Rheumatology Flashcards
(172 cards)
1
Q
NSAID MOA and effects? (Hint: 3)
A
Inhibit cyclooxygenase and prostalglandin. Anti-pyretic, anti-pain, anti-inflammatory
2
Q
Steroid MOA?
A
Upregulate expression of anti-inflammatory proteins and downregulate expression of proinflammatory poroteins
3
Q
Sulfa class and MOA?
A
DMARD/Non-biologic.
MOA not well understood. Slows down or stops joint damage.
4
Q
Antimalarial class and MOA?
A
DMARD/Non-biologic.
Reduces activation fo dendritic cells and the inflammatory process
5
Q
Alkylating Agents class and MOA?
A
DMARD/Non-biologic. Chemotherapy agents.
Interferes with DNA replication.
6
Q
Antimetabolite class and MOA?
A
DMARD/Non-biologic.
Interfere with nucleic acid synthesis
7
Q
Methotrexate which type of drug?
A
Antimetabolites
8
Q
Immunosppressant class and MOA?
A
DMARD/Non-biologic.
Suppress B and T cells (big roles in inflammation)
9
Q
Tacrolimus which type of drug?
A
Immunosuppressant
10
Q
What are DMARD/Biologic drugs?
A
Genetically engineered proteins originally from human genes. Target specific parts of immune system which fuel inflammation.
11
Q
TNF-Alpha-Neutralizer class and MOA?
A
DMARD/Biologic.
Blocks tumor necrosis factor, messenger which drives inflammation.
12
Q
IL-6-Inhibitor class and MOA?
A
DMARD/Biologic.
Blocks protein IL-6 from attaching to cells stoking inflammation.
13
Q
Tocilizumab (Actrema) drug class?
A
DMARD/Biologic. IL-6-Inhibitor.
14
Q
B-Cell Biologic class and MOA?
A
DMARD/Biologic.
Wipes out B-cells involved in inflammation.
15
Q
T-Cell Biologic class and MOA?
A
Attaches to surface of T-Cells blocking communication between them
16
Q
Novel Class class and MOA?
A
Inhibits Janus Kinase enzymes of inflammation. Targets RA cells from inside, single target.
17
Q
What cells and where do the Novel Class target?
A
RA cells from inside.
18
Q
Is the etiology of Rheumatoid Arthritis known?
A
Unknown eti
19
Q
Rheumatoid Arthritis affects joints with what sort of lining?
A
Synovial lining
20
Q
Which cell mediates Rheumatoid Arthritis?
A
T-Cells
21
Q
Hallmark sx of Rheumatoid Arthritis?
A
Symmetrical Synovitis
22
Q
What parts of body most affected by Rheumatoid Arthritis?
A
Hands and feet
23
Q
How many joints swollen for how long to make dx for Rheumatoid Arthritis?
A
2+ swollen joints for 6+ weeks
24
Q
Which 2 antibodies in Rheumatoid Arthritis?
A
RF or ACPA Antibodies
25
Tx for Rheumatoid Arthritis?
Early DMARD is TOC
26
Etiology of Reactive Arthritis?
Arthritis due infection in other part of body
27
Which bacteria and what site most common in men with Reactive Arthritis?
Camphylobacter in enteric
28
Triad in Reactive Arthritis?
Urethritis, Arthritis, Conjunctivitis
29
Symmetric or Asymmetric arthritis in Reactive Arthritis?
Asymmetric
30
When do sx appear in Reactive Arthritis?
2-4 weeks post GI or GU infection
31
Other than joint pain what sx in Reactive Arthritis?
Malaise, fever, fatigue
32
Can infection be cultures from joints in Reactive Arthritis?
Nope
33
What is Dx based on in Reactive Arthritis?
History and Physical. No labs.
34
Gene associated with 30-50% of Reactive Arthritis?
HLA-B27
35
Tx for Reactive Arthritis?
NSAIDs, intraarticular glucocorticoid injectin, systemic glucocorticoids, non-bio DMARDs (sulfa, methro), bio DMARDs (TNF-I)
36
Eti of Juvenille Rheumatoid Arthritis?
Unknown
37
Age of onset in Juvenille Rheumatoid Arthritis?
<16 y/o
38
Most common rheumatoid disease in kids?
Juvenille Rheumatoid Arthritis
39
Oligo/Pauci Articular JRA what percent of cases?
50%
40
How any joints affected in Oligo/Pauci JRA? Which?
