Rheumotology Flashcards
(44 cards)
Auto Immune syndromes
Lupus, Rheum Arthritis, Hashimotos Thyroiditis, IBS, interstitial lung disease, MS
auto immune arthritis- 4 chronic groups
rheum arthritis, systemic lupus erythmatosus, seronegative spondloarthopathy, infection
seronegative spondyloarthropathy
ankylosing spondytitis
IBS
psoriatic arthritis
reactive arthritis
biologic MARD
• Etanercept (Enbrel) • Infliximab(remicade) • Adalimumab (humira) • Golimumab(simponi) • Certolizumab(simzia) anti TNF agents and growing RA
DMARD (pneumonic)
disease modifying anti-rheum drugs for RA
types of DMARD
• Methotrexate, leflunomide • Plaquenil/sulfasalazine • Prednisone- not long term use due to SE for RA 1st line
methotrexate
use : RA, JRA, pSA, myositis, SLE,sarcoidosis
antagonis that interacts with inflammatory prosess
SE>: infeciton, GI, oral uclers, bm suppression, liver effects, CBC/LFT monitor every 8 weeks
RA
chronic systemic inflammatory autoimmune polyarthritis of >3 joints (small jts most common), morning stiffness >1 hr, symmetric painful joints, radiographic erosion, nodules
thicken, boggy, tender joints with shiny thin ruddy skin over it
peaks in 20s and 60s, F>M
SLE
Multi- system autoimmune inflammatory disease characterized by a chronic relapsing/remitting course; varies from mild to severe and may be life-threatening (CNS and renal forms)
methotrexate SE
DOC for R.A= 7.5–25 mg per week PO. The DMARD with most predictable benefit. Many significant side effects, but the addition of folate reduces toxicity. 3–6-month trial. Monitor CBC, renal, and liver function every 8–12 weeks. Contraindicated in renal disease
RH false positive in ____
for R.A
• Disorders that may yield false-positive RF results: Sjögren syndrome, mixed cryoglobulinemia, parasitic infections (e.g., malaria), liver disease, endocarditis, acute viral infections.
synovial fluid in R.A
No pathognomonic findings Yellowish-white, turbid, poor viscosity WBC increased (3,500–50,000) Protein: ∼4.2 g/dL (42 g/L) Serum-synovial glucose difference ≥30 mg/dL (≥1.67 mmol/L) pannus invades cartilage and bone
SLE s&S pneumotic
MDSOAP BRAIN
malar rash, discoid rash, serositis , oral painless ulcers, arhtirtis (mild than RA non erosive no jt deformities, photosensitive, blood (anemia), renal (proteinuria), ANA(false + in elderly, women thyroid- low titer not alarming), immune (VDLR false +, ptt, anti-phos) neuro (seizures, psychosis)
SLE tx
NSAIDS for pain/fever/serositis
hydroxychloroquine - DOC for flares and taper steroids
steroids- prednisone- increase dose for organ threaten)
6 month > tx- azathioprine, mycophenolate mofetil, cyclophosphamide, methotrexate with folic acid)
hydroxychloroquine (Plaquenil)
200mg PO BID for long term SLE to reduce flare increase survival and taper steroids
methotrexate
7.5-15mg/week with 1mg/day of folic acid to help SLE for 6month> tx
SLE education
avoid sun, SPF >30/clothing statin, omega 3, vit d and calcium for CV and osteoporosis and chol prevention GYN check up- HPV/dysplasia exercise smoke cessation screen for depression
OA
most common progressive degenerative synovial joint disease
2nd or 3rd decade in life
hips/knees/spine/pip/dips/thumb
central load off center and increasing shearing force= problem
xray NOT correlate with symptoms
OA risk factors
age, obese, stress, females, genetics, prior jt trauma, hem/metabolic/neuro conditions
heberdens nodes
DIP in OA
boney hard non tender
bouchard nodes
PIP in OA
boney hard non-tender
no mcp jts involved
OA usually only DIP, PIP and 1st CMC jt of thumb
OA tx
DOC- tyelnol
then NSAIDS, cox2
capsaicin HP cream, corticosteroid injections (if PO fails), hyaluronic acid injection, glucosamine/chondroitin supplement, sx
capsaicin HP cream SE
to knees or hands- best for R.A small effects on OA, 3 days to burn red on site area- dont touch eyes/mouth
