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Flashcards in Rheumatology Deck (46):
1

Gout Characteristics

1. systemic disease of altered purine metabolism

2. more common in men until women until menopause

2

Gout Clinical Features

1. initial attack of metatarsal phalangeal joint of greater toe

2. tophi in chronic gout form adjacent to affected joint

3

Gout Diagnostic Studies

1. Joint fluid analysis (rod-shaped, negatively birefringent urate cystals)

2. uric acid above 8mg/dL

4

Non-pharm Gout Treatment

1. elevation and rest

2. dietary modifications (etoh, red meats)

5

Pharm Gout Treatment

1. NSAIDs (indomethacin)

2. colchicine

3. corticosteroid injections

4. between acute attacks: colchicine, probenacid, sulfapyrazine, allopurinol (not during acute attack), febuxostat

6

Calcium pyrophosphate dihydrate (CPPD)/pseudogout general characteristics

affects peripheral joints, usually lower extremity, results from intra-articular deposition of calcium pyrophosphate

7

Pseudogout Clinical Features

most common joints are knees, wrist and elbows

8

Pseudogout Diagnostic Studies

1. Rhomboid-shaped, positively birefringement crystals
2. linear calcifications (chondrocalcinosis)

9

Pseudogout Treatment

1. NSAIDs

2. colchicine

10

SLE General Characteristics

1. autoimmune disorder characterized by inflammation, positive ANA, involvement of multiple organs

11

Who does SLE most commonly affect?

1. women of child-bearing age
2. prevalance among familial and ethnic groups (most common in African Americans)

12

Clinical Features of SLE

1. positive ANA
2. 4/11 criteria (malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disease, hematologic, immunologic, neurologic)

13

Drug-Induced Lupus

1. Histone ANA

14

SLE diagnostic studies

1. CBC, BUN, creatinine, UA, ESR, C3/C4

2. Antibodies to smith antigen, dsDNA

3. postive ANA

15

SLE treatment

1. regular exercise
2. sun protection
3. NSAIDs for MSK pain
4. Antimalarials (hydroxyxholoquine)
5. corticosteroids
6. methotrexate

16

Polymyositis Characteristics

1. inflammatory disease of striated muscle affected the proximal limbs, beck, pharynx

17

Dermatomyositis

1. skin manifestation of polymyositis
2. related to underlying malignancies

18

Clinical Features of Dermatomyositis

1. heliotrope
2. Grottens Papules (rash on knuckls)
3. Shawl sign

19

Clinical Features of Polymyositis

painless muscle weakness

20

Polymyositis Diagnostic Studies

1. elevated CPK/ESR
2. elevated aldolase
3. muscle biopsy with myopathic inflammatory changes

21

Polymyositis Treatment

1. High-dose steroids
2. methotrexate/azathioprine

22

Polymyalgia Rheumatica Characteristics

1. 50yo+
2. women more than men

23

Polymyalgia Rheumatica Clinical Features

1. pain/stiffness in the neck, shoulder, pelvic girdles (especially morning)
2. fever, fatigue, weight loss, depression
3. MSK symptoms symmetrical, bilateral, proximal

24

Giant Cell Arteritis Clinical Features

1. scalp tenderness
2. jaw claudication
3. temporal artery tenderness
4. BLINDNESS

25

Giant Cell Arteritis Diagnostic

1. Temporal Artery Biopsy

26

Polymylagia Rheumatica Diagnostic Study

1. ESR very elevated

27

Polymylagia Rheumatica Treatment

Low dose steroids (may be required for up to 2 years)

28

Polyarteritis Nodosa Characteristics

1. medium arteries
2. male more than females
3. 40-60yo onset
4. associated with Hep B

29

Polyarteritis Nodosa Clinical Features

1. fever, anorexia, weight loss, abd pain, pripheral neuropathy, arthralgias, arthritis
2. palpable purapura
3. livedo reticularis
4. renal involvement (HTN, edema, oliguria, uremia)

30

Polyarteritis Nodosa Diagnostic Studies

1. ANCA
2. vessel biopsy
3. angiography
4. elevated ESR/CRP and protein uria
5. hep B antibody possible

31

Polyarteritis Nodosa Treatment

high dose steroids

32

Scleroderma (Systemic) Characteristics

1. collagen deposition in skin, heart, lungs, stomach
2. females more than males
3. 30-50yo onset

33

Scleroderma Clinical Features

1. Raynauds
2. collagen depositions
3. puffy hand stage
4. nailfold involvement
5. watermelon stomach, GI dismotility
6. pHTN

34

CREST Clinical features

C- calcinosis cutitis
R- Raynauds
E- esophageal dysfunction
S- sclerodactyly (thickening of skin on fingers)
T- telanigctasia (dilated small vessels)

35

Diagnostic Studies of CREST

+ANA with centromere pattern

36

Diagnostic Studies of SS

1. +ANA (speckled pattern)
2. anti-SCL-70

37

Scleroderma monitoring

PFT's annually!! screening for phtn

38

Scleroderma Treatment

1. No cure
Organ-specific:
2. PPI for reflux
3. ACE inhibitors for renal disease
4. Ca-channel blockers for Raynauds
5. immunosuppresives for pHTN

39

Sjogren Characteristics

1.autoimmune disorder that destroys salivary and lacrimal glands

2. could be secondary to to RA, SLE, polyomyostitis, scleroderma

40

Sjogren Clinical Features

1. xerostomia (dry mouth)
2. xerophthalmia (dry eyes)
3. swollen parotid gland

41

Sjogren Diagnostic Studies

1. Shirmer test
2. +RF
3. + ANA
4. anti-Ro antibodies
5. anti-La antibodies
6. lower lip biopsy

42

Sjogren Treatment

Symptomatic
1. pilocarpine (increase salia flow)
2. cyclosporine (ocular sxs)

43

Fibromylagia Characteristics

Central pain diorder

44

Fibromylagia Clinical Features

1. nonarticular MSK aches, pains, fatigue, sleep disturbances, multiple tender "trigger" points
2. fatigue, sleep disruption, mood changes, cognitive disturbances, anxiety, depression, HA, IBS

45

Fibromylagia Diagnostic Studies

exclusion of other dxs

46

Fibromylagia Treatment

1. SSRI
2. TCA
3. Pregabalin (Lyrica)
4. aerobic exercise
5. patient education! (stress reduction, sleep assistance)