Rheumatology

Question 1

Rheumatoid Arthritis

Answer 1

Chronic systemic inflammatory dz

F>Ml 40-60yo

Sxs:

• Arthralgias, morning stiffness, and fatigue
• gets better with movement, worse with rest
• Wrists, MCP, PIP joints - ulnar deviation
  
  • Spares DIP
  • Swan neck/boutoniere deformity

Dx:

• Xray - erosions
• anti-CCP (more sensitive) + RF

Tx:

• Initial tx - NSAIDs, CS
• DMARDs
  
  • Methotrexate
  • Azathioprine
  • TNF-i/biologics
    
    • ​can reactive latent TB and cause lymphoma

Question 2

Systemic Lupus Erythematous

eti, sxs

Answer 2

90% young women, more commonly AA, inherited

Sxs:

• Malar rash, Discoid rash
• Serositis
• Oral ulcers
• Arthritis
• Photosensitivty
• Blood disorder
• Renal disease
• ANA+

Question 3

Systemic Erythematous Lupus

dx, tx

Answer 3

Dx: -4 or more of following

• Malar rash
• discoid lesions
• photosensitivty
• Oral ulcers
• arthritis
• serositis - pericarditis, pleuritis
• Renal dz - proteinuria
• abn ANA
• anti DNA
• anemia, leukopenia, thrombocytopenia

Tx:

• NSAID, exercise
• Sun protection
• CS prednisone - mainstain
• Hydroxychloroquine - check retina freq

Question 4

Sjorgen’s Syndrome

Answer 4

Lymphocytic invasion of lacrimal and salivary gland

Sxs:

• dry eyes, mouth
• a/o SLE or RA

Dx:

• +ANA
• SS-A (Ro) and SS-B (La)
• Schrimer’s test

Tx

• Immunosuppression tx
• Moisturizers for eyes/mouth

Question 5

Systemic Sclerosis Scleroderma

Answer 5

Thickness/fibrosis of skin d/t excess collagen

Dx - ANA, Anti-centromere AB

Tx

PPI for GI

ACE for renal

CCB for raynauds

Question 6

Reactive Arthritis

Answer 6

Can’t see, cant pee, cant climb a tree

Conjunctivitis, urethritis, arthritis

HLA-B27

F/u GU chlamydia infx

Tx - abx

NSAIDs

CS

Question 7

Temporal Arteritis

Answer 7

>55yo, F>M

Sxs:

• Tender inflammed, cordlike temporal arteries w/o pulse
• HA
• Acute vision loss vs diplopia
• Tinnitus
• Comorbid polymyalgia rheumatica

Dx:

• Ele ESR , always >70, usu >100
• Bx to confirm - multinucleated giant cells

Tx:

• High dose prednisone (60-120mg) slow taper
• 6-12 mos
• Thoracic aneurysms - more common

Question 8

Polymyalgia Rheumatica

Answer 8

Pain and stiffness in shoulder, neck, pelvic girdle - older patients

Sxs:

• fever, malaise, wt loss, fatigue
• a/w Giant cell Arteritis

Dx:

• High ESR, CRP

Tx:

• Prednisone
• NSAID
• exercise