Flashcards in Rheumatology Deck (85):
Side effects with Hydroxychloroquine (1)?
Side effects with Thalidomide (2)?
Teratogenicity and peripheral neuropathy
What is ds-DNA antibody associated with?
Describe these types of systemic sclerosis:
1. Limited cutaneous
2. Diffuse cutaneous
3. Sine scleroderma
1. Limited cutaneous (distal to elbows/knees)
2. Diffuse cutaneous (proximal elbows/knees)
3. Sine scleroderma: Visceral involvement without skin fibrosis
What is anti-Scl-70 associated with (2)?
1. Diffuse cutaneous systemic sclerosis
2. Interstitial lung disease
What is treatment for ILD associated with scleroderma?
Considering SLE, what is treatment for:
1. Joint pain alone
2. Mild rash or arthralgias (2)
3. Moderate disease (2)
4. Lupus nephritis (2)
5. What has not been shown effective?
2. Hydroxychloroquine and steroids
3. Azathioprine, Methotrexate, etc...
4. Cyclophosphamide, Mycophenolate
5. NOT Rituximab
Common Side effect with Colchicine (2)?
2. Bone marrow suppression
Critical Side effect with Allopurinol (1)?
Rash, must stop medication because of risk for Stephens-Johnson syndrome
Name four drugs that INCREASE excretion of uric acid
2. High-dose Aspirin
Name four drugs that DECREASE excretion of uric acid
1. Calcinurin Inhibitors (Cyclosporine or Tacrolimus)
2. Organic Acids
Diagnostic elements to CPPD (3)?
Calcium Pyrophosphage Deposition Disease
1. WEAKLY birefringent crystals in synovium
2. Xray CHONDROCALCINOSIS
3. Cystic erosions without marked joint space narrowing
Etiologies for Septic Arthritis (6) and susceptible populations:
3. a, b, c
1. Staphylococcus Aureus, (esp RA or HD)
2. Streptococci (esp DM)
3. Gram Negative
Salmonella (esp SLE, AIDS, sickle cell)
Pseduomonas (esp IVDU)
Pasteurella (esp cat/dog bites)
4. Disseminated Gonococcal
5. Mycobacterium Marinum (esp swimming and fish tanks)
6. Mycobacterium Tuberculosis (esp sinus tracts)
How do you diagnose Parvovirus B19?
Which lab is falsely positive with Parvovirus B19?
Name the three types of idiopathic inflammatory myopathies. Which one is clinically distinct?
3. Inclusion Body Myositis - distal muscles, asymmetric and male predominant
Which malignancy risk is increased with inflammatory myopathies (men =3, women = 4)?
Men: Lung, Colon, Pancreas
Woman: Breast, OVARY, Colon, Pancreas
Define mild disease in Rheumatoid Arthritis (5)
1. 5-10 inflamed joints
2. Mild function limitation
3. Minimally elevated ESR/CRP
4. No erosions
5. No anemia
1. List treatment for MILD Rheumatoid Arthritis (3)
2. Which can be used safely in pregnancy?
1. Methotrexate with folic acid (first line)
****Can be used in pregnancy
List treatment for SEVERE Rheumatoid Arthritis (2)
2. TNF-alpha antagonists
When should you supsect steroid induced myopathy in PM-DM?
When weakness worsens while CPK improves
What diseases are associated with anterior uveitis (3)?
2. Ankylosing Spondylitis
3. Reactive Arthritis
What is the triad of anterior uveitis?
1. Eye pain
3. Blurred vision
What are the three ant-TNF-alpha meds?
Mnemonic = AEI
What medication usually precedes a Sclerodermal Renal Crisis?
Steroids six months prior
What is Löfgren syndrome and what are three clinical features associated with it?
Variant of sarcoidosis with:
1. Acute inflammatory arthritis, typically ankles
2. Erythema nodosum
3. Hilar lymphadenopathy
What is the difference between IgG and IgM?
