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Flashcards in Rheumatology Deck (78):
1

What is the most common autoimmune arthritis?

Rheumatoid arthritis

2

What allele and what gene are associated with increased risk of RA?

Gene: HLA-D4

Allele: HLA-DRB1

3

Patient presents with symmetric arthritis with small joint involvement.   Patient is experiencing early morning stiffness, and joints are tender and swollen. Sedimentation rate, c reactive protein, RF and anti-CCP are positive on labs.  What is the likely diagnosis?

Rheumatoid arthritis

4

What is involved in the fluid phase of rheumatoid arthritis pathophysiology?

  • Overall:
    • vasodilation
    • swelling
    • pain
    • superficial cartilage damage
  • Neutrophil recruitment
  • Complement activation
  • Release of Pgs, LTs, and ROS

5

What is involved in the tissue phase of rheumatoid arthritis pathophysiology?

  • Overall:
    • Pannus formation that invades bone, cartilage, and ligaments
  • Mech
    • Stimulates
      • T cells: cytokines
      • B cells: RF, anti-CCP
      • Monocytes: IL-1, TNF alpha
    • Synovial cells proliferate
    • Synthesis of collagenase and metalloproteinases
      • break down cartilage and bone
    • Activation of osteoclasts

6

What is the function of metalloproteinases? 

Break down of bone

7

What joints are most commonly affected by RA?

Hands

Feet

Ankles

Elbows

Large joints as well

8

What is present in the X-rays of RA?

  • Joint space loss
  • Erosions
  • Subluxation
  • Ulnar drift of MCPs
  • Swan neck deformities
  • Boutonniere

9

What complication can arise in the posterior popliteal fossa of RA patients?

Bakers cyst

10

What complication can arise in the neck of RA patients?

C1-C2 subluxation

11

Where are rheumatoid nodules found?

extensor tendons

12

What is Caplan Syndrome?

Multiple RA nodules in lung with pneumoconiosis

13

What is Felty's syndrome?

Splenomegaly

Leukopenia

Recurrent pulm infections

(in RA patients)

14

What labs are elevated in RA?

  • Sedimentation rate
  • C reactive protein
  • RF
  • anti-CCP

15

RA patients are at an increased risk of what systemic disease?  What neoplasm?

CV disease

Non-Hodgkin's lymphoma

16

What is the most common population affected by SLE?

Females in reproductive years

Blacks and Hispanics

17

How does arthritis present in SLE?

Symmetric (like RA)

Non-erosive (unlike RA)

Causes joint laxity

18

What is the most common serious organ involvement in SLE?

Lupus Nephritis

Class V: diffuse membranous (nephrotic syndrome)

Class VI: diffuse proliferative

19

What are possible symptoms of Lupus Cerebritis?

  • Psychosis
  • Seizure
  • Coma
  • Transverse myelitis

20

How does SLE present in its mildest form?

  • Rash
    • Butterfly
    • Photosensitive
    • Alopecia
  • Arthritis

21

What occurs in Discoid rash of SLE?

Follicular plugging

Alopecia

Scarring

22

What auto-Abs are present in SLE?

  • ANA
    • sensitive
    • not specific
  • dsDNA and Smith
    • not sensitive
    • specific
  • SSA
  • SSB
  • Others

23

What causes increased rates of miscarriage in SLE patients?

Antiphospholipid Ab Syndrome

(clotting of placental vessels)

24

What is Rhupus?

erosive arthritis

evidence of RA and SLE

25

What is Mixed Connective Tissue Disease?

SLE

Myositis

Scleroderma

26

Which drugs can cause SLE as a side effect?

Procainamide

Hydralazine

27

How is Neonatal Lupus acquired?

Passive transfer of Ab to child thru placenta

Will resolve in time after birth

28

Which Ab is associated with complete heart block in neonatal lupus?

SSA

This complicatino is permanent

29

What are the signs and symptoms of Antiphospholipid Ab Syndrome?

Recurrent arterial or venous thrombosis

Recurrent spontaneous abortions

30

What causes gout?

Deposits of uric acid (end product of purine metabolism) around joints = tophi

Can form renal calculi

 

31

What population is most affected by gout?

Men

Post-menopausal women

32

How and where does gout typically present?

  • Presentation
    • Painful
    • Red
    • Swollen
    • Single joint
  • Location:
    • 1st MTP
    • Cooler temperature promotes deposition
      • most common in lower extremities

33

What is the gold standard for diagnosis of gout?

Synovial fluid examination

Looks like toothpaste (white)

34

What is seen on polarized light microscopy in gout?

Strongly negatively birefringent crystals

35

What are the characteristics of pseudogout?

  • Joints affected
  • Population
  • Material Deposited
  • X-ray appearance
  • Polarized light microscopy appearance

  • Joints
    • large joint involvement
  • Population
    • aging pop
  • Deposition of:
    • Calcium Pyrophosphate dihydrate crystals
  • X-ray
    • Chondrocalcinosis
  • Polarized light microscopy
    • Rhomboid crystals
    • Weakly positive

36

What is the difference in distribution of Diffuse Scleroderma vs CREST syndrome?

  • Diffuse
    • Trunk, face, proximal extremities
  • Limited
    • Face, fingers, toes

37

What are the symptoms of CREST?

  • Calcinosis
  • Raynauds
  • Esophageal hypomotility
  • Scleroderma
  • Telangectasia

38

What autoantibodies are present in Systemic Sclerosis?

ANA family

  • anti-topoisomerase I (scl-70)
    • more common in diffuse
  • Anti-centromere
    • more common in limited

39

What common symptom affecting tendons is found in diffuse sclerosis?

