Rheumatology Flashcards
(29 cards)
Which medication is a huge risk factor in causing scleroderma renal crisis?
glucocorticoids – do NOT use them to treat scleroderma
how do you treat scleroderma renal crisis vs. Lupus nephritis?
- ACE-i, no matter degree of AKI (captopril)
2. Myophenolate mofetil»_space; cyclophosphamide
In what condition are anti-U1 RNP antibodies positive? what defines this disease? what causes mortality?
MCTD (mixed connective tissue disease)
Includes features of at least 2 of the following - SLE/SSc/Polymyositis in the presence of antiU1 RNP
Mortality largely attributable to PH
What 3 medications are FDA approved for fibromyalgia?
Pregabalin
Duloxetine
Milnacipran (SNRI)
which antihypertensive should you use vs. NOT use in gout?
Use – Losartan (modest uricosuric effect)
NOT - HCTZ (common gout trigger)
What can you use for chronic refractory gout, when standard urate therapy is not working? whats MOA?
IV pegloticase
enzymatically converts urate to more soluble compound (allantoin)
Which medication is contraindicated with the use of allopurinol or febuxostat?
Azathioprine
because combination will raise azathioprine levels!
what are the 4 clinical presentations of CPPD? (Calcium Pyrophosphate Deposition) Describe the crystals
- Chondrocalcinosis - asymptomatic cartilage calcification - ie. traingualr fibrocartilage of wrist joing, menisci of knee (line in cartilage), symphysis pubis
- pseudogout - acute CPP crystal arthritis
- chronic CPP crystal inflammatory arthritis (resenbles RA)
- OA with CPPD
rhomboid shaped positively birefringent crystals (blue)
IF someone is <50yo and has CPPD, what 4 things should you screen them for?
- hemochromatosis
- hypomagnesemia
- hyperparathyroidism
- hypothyroidism
How do you treat CPPD?
- intra-articular glucocortioids if one or two joints
- NSAIDs (initial)
- Colchicine if doesn’t respond to NSAIDS or contraindicated
- systemic glucocorticoids if unable to take colchicine or NSAIDs
How do you diagnose Tuberculous arthritis?
Synovial biopsy
gram stain and culture will be negative, TST may not be positive
What is antisynthetase syndrome? in what patient population is it seen? What antibody?
ILD + inflammatory polyarthritis + fever + Raynaud’s + “mechanics hands” (dry, rough, scaly, cracked) –> increased risk of sudden death
seen in patients with polymyositis or dermatomyositis but NOT with inclusion body myositis
anti aminoacyl-transfer (t)RNA synthetase enzymes (e.g. anti-Jo-1 antibodies)
What are the 3-4 types of inflammatory myopathies?
proximal muscle weakness (gradual, painless) + pharyngeal and respiratory muscle weakness, 80% positive ANA –> (1)polymyositis . and.. (2)dermatomyositis
proximal AND distal muscle weakness, asymmetric, usu quads, wrists, finger flexers, 20% +ANA –> (3) inclusion body myositis
(4) toxic myopathy 2/2 meds (glucocorticoids, statins) or alcohol
Name 3 large vessel vasculitis, how to treat?
Giant Cell Arteritis (GCA)
Polymyalgia Rheumatica (PMR)
Takayasu Arteritis
Tx– GCA - high dose glucocorticoids or tocilizumab (steroid sparing) + baby ASA
PMR + Takayasu - prednisone
Name 2 medium vessel vasculitis, how do you treat them?
Polyarteritis Nodosa (PAN) Primary angiitis of the CNS (PACNS)
tx – prednisone + cyclophosphamide
Name as many small vessel vasculitis as you can (7)
Name the one with C-ANCA and the two with P-ANCA
- GPA (wegners) – C- ANCA/anti PR3
- MPA (microscopic polyangitis) - P-ANCA/anti MPO
- Eosinophilic Granulomatosis with Polyangitis (churg strauss) - P-ANCA/anti MPO
- HSP
- hypersensitivity vasculitis (leukoclatic vasulitis)
- Cryoglobulinemic vasculitis
- Bechets syndrome
Name some conditions in which you can see saddle nose deformity
Relapsing Polychondritis Granulomatosis with Polyangitis (GPA) syphilis cocaine use leprosy
How do you treat relapsing polychondritis?
minor - NSAIDs, colchicine, or dapsone
severe - glucocorticoids and steroid sparing agents
Familial Mediterranean Fever
- symptoms
- lab findings
- treatment
- recurrent, self limited fever and serositis (abdominal or pleuritic pain), arthritis, rashes lasting 3-4 days
- elev ESR, CRP, +AA protein (amyloid A), proteinuria, MEFV gene
- colchicine – prevents symptomatic attacks + development of AA amyloidosis
Treatment for adult onset stills disease
1st line - NSAIDs
Refractory - glucocorticoids
Refractory - MTX, TNF-a inhibigtor, or anakinra (IL-1 inhibitor)
In unclear cases what is the Gold Standard to diagnose Sjogren syndrome?
lip biopsy - of minor salivary gland
Dx?
2nd +/- 3rd MCP and PIP joint arthritis + hook like osteophytes (not RA)
hemochromatosis
What is DISH?
Diffuse idiopathic skeletal hyperostosis is a noninflammatory condition that involves ossification of spinal ligaments and entheses and usually presents as back pain and stiffness; characteristic radiographic changes include confluent ossification of at least four contiguous vertebral levels, usually on the right side of the spine. THORACIC most often involved.
Side effects of colchicine + drug interactions
diarrhea
colchicine + CYP3A4 inhibitors (clarithromycin or fluconazole) –> potentially fatal colchicine toxicity with kidney failure, rhabdomyolysis, and bone marrow suppression may occur.
