

NSAIDs, glucocorticoids, colchicine; preventives: xanthine oxidase inhibitors (allopurinol, febuxostat)


What differentiates pseudo gout from gout?

Pseudogout is the deposition of calcium pyrophosphate crystals in a joint space. Basophilic, rhomboid crystals, weakly birefringent (blue in parallel light), Usually affects large joints (knees) Associated with hemochromatosis, hyper- and hypo-parathyroidism.


What is the definition of a seronegative spondyloarthropathy?

Negative for Rheumatoid factor and ANA, Strong association with HLA-B27, also known as Axial Arthropathies sometimes with peripheral arthropathy, Affect Enthesis, subdivided into Ankylosing Spondylitis, Psoriatic arthritis, reactive arthritis, and IBD related arthritis.


High points of Psoriatic arthritis

Joint pain and stiffness associated with psoriasis, Asymmetric and patchy joint involvement usually upper extremity, PIP, DIP, MCP, also may have Dactylitis (sausage fingers),


High points of Ankylosing Spondylitis

Chronic inflammatory disease of spine and sacroiliac joints, "Ankylosis" stiff spine due to fusion of joints, uveitis, aortic regurgitation. Males 16-40 y/o, "Bamboo spine"


High points of IBD associated Arthritis

Crohn disease and ulcerative colitis are often accompanied by ankylosing spondylitis or peripheral arthritis


High points of reactive arthritis (Reiter syndrome)

Classic triad: Conjunctivitis and anterior uveitis, Urethritis, Arthritis ("can't see, can't pee, can't bend my knee") Follows GI infection by shigella, salmonella, yersinia, campylobacter, or Chlamydia infection.


What are the symptoms of Systemic Lupus Erythematosus?

Classic presentation: Rash, joint pain, fever most commonly in females of reproductive age and African descent, Lupus nephritis: Type III hypersensitivity reaction, may be diffuse proliferative glomerulonephritis or membranous glomerulonephritis.


What are common lab findings in SLE?

ANA, Anti-dsDNA antibodies, Anti-Smith antibodies (against snRNPs), Anti-histone antibodies (drug induced lupus), Anticardiolipin antibodies (prolonged PTT but with inc. risk of arteriovenous thromboembolism), dec C3, C4, and CH50 due to immune complex formation.


What are treatments for SLE?

NSAIDs, steroids, immunosuppressants, hydroxychloroquine


What are the signs/symptoms of Polymyositis?

Progressive symmetrical proximal muscle weakness, characterized by endomysial inflammation with CD8 T-cells (inside the muscle fibers). Often involves shoulders.


What are the signs/symptoms of Dermatomyositis?

Similar to Polymyositis, but involves perimysial inflammation with CD4 T-cells (outside the muscle fibers). Also may show: malar rash, Gorton papules, heliotrope rash, shawl sign, mechanics hands, and increase in occult malignancy.


Lab findings common to PM and DM?

Inc. CK, Positive ANA, anti-Jo-1, anti-SRP, anti-Mi-2 antibodies.


What is the treatment for PM and DM?