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MSK/Rheumatology (Inpt) > Rheumatology > Flashcards

Rheumatology Flashcards

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1
Q

SLE

A

-autoimmune disorder characterized by inflammation, a positive ANA, and involvement of multiple organs

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2
Q

what population does SLE affect the most?

A

women of childbearing age

-AA

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3
Q

what are the criteria for SLE diagnosis?

A
  • malar rash
  • discoid rash
  • photosensitivity
  • oral ulcers
  • arthritis
  • serositis
  • renal disease
  • ANA
  • hematologic disorders
  • immunologic disorders
  • neurologic disorders
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4
Q

what are some hematologic disorders common with SLE?

A

hemolytic anemia, leukopenia, leukocytosis, thrombocytopenia

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5
Q

what are some renal diseases common with SLE?

A

proteinuria, cellular casts

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6
Q

what are some immunologic disorders common w/ SLE

A

LE cells, anti-DNA, anti-Sm, false positive serologic test for syphilis

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7
Q

what are LE cells?

A

LE cell is a neutrophil or, occasionally, a macrophage that has engulfed the denatured nucleus of an injured cell, the injury having been caused by circulating antinuclear antibodies present in excessive amounts in the serum of patients with SLE.

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8
Q

what does dx of SLE require?

A

at least four criteria to be met

including a significanly high-titer ANA

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9
Q

what are some drugs that can cause SLE?

A

procainamide, hydralazine, isoniazide, methyldopa, quinidine, chlorpormazine

(positive antihistone antibodies)

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10
Q

how do the sx of SLE present?

A

relapsing and remitting pattern

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11
Q

what dx studies can be done for SLE

A

CBC, BUN, creatinine, UA,, ESR, serum complement (C3/C4)

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12
Q

what antibodies can be used as markers for SLE dz progression?

A

smith antigen, double stranded DNA, depressed levels of serum complement

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13
Q

what is C3/C4

A

play central role in the activation of the complement system

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14
Q

what is ANA?

A

anti-nuclear antibodies that are directed against contents of the nucleus

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15
Q

tx of SLE

A

regular exercise and sun protection, NSAIDs, methotrexates, corticosteroids

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16
Q

what can be used for MSK complaints and cutaneous manifestations of SLE?

A

antimalarials (hydroxychloroquine or quinacrine)

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17
Q

polymyositis

A

inflammatory disease of striated muscle affecting the proximal limbs, neck, and pharynx

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18
Q

what is dermatomyositis?

A

polymyositis with a skin rash (red, plaque like lesions on posterior aspect of joints)

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19
Q

what are some other organ systems that can be affected by polymyositis?

A

joints, lungs heart, and G tract

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20
Q

what is an occult malignancy?

A

when a primary tumor can’t be found

-associated with polymyositis

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21
Q

what population is most associated with polymoysitis?

A

women (3:1)

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22
Q

what are the clinical features of polymyositis?

A

insidious, painless, proximal muslce wkns; dysphagia, skin rash (maar or heliotrope), polyarthralgias, muscle atropy

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23
Q

dx studes of polymyositis?

A

creatine phosphokinase (CPK) and alsolase will be increased

-muscle biopsy: myopathic inflammatory changes

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24
Q

what is the treatment of Polymyositis?