≤5 joints. Weight-bearing joints.
41
What ophthamological complication in Oligo/Pauci Articular JRA?
Anterior Uveitis
42
How to Oligo/Pauci JRA kids appear?
Appear well
43
Polyarticular JRA what percent?
30-40%
44
Polyarticular JRA number of joints and what types?
≥6 joints, any size
45
Which joints stiff in Polyarticular JRA?
TMJ and cervical joints
46
Small joints involvement in Polyarticular JRA- symmetrical or asymmetric?
Symmetric small joint involvement
47
Systemic JRA what percent of cases?
10%
48
Systemic JRA appear? Fever?
Fever 103+ once or twice a day around same time. Appear ill, chest pain, friction rub.
49
Rash in Systemic JRA? Where on body?
Evanescent rash, no itch. On trunk and extremities
50
If JRA dx and tx before 7 y/o vs after 7?
Before 7=good chance of remission
| After 7=might spread and stick around
51
Tx for JRA?
NSAIDS and corticosteroids to reduce joint dmg and prevent loss of function, induce remission and reduce flares.
Intraarticular triancinolone. Methotrex or Lefuomide.
52
Polymyositis etiology? Who gets most?
Idiopathic inflammatory myopathy. W>M.
| >Black population
53
What happens to muscles in Polymyositis?
CD8 T-cells and macrophages surround and invade healthy muscle fibers and destroy them
54
Polymyositis develops over how long?
Develops over 3-6 months
55
Location of muscles affected by Polymyositis? Symmetrical or asymmetrical?
Symmetrical proximal muscle
56
Two major risks in Polymyositis?
Dysphagia and aspiration
57
Difficult movements in Polymyositis?
Difficulty kneeling, climbing stairs, get up from chair, hold head up
58
Two muscles sparred in Polymyositis?
Ocular and facial muscles normal
59
Any pain or sensation in Polymyositis?
No pain, normal sensation
60
CPK in Polymyositis?
5-50x elevated
61
LAD in Polymyositis means what?
Muscle damage
62
AntiJo-1 and EMG in Polymyositis?
Positive for AntiJo-1. Abnormal EMG in 90%
63
Test of choice in Polymyositis?
Muscle biopsy. Show focal CD8 T-lymph infiltration.
64
1st line tx in Polymyositis? If no improvement in 4 weeks? Refractory?
1st line=Prednisone
4 weeks=Immunomodulators
Refractory=Tacrolimus
65
Polymylalgia Rheumatics (PMR) etiology? Who gets?
Unknown. Effect eldery 72+, mostly women.
66
What activated in PMR?
Systemic macrophage and T-cell activation
67
Location of myalgia in PMR? When most stiff?
Proximal myalgia of shoulders and hip girdle. Morning stiff for 1+ hr.
68
Shoulder pain unilateral or bilateral in PMR?
Initially unilateral then bilateral
69
Difficulty doing what in PMR?
Difficult woverhead activities and getting out of bed
70
ESR in PMR?
>40
71
Pain and morning stiff in PMR?
Pain >1 month
| Stiff 1+hr
72
1st line Tx in PMR?
Prednisone and NSAIDs when tapering
73
Vasculitis divided into what three main types?
1. Large vessel
2. Medium vessel
3. Small vessel
74
Giant Cell Arteritis has major crossover with what other rheumatological condition?
Polymylagia Rheumatics
75
Takaayshu Arteritis can result in what syndrome?
Subclavian Steel Syndrome
76
Subclavian Steel Syndrome cause?
Stenotic lesion of vetebral artery causing retrograde blood flow
77
Subclavian Steel Syndrome manifestation?
Decreased BP in arms, asymmetrical decreased pulses in arms and legs
78
Who mostly develops Takayasu Arteritis?
Female asian 40+
79
What major artery does Takayasu Arteritis affect?
Aortic body and branches
80
Tx of Giant Cell Arteritis if vision preserved?
PO Prednisone 40-60mg
81
Tx of Giant Cell Arteritis if vision not preserved?
IV Methylprednisolone 1g x3 days
82
Medium Vessel Vasculitis affects which 4 arteries?
1. Splenic
2. Renal
3. Hepatic
4. Mesenteric
83
Polyarteritis Nodosa (PAN) spares which organ but always affects what?
Spared lungs, kidneys always affected
84
Polyarteritis Nodosa (PAN) GI manifestations?