IgM - Acute exposure
IgG - Long-term immunity
Mnemonic "M" = MORNING
Name two LARGE vessel vasculitic diseases
1. Giant Cell Arteritis (ESR>40)
2. Takayasu's Arteritis
Name two MEDIUM vessel vasculitic diseases (one is clinically distinct)
1. Polyarteritis Nodosa (NO glomerulonephritis)
2. Kawasaki Disease
Name 6 SMALL vessel vasculitic diseases.
Which are three major forms and how are they related (2)?
1. Wegener's Granulomatosis***
2. Churg-Strauss Syndrome***
3. Microscopic Polyangiitis***
4. Henoch-Schonlein Purpura
5. Essential Cryoglobulinemic Vasculitis
6. Cutaneous Leukocytoclastic Vasculitis
***Focal segmental necrotising glomerulonephritis without immune complexes (pauci-immune) AND +ANCA
What are two medications to start for treatment of Giant Cell Arteritis?
1. Prednisone 40-60 mg daily
2. Aspirin 81 mg daily
What condition is associated with GCA?
- 50% of GCA have PMR
- 10% of PMR have GCA (no bx required)
1. Which specific vessels are affected?
2. What are symptoms (3-4)?
3. How is it diagnosed?
4. Who does it affect?
1. Aorta and its branches
2. Fever, weight loss, sweats, arthralgias, LIMB claudication, TIA, syncope
4. Young women
What c-ANCA and p-ANCA? Which diseases are mostly associated with them (1, 2)?
1. c-ANCA = Cytoplasmic staining for protease-3
2. p-ANCA = Perinuclear staining for MPO
1. What is another name for Wegener's Granulomatosis?
2. What is it histologically?
1. Granulomatosis with Polyangiitis
2. Necrotizing vasculitis with parenchymal granulomas of small- and medium-vessels but NO IMMUNE COMPLEXES on histology
How does Wegener's manifest clinically (3)?
1. Glomerulonephritis (rapid progressive)
2. Pulmonary nodules ("coin lesions"), infiltrates and/or cavities with hemoptysis
3. Destructive rhinitis or sinusitis
How is Wegener's treated (active vs. remission)?
1. Cyclophosphamide + Pred
2. a. MTX + Pred
b. Azathioprine + Pred
What is the dignostic criteria for Adult Onset Still Disease (major 4, minor 5)?
Two of five features:
1. Fevers (daily) >39C for >1 week
3. Leukocytosis >80% granulocytes
4. Macular rash during fevers
3. Abnormal LFT
4. Sore throat
5. Negative ANA and RF
What is a symptom of Adult Onset Still Disease (with two etiologies for this one symptom)?
Pleuritic Chest Pain
1. Pleural Serositis
What are some CBC and rheumatologic lab valuves for Adult Onset Still Disease (4)?
1. Normocytic anemia
2. Elevated ESR/CRP
3. Elevated (markedly) ferritin > 2500
4. Absence of ANA or RF
What is a non-systemic treatment for acute gout attack?
What gastric pathology can occur in patient's with systemic sclerosis?
GAVE (gastric antral vascular ectasia) which can lead to GIB with microcytic anemia
What are three clinical manifestations related to a Sclerodermal Renal Crisis?
What is treatment for a Sclerodermal Renal Crisis? What is CONTRAINDICATED?
Treatment: ACEI like captopril
Contraindicated: Cyclosporine can worsen renal disease by renal vasoconstriction
Name 4 side effects of Cyclophosphamide
1. Bone marrow suppression
2. Bladder Cancer (transitional)
3. Infertility (ovarian failure)
4. Myeloproliferative disease
What is Microscopic Polyangiitis (histologically)?
Necrotizing vasculitis with few or no immune complexes (pauci-immune) and NO GRANULOMAS (unlike Wegener's)
What are clinical features of Microscopic Polyangitis (4)?
2. Pulmonary hemorrhage
3. Mononeuritis multiplex
4. Cutaneous small-vessel vasculitis with palpable purpura
What are the clinical features of Henoch-Schonlein Purpura (4)?
2. Palpable purpura
4. Gastrointestinal complaints (intussception) think IgA
What is Henoch-Schonlein Purpura (histologically)?
