Flashcards in Rheumatology Deck (74):
-autoimmune disorder characterized by inflammation, a positive ANA, and involvement of multiple organs
what population does SLE affect the most?
women of childbearing age
what are the criteria for SLE diagnosis?
what are some hematologic disorders common with SLE?
hemolytic anemia, leukopenia, leukocytosis, thrombocytopenia
what are some renal diseases common with SLE?
proteinuria, cellular casts
what are some immunologic disorders common w/ SLE
LE cells, anti-DNA, anti-Sm, false positive serologic test for syphilis
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.
what does dx of SLE require?
at least four criteria to be met
including a significanly high-titer ANA
what are some drugs that can cause SLE?
procainamide, hydralazine, isoniazide, methyldopa, quinidine, chlorpormazine
(positive antihistone antibodies)
how do the sx of SLE present?
relapsing and remitting pattern
what dx studies can be done for SLE
CBC, BUN, creatinine, UA,, ESR, serum complement (C3/C4)
what antibodies can be used as markers for SLE dz progression?
smith antigen, double stranded DNA, depressed levels of serum complement
what is C3/C4
play central role in the activation of the complement system
what is ANA?
anti-nuclear antibodies that are directed against contents of the nucleus
tx of SLE
regular exercise and sun protection, NSAIDs, methotrexates, corticosteroids
what can be used for MSK complaints and cutaneous manifestations of SLE?
antimalarials (hydroxychloroquine or quinacrine)
inflammatory disease of striated muscle affecting the proximal limbs, neck, and pharynx
what is dermatomyositis?
polymyositis with a skin rash (red, plaque like lesions on posterior aspect of joints)
what are some other organ systems that can be affected by polymyositis?
joints, lungs heart, and G tract
what is an occult malignancy?
when a primary tumor can't be found
-associated with polymyositis
what population is most associated with polymoysitis?
what are the clinical features of polymyositis?
insidious, painless, proximal muslce wkns; dysphagia, skin rash (maar or heliotrope), polyarthralgias, muscle atropy
dx studes of polymyositis?
creatine phosphokinase (CPK) and alsolase will be increased
-muscle biopsy: myopathic inflammatory changes
what is the treatment of Polymyositis?
high-dose steroids, methotrexate, azathioprine
what is azathioprine?
ADR: leukopenia, thrombocytopenai, increased LFTs, fever, rash, neoplasm
what are some skin sx of dermatomyositis?
-photodistributed poikioerma (shawl ad V sign, holster sign)
-perinungual abnormalities (around nails)
what are gottron's papules?
smooth, violaceous papules
-knuckles. side of fingers
what is polymyalgia Rheumatica?
pain and stiffness of the neck, shoulder, and pelvic girdles accompanied by constitutional sx (fever, fatigue, weight loss, depression)
what population is most likely to be affected by PMR?
women, pts older tan 50
what other dz state is PMR associated with?
giant cell arteritis
what are clinkcal features associated with PMR?
S-stiffness and pain
C-constitutional sx, caucasian
DX studies of PMR?
elevated ESR (>50)
must r/o GCA (temporal artery bx of 2.5 cm)
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
small and medium artery inflammation involving skin, kidney, peripheral nerves, muscle, and gut
what pop is most affected by PAN?
when is the usual onset of PAN?
btw 40-60 yo
what is the cause of PAN?
but assocated with Hep B
what are clinical features of PAN?
fever, anorexia, weight loss, abdominal pain, peripheral neuropathy, arthralgias, arthritis
what skin lesions may be seen with PAN?
palpable purpura, livedo reticularis
what else may be seen with PAN? (think renal involvment)
HTN, edema, oliguria, uremia
what diagnostic studies need to be done with PAN?
-vessel bx or angiography
-ESR, CRP, proteinuria
(+) ANCA-suggestive but not diagnostic
what is the tx of PAN?
initial managemet: high doses of corticosteroids
-cytotoxic and immunotheraphy can also be used
systemic sclerosis (scleroderma)
unknown cause, characterized by deposition of collagen in the skin and, less commonly, the kidney, heart, lungs, and stomach
what is the general population that is affected by SS?
women, age 30-50 yo
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
what is the most common first finding in scleroderma?
swelling in the fingers and hands- may spread to involve the trunk and face
what type of scleroderma prsents with the CREST syndrome?
limited cutaneous sytemic sclerosis
what is the CREST syndrome?
what is the "water melon" stomach?
vascular ectasias in the antrum of the stomach
diagnostic studies for scleroderma
ANA-90% of pts w/ diffuse
Anti-SCL-70 antibody (poor prognosis)
what else needs to be monitored in sclerodera?
HTN- heralding kidney involvment
tx of scle)
none-tx of organ specific dz
CCB for raynauds
immunosuppresive drugs for pulmonary HTN
autoimmune disorder that destroys the salivary and lacrimal glands (exocrine)
what can sjogren's be a secondary complication of?
preexisting connective tissue diosrder such as RA, SLE, polymyositis, or scleroderma
who is most likely to be dx with sjogren's?
clincla features of sjogrens?
-dry moth (xerostomia)
-dry eyes (xeropthalmia or keratoconjuectivitis sicca)
+/- parotid gland swelling
dx studies for sjogrens
+ RF (70%)
+ ANA (60%)
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
what would abx of the lower lip show in sjogrens?
lymphocytic infiltrate and gland fibrosis
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
what drug can be used to increase saliva flow in sjogren's?
pilocarpine (stimulates muscarine cholinergic receptors)
what drug can improve ocular sx of sjogrens?
central pain disorder whose cause and pathogeesis are poorly understood
what other dz states may FM occur with?
RA, SLE, Sjogren
Clinical features of FM
nonarticular MSK aches, pains, fatigure, sleep disturbances, and multiple tender "trigger " pts on exam
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
what are some nonspecific complaints of FM?
fatiuge, sleep disruption, mood changes, cognitive disturbances, anxiety, depression, Ha, IBS, dysmenorrhea, paresthesias
dx studies for FM?
recognized by the typical pattern of pain and other sx-exculsion of hypothyroidsim, hep c, vit D deficiency
what are some random abnormalities one might find iwht FM?
abnormality of the T-Cell subses
tx of FM? (nonmedical)
aerobic exercise, CVT, pt education, stress reduction,, sleep assistance, tx of psycholocial problems
what are drug tx for FM?
SSRI, SSNRIs, TCA
what aer some side effects of pregabalin?
fatigue, trouble concentrations, sleepiness, edema
what is milnicipran
warnings: suicidal ideation
elevated BP, tachycardia