Bleesing, pain, NV
85
Polyarteritis Nodosa (PAN) and skin manifestations?
Skin molting, purpura, ulcers, nodules
86
Polyarteritis Nodosa (PAN) and kidneys?
Glomerular ischemia + HTN
87
Polyarteritis Nodosa (PAN) tx? Mild, moderate, severe?
Mild=PO Prednisone
Moderate=Cyclophosphamide
Severe=Methylprednisolone IV
88
Kawasaki Dz primarily affects who?
Infants and young children
89
Kawasaki Dz fever lasts for how long?
5 days!
90
Kawasaki Dz and tongue?
Strawberry tongue
91
Kawasaki Dz involves what major organ?
Heart! Can affect coronary arteries!
92
Kawasaki Dz hands and feet? Skin?
Red palms and soles. Polymorphous rash.
93
How often EKG with Kawasaki Dz?
2 and 6 weeks
94
Kawasaki Dz tx?
IVIG 2g/kg over 8-12h and ASA 30-50mg/kg q8h. Observe for 12-24h until fever gone.
95
Small Vessel Vasculitis affects which vessels?
Small intraparynchymal arteries, arterioles, capillaries, venules
96
Micropolyangitis most common syndrome?
Pulmonary-Renal Syndrome most common in small to med vessels
97
Micropolyangitis most common in?
4-5th decade. Men=Women
98
Micropolyangitis clinical manifestation? (Hint: lungs)
Purpura, pulmonary hemmorhage, splinter hemmorhage, interstitial lungs fibrosis, ulcers
99
Micropolyangitis dx?
Elevated acute phase reactants
| +ANCA, +Hema/Proteinuria, +RBC Casts
100
Granulomatosis with polyangiitis classic triad? What else affect?
Triad=Upper resp dz, lower resp dz, glomerulonephritis
Other=proptosis, ptosis, ophaloplegia, slcerosis
101
Granulomatosis with polyangiitis sx develop over how long?
4 months and slowly
102
Granulomatosis with polyangiitis and nose?
Crusting/ulcerating/bleeding nasal septum
103
Granulomatosis with polyangiitis dx?
Chest CT, UA, elevated ESR and CRP
104
Tx for Granulomatosis with polyangiitis and Micropolyangitis?
Cyclophosphamide PO + Prednisone, Rituximab PO + Prednisone, continue Cylo x3-6 months
105
Who gets IgA Vasculitis?
5-7 y/o, Fall/Winter/spring
106
IgA Vasculitis deposits?
IgA1-dominant immune deposits
107
IgA Vasculitis and purpura?
Palpable purpura
108
IgA Vasculitis classic tetrad?
Palpable purpura, arthralgia/arthritis of LE large joints, abd pain, renal dz
109
IgA Vasculitis dx?
H+P. If doubt then biospy.
110
IgA Vasculitis tx?
PO Hydration, rest, NSAIDS.
| Severe abd pain and can't PO=Prednisone
111
Variable Vessel Vasculitis Behcet Dz gene risk?
HLA-B51 increases risk
112
Variable Vessel Vasculitis Behcet Dz triad?
Aphthous ulcers, genical lesions, recurrent eye inflammation
113
Variable Vessel Vasculitis Behcet Dz leading cause of blindness where?
Japan
114
Giant Cell Arteritis dx gold standard?
Biopsy
115
Giant Cell Arteritis ESR?
Always above 70, often above 100
116
Wegner's aka
Granulomatis w/polyangiitis
117
What causes gout?
Overproduction or underexcretion of uric acid crystals which building up in joints, tissues (tophi), and fluids
118
What is cause of 90% of gout?
Underexcretion of urate
119
What is #1 arthopathy in US?
Gout
120
What do Thiazides (HCZT) and low-dose ASA do in gout patient?
Increase uric acid levels
121
Define Podagra in gout patient
Severe pain, redness, and tender joints.
122
What do joints look like in gout patient?
Warm, tense, dusky red
123
Where to 50% of initial gout attack occur?
MPT of great toe
124
Where does gout usually occur? (Hint: Three places)
Feet, angles, knees
125
What are tophi?
Happens in chronic gout. Bone destruction and erosion d/t urate crystals. Causes gross deformity and functional loss.
126
Dx of gout?
Arthrocentesis. Shows intracellular uric acid crystals.
127
What will 24h urine test show in gout patients?
Underexcretors=normal
| Overproducers=high
128
Dietary tx for gout?