SKIN biopsy with Leukocytoclastic Vasculitis with predominant IgA deposition on vessel walls
What is the pathophysiology of Cryoglobulinemic Vasculitis?
Cold-precipitable monoclonal or polyclonal immunoglobulins
What diseases are associated with Cryoglobulinemic Vasculitis (4)?
2. B cell dyscrasias
3. Chronic Infections
4. Inflammatory Disease
1. Who is affected by Behcet's Disease?
2. What are the clinical manifestations?-
1. Asians and Eastern Mediterraneans
a. Recurrent aphthous oral ulcers
b. Two of the following:
- Cutaneous lesions
- Recurrent genital ulcers
- Uveitis with HYPOPYON
- Positive pathergy (skin prick test)
What are three features of Sjogren's syndome?
Autoimmune disorder characterized by:
1. Keratoconjunctivitis sicca
3. Presence of antibodies (SSA, SSB)
What malignancy is associated with Sjogren's syndrome?
List causes of salivary gland enlargement (8)
2. Excess EtOH
5. Infection: GC, RPR, mono, HIV, TB, fungal
6. Neoplasm: adenoma, adeno
7. Toxicity: lead, iodide, copper
Mnemonic = BE SAINTS
Which rheumatology patient should receive Isoniazid prophylaxis?
1. PPD > 5mm AND
2. Taking > Prednisone 15 mg or other rx
Which rheumatology patient should receive osteoporosis prophylaxis?
Patients taking >5mg Prednisone for more than three months
What joints are affected with arthritis associated with Hemochromatosis?
2nd MCP and PIP
What is the diagnostic test for osteonecrosis? What ISN'T the diagnostic test?
MRI and not X-ray
What are two indications for an ankle x-ray?
1. Patient cannot bear weight
2. Lateral malleolus pain
What is a serologic test for CREST syndrome?
What is a serologic test for Autoimmune Hepatitis (2)?
1. Anti-smooth muscle antibody
What is a serologic test for Mixed Connective Tissue Disease?
1. What is a serologic test for Churg Strauss?
2. What are three other features?
1. p-ANCA with Antimyeloperoxidase-ab
What is a serologic test for Microscopic Polyangiitis?
In which population is RF positivity not a sensitive marker for Rheumatoid Arthritis?
What are 3 exam findings of Takayasu Arteritis?
1. HTN (from bilateral renal artery stenosis)
3. Diminished or asymmetric pulses
**Think diffuse vascular insufficiency
What is a radiographic feature of Polyarteritis Nodosa?
Aneurysmal beading on angiography
Which infections are associated with Polyarteritis Nodosa?
HBV and (less) HCV
Which rheumatologic drug should be discontinued after a diagnosis of cancer and why?
TNF-alpha inhibitors because TNF-alpha is active against certain forms of cancer
What is anti-Jo related to (2)?
PM/DM and Interstitial Lung Disease
1. What is the symptom and exam finding for a Morton's Neuroma?
2. What is treatment?
1. Pain between 3rd-4th MTP when weight bearing in shoes with Mulder's sign (click with transverse loading)
2. Metatarsal pad and wider shoes
What is the general upper limit of normal in ESR for men and women?
Men = Age / 2
Women = (Age + 10) / 2
What is a rheumatologic lab pattern for Sjogrens (4)?
What is a serologic test for Primary Biliary Cirrhosis?
What is a serologic test for Hashimoto's thyroiditis (2)?
What is the histological feature of Polyarteritis Nodosa?
PANmural necrotizing inflammation by PMNs
Mnemonic = PAN
What is treatment for Reactive Arthritis?
List four rheumatologic labs findings of Drug-Induced Lupus.
What nonbiologic DMARD is use in the treatment of IBD arthritis?
What is Morphea?
Scleroderma limited to the skin only
What is treatment for Psoriatic Arthritis?
What is the difference between Type I and Type II cryoglobulinemia?
Type I: IN-active HCV disease
Type II: active HCV disease
1. What is treatment for acutely painful ischemic fingers withy Raynaud's?
2. How does it work?
Epoprostenol - prostacyclin analogue that decreases sympathetic vasoconstriction