A

high-dose steroids, methotrexate, azathioprine

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25
what is azathioprine?
DMARD ADR: leukopenia, thrombocytopenai, increased LFTs, fever, rash, neoplasm
26
what are some skin sx of dermatomyositis?
- gottron's papules - heliotrope erupion - facial erythema - photodistributed poikioerma (shawl ad V sign, holster sign) - perinungual abnormalities (around nails) - mechanic's hands
27
what are gottron's papules?
smooth, violaceous papules | -knuckles. side of fingers
28
what is polymyalgia Rheumatica?
pain and stiffness of the neck, shoulder, and pelvic girdles accompanied by constitutional sx (fever, fatigue, weight loss, depression)
29
what population is most likely to be affected by PMR?
women, pts older tan 50
30
what other dz state is PMR associated with?
giant cell arteritis
31
what are clinkcal features associated with PMR?
``` "SECRET" S-stiffness and pain E-elderly individuals C-constitutional sx, caucasian R- Rheumatis E-elevated ESR T-temporal arteritis ```
32
DX studies of PMR?
``` elevated ESR (>50) must r/o GCA (temporal artery bx of 2.5 cm) ```
33
tx of PMR?
low-dose corticosteroid therapy, which may be needed for up to 2 years -higher doses if GCA and shouldnt be delayed while waiting for bx
34
polyarteritis nodosa
small and medium artery inflammation involving skin, kidney, peripheral nerves, muscle, and gut
35
what pop is most affected by PAN?
MEN!
36
when is the usual onset of PAN?
btw 40-60 yo
37
what is the cause of PAN?
unknown | but assocated with Hep B
38
what are clinical features of PAN?
fever, anorexia, weight loss, abdominal pain, peripheral neuropathy, arthralgias, arthritis
39
what skin lesions may be seen with PAN?
palpable purpura, livedo reticularis
40
what else may be seen with PAN? (think renal involvment)
HTN, edema, oliguria, uremia
41
what diagnostic studies need to be done with PAN?
-vessel bx or angiography -ESR, CRP, proteinuria -(+) HBsAg) (+) ANCA-suggestive but not diagnostic
42
what is the tx of PAN?
initial managemet: high doses of corticosteroids -cytotoxic and immunotheraphy can also be used
43
systemic sclerosis (scleroderma)
unknown cause, characterized by deposition of collagen in the skin and, less commonly, the kidney, heart, lungs, and stomach
44
what is the general population that is affected by SS?
women, age 30-50 yo
45
what are the two types of scleroderma?
diffuse: affects skin, heart, lungs,GI, kidneys limited: skin of face, neck, distal elbows, kness, and late in the dz pulmonary HTN
46
what is the most common first finding in scleroderma?
swelling in the fingers and hands- may spread to involve the trunk and face
47
what type of scleroderma prsents with the CREST syndrome?
limited cutaneous sytemic sclerosis
48
what is the CREST syndrome?
``` C-calcinosis cutis R-raynaud phenomenon E-esophageal dysmotility S-sclerodactyly T-telangiectasia ```
49
what is the "water melon" stomach?
vascular ectasias in the antrum of the stomach
50
diagnostic studies for scleroderma
ANA-90% of pts w/ diffuse Anticentromere antibody-CREST Anti-SCL-70 antibody (poor prognosis)
51
what else needs to be monitored in sclerodera?
HTN- heralding kidney involvment
52
tx of scle)
``` none-tx of organ specific dz (PPI-GI) ACEI CCB for raynauds immunosuppresive drugs for pulmonary HTN ```
53
Sjogren syndrome
autoimmune disorder that destroys the salivary and lacrimal glands (exocrine)
54
what can sjogren's be a secondary complication of?
preexisting connective tissue diosrder such as RA, SLE, polymyositis, or scleroderma
55
who is most likely to be dx with sjogren's?
middle-aged F
56
clincla features of sjogrens?
mucouse membranes - dry moth (xerostomia) - dry eyes (xeropthalmia or keratoconjuectivitis sicca) +/- parotid gland swelling
57
dx studies for sjogrens
+ RF (70%) + ANA (60%) + anti-Ro + anti-La schirmer test
58
what would a schirmer test show in sjogrens?
wetting of less than 5 mm of filter paper placed in lower eyelid for 5 mins is positive for decreased secretions
59
what would abx of the lower lip show in sjogrens?
lymphocytic infiltrate and gland fibrosis
60
tx of sjogren's?
tx is sx, goal of keeping the mucosal surfaces moist -artifical tears and saliva, increased oral fluid intake, ocular and vaginal lubs
61
what drug can be used to increase saliva flow in sjogren's?
pilocarpine (stimulates muscarine cholinergic receptors)
62
what drug can improve ocular sx of sjogrens?
cyclosporine
63
Fibromyalgia syndrome
central pain disorder whose cause and pathogeesis are poorly understood
64
what other dz states may FM occur with?
RA, SLE, Sjogren
65
Clinical features of FM
nonarticular MSK aches, pains, fatigure, sleep disturbances, and multiple tender "trigger " pts on exam
66
what is characteristic of FM?
pain above and below the waist that is bilateral and axial for at least 3 mnths *a total of 11 + tender pts with a hx of widespread paine
67
what are some nonspecific complaints of FM?
fatiuge, sleep disruption, mood changes, cognitive disturbances, anxiety, depression, Ha, IBS, dysmenorrhea, paresthesias
68
dx studies for FM?
recognized by the typical pattern of pain and other sx-exculsion of hypothyroidsim, hep c, vit D deficiency
69
what are some random abnormalities one might find iwht FM?
abnormality of the T-Cell subses
70
tx of FM? (nonmedical)
aerobic exercise, CVT, pt education, stress reduction,, sleep assistance, tx of psycholocial problems
71
what are drug tx for FM?
SSRI, SSNRIs, TCA -milnicipran, duloxetine (amitriptyline, cyclobenzaprine-anticholinergic) pregabalin (lyrica)
72
what aer some side effects of pregabalin?
fatigue, trouble concentrations, sleepiness, edema
73
what is milnicipran
SNRI warnings: suicidal ideation serotonin syndrome elevated BP, tachycardia
74
what are ADRs of milnicipran?
``` N/V Palpitations, tachycardia HA Constipation Hyperhidrosis Dizziness ```

MSK/Rheumatology (Inpt) (2 decks)

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