Tendon Friction Rub

40

Secondary Raynaud's is found in which rheumatic diseases?

  • Scleroderma
  • SLE
  • RA

41

How are vessels affected by Systeic sclerosis?

Endothelial and smooth muscle cell proliferation

Obliteration of vessel

42

Anti-topoisomerase is most associated with which form of systemic sclerosis?  What complications are more likely to result?

Diffuse Sclerosis

Increased risk of renal and lung involvement

43

Anti-centromere is most associated with which form of systemic sclerosis?  What complications are more likely to result?

Limited Sclerosis

Increased risk of Pulm HTN

44

What is Scleroderma sine scleroderma?

Findings of vascular and visceral involvement without skin findings

45

What is Morphea?

Inflamed skin, fibrosis, and atrophy (even down to the bone) w/o Raynaud's or other scleroderma features

46

What Auto-Ab is present in spondyloarthropathies?

None!

Trick Question!

47

Which Spondyloarthropathises are related to HLA B27?

Ankylosing Spondylitis

Reactive arthritis

Psoriatic arthritis

Enteropathic arthritis

Uveitis

(arthritic diseases with spinal involvement)

48

What are the causes of Reactive Arthritis?

Chlamydia trachomatis

Shigella

Salmonella

Campylobacter

Yersinia

Klebsiella pneumonia

49

What are the symptoms of Reactive Arthritis?

Conjunctivitis

Urethritis

Arthritis

(Can't see, can't pee, can't climb a tree)

Skin (including palms)

Oral ulcers

Nail thickening

50

Enteropathic Arthritis

  • Path
  • Common location
  • Associated diseases

  • Path
    • Non-erosive
  • Common location
    • Lwr Extremities
  • Associated diseases
    • Crohns
    • Ulcerative colitis

51

What is the treatment for Spondyloarthropathy affecting the spine?

Physical therapy

Daily exercise

52

What auto-Ab is present in inflammatory myopathies?

Anti-Jo

(antisynthetase)

53

Inclusion Body Myositis

  • Population affected
  • Symptoms

  • Population affected
    • >50
  • Symptoms
    • DIstal muscle weakness
    • Problems with balance and falls

54

Dermatomyositis

  • Symptoms
  • Lab results
  • Auto-Ab
  • Testing

  • Symptoms
    • Slowly progressive, symmetrical, proximal weakness
    • Minimal pain
    • Shawl (v-shaped) rash
    • Gottron's Lesions
  • Lab results
    • increased muscle enzymes
  • Auto-Ab
    • Anti-Jo
  • Testing
    • muscle biopsy
      • quadriceps

55

What is the cancer risk in dermatomyositis?

2X increase

56

What extra-dermal symptoms are often present in dermatomyositis?

Pulm involvement

57

What  type of crystals are found in osteoarthritis?

Calcium pyrophosphate crystals

Apatite crystals

58

Which joint disease has cysts and osteophytes?

Osteoarthritis

59

What is the most common cause of Septic Bursitis?

S. aureus

60

Where is pain localized in subacromial bursitis?

Deltoid area

Pain on abduction or external rotation

61

What are the characteristics of Hypertrophic osteoarthropathy?  It is associated with which type of cancer?

  • Characteristics
    • Clubbing
    • Periostitis (long bones)
  • Cancer
    • Lung cancer (90%)

62

What rheumatic manifestation presents in Leukemia and Lymphoma?

Arthritis

63

What rheumatic manifestation presents in Hemophilia?

Hemarthrosis

Aspirate only if spetic joint is considered!!

64

What rheumatic manifestation presents in Sickle cell and thalassemia?

Bone pain

Fractures

Osteonecrosis

65

What rheumatic manifestation presents in Multiple Myeloma and amyloidosis?

Bone pain

Osteoporosis

Enlarged tongue

66

What is seen in tissue biopsy in amyloidosis?

Apple green birefringent fluorescence with congo red stain

67

What rheumatic manifestation presents in Hemochromatosis?

Pseudogoat

Symmetric arthropathy of 2,3 MCP

OA

68

What rheumatic manifestation presents in Whipple disease?

Arthritis

69

What rheumatic manifestation presents in Primary Biliary Chirrhosis?

Osteoporosis

Pruritis

Assoc. w/ other autoimmune disorders

70

What is diabetic hand syndrome?

Thickening of joint capsules, tendons, skin

71

What rheumatic manifestation presents with hyperparathyroidism?

Joint symptoms

Pseudogout

72

What rheumatic manifestation presents in sarcoidosis?

Arthritis

73

What is Lofgren's Syndrome?

Acute Sarcoidosis

Hilar adenopathy

Erythema nodosum

Arthritis of ankles

74

Polymyalgia Rheumatica

  • Symptoms
  • Associated disorder
  • Labs

  • Symptoms
    • proximal mm pain and stiffness
  • Associated disorder
    • Giant Cell Arteritis
  • Labs
    • Increased ESR

75

Polyarteritis Nodosa

  • Size of artery affected
  • Most common arteries affected
  • Diagnosis

  • Size of artery affected
    • Medium
  • Most common arteries affected
    • Renal
    • Mesenteric
  • Diagnosis
    • Angiogram
    • ANCA

76

Churg Strauss Syndrome

  • Size of vessel affected
  • Population

  • Size of vessel affected
    • Small to medium
  • Population
    • Middle aged
    • Chronic Asthma

77

Where are pseudotumors found in Wegener's Granulomatosis?

Lung

Retro-orbital

78

What is Leukocytoclasstic Vasculitis?

Palpable purpura

Seen w/ any vasculitis of small / medium vessels