Avoid red and organ meat, beans, peas, EtOH, fat milk
129
1st line tx in Acute Gout?
NSAIDS within 24 h. Naproxen, Ibuprofen, Diclofenac, Indomethicin
130
2st line tx in Acute Gout?
Colchicine
131
3st line tx in Acute Gout?
Corticosteroids. Intraarticular and systemic.
132
4st line tx in Acute Gout?
IL-1-Beta-inhibitor (Anakinra)
133
Chronic Gout urate goal?
<5
134
Chronic Gout indications?
Urate >6.5, tophi, multiple attacks
135
Chronic Gout 1st line tx? CI?
Xanthine oxidase inhibitors (Allopurinol). C/I in moderate to severe renal failure.
136
Chronic Gout 2nd line tx?
Uricosurics. Probenecid (1st line if Allopurinol C/I'd)
137
Gout underexcretor prophylaxis?
Uricosuric (probenecic, Sulfindyrazone)
138
Gout flare tx?
- Pegloticase IV q2w
- Colchicine
- NSAIDs
139
3rd line Chronic Gout tx?
Colchicine
140
Only drug used in both acute and chronic gout?
Colchicine
141
Negatively birefringent need-shaped urate cryststals in Gout or Pseudogout?
Gout
142
Positively birefringent rhomboid shaped CPP crystals in Gout or Pseudogout?
Pseudogout
143
Calcium Pyrophosphate Dihydrate deposite in kidneys and joints are consistent with which disease?
Pseudogout
144
Pseudogout most common in which two joints?
Knee or wrist
145
Pseudogout joint looks like?
Red, swollen, tender
146
Pseudogout arthocentesis shows what?
Positively Birefrincence Rhomboid Crystals
147
Pseudogout crystals in parallel are what color? Perpendicular?
Parallel=Blue
| Perpendicular=Yellow
148
X-ray joint space in Pseudogout shows what?
Chondrocalcinosis
149
Which test is diagnostic for Pseudogout?
X-ray joint space showing chondrocalcinosis
150
1st line tx for Pseudogout?
Colchicine
151
2nd line tx for Pseudogout
NSAIDS
152
Who gets Fibromyalgia?
W>M. 20-50 y/o.
153
What sort of sensitization in Fibromyalgia?
Central Sensitization
154
What is Central Sensitization in Fibromyalgia mean?
Abnormal biochemical and endocrine findings
155
Psychological steps in Fibromyalgia leading to sensitization? (Hint: 3)
Psych trauma->psych distress->sensitization of pain system
156
Define Fibromyalgia
Persistent widespread pain and abnormal tenderness, fatigue, sleep, and autonomic disturbances
157
What sort of Sx in Fibromyalgia?
GI, GU, chronic HA, poor concentration, memory disturbances
158
Tenderness and Fibromyalgia? Swelling and erythema?
11 of 18 points and 3+ months.
| No swelling, no erythema.
159
What sort of diagnosis if Fibromyalgia?
Dx of exclusion. Must rule out everything else.
160
Tests for Fibromyalgia?
Labs to r/o known causes, sleep study, imaging for OA/DJD, cerebral flow MRI
161
Non-pharm tx for Fibromyalgia?
CBT, exercise, weight loss, acupuncture, chiropractic
162
1st line tx for Fibromyalgia?
Tylenol, Tramadol, or mix (Ultracet)
163
2nd line tx for Fibromyalgia
TCA (strongest evidence of working!)
164
3rd line TXs for Fibromyalgia?
SNRI, SSRI, Milacipran, antepileptics
165
Raynaud's Phenomema types?
Primary and Secondary
166
Primary Raynaud's Phenomema age and associated dz?
<30, no associated dz
167
Secondary Raynaud's Phenomema age and associated dz?
>30, has associates dz (CREST syndrome, etc)
168
Raynaud's Phenomona clin manifestiation?
Abrupt onset of well-demarcated pallor of digits progressing to cyanosis w/pain and often numbess followed by reactive hyperemia on rewarming.
169
Raynaud's Phenomona vasospasm/vasoconstriction due to?
Cold or stress
170
Gangrene in Raynaud's Phenomona?
Happens in Secondary Raynaud's Phenomona
171
Primary Raynaud's Phenomona bilateral?
Yes
172
Tx of choice for Raynaud's Phenomona
Dihydropyradine CCBs (Amlodipine, Nifedipine)
