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Flashcards in Rheumatology Deck (74):
1

SLE

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

2

what population does SLE affect the most?

women of childbearing age
-AA

3

what are the criteria for SLE diagnosis?

-malar rash
-discoid rash
-photosensitivity
-oral ulcers
-arthritis
-serositis
-renal disease
-ANA
-hematologic disorders
-immunologic disorders
-neurologic disorders

4

what are some hematologic disorders common with SLE?

hemolytic anemia, leukopenia, leukocytosis, thrombocytopenia

5

what are some renal diseases common with SLE?

proteinuria, cellular casts

6

what are some immunologic disorders common w/ SLE

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

7

what are LE cells?

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.

8

what does dx of SLE require?

at least four criteria to be met
including a significanly high-titer ANA

9

what are some drugs that can cause SLE?

procainamide, hydralazine, isoniazide, methyldopa, quinidine, chlorpormazine

(positive antihistone antibodies)

10

how do the sx of SLE present?

relapsing and remitting pattern

11

what dx studies can be done for SLE

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

12

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

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

13

what is C3/C4

play central role in the activation of the complement system

14

what is ANA?

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

15

tx of SLE

regular exercise and sun protection, NSAIDs, methotrexates, corticosteroids

16

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

antimalarials (hydroxychloroquine or quinacrine)

17

polymyositis

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

18

what is dermatomyositis?

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

19

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

joints, lungs heart, and G tract

20

what is an occult malignancy?

when a primary tumor can't be found
-associated with polymyositis

21

what population is most associated with polymoysitis?

women (3:1)

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what are the clinical features of polymyositis?

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

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dx studes of polymyositis?

creatine phosphokinase (CPK) and alsolase will be increased

-muscle biopsy: myopathic inflammatory changes

24

what is the treatment of Polymyositis?

high-dose steroids, methotrexate, azathioprine

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

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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

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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