Step Up - Connective Tissue and Joint Disease Flashcards Preview

Internal Medicine > Step Up - Connective Tissue and Joint Disease > Flashcards

Flashcards in Step Up - Connective Tissue and Joint Disease Deck (45)
Loading flashcards...
1
Q

What is the most common antibody found in patients with SLE? What 2 antibodies are considered diagnostic for SLE? What antibody is present in drug-induced lupus?

A

1) ANA
2) Anti-ds DNA, Anti-Sm Ab
3) Antihistone Abs

2
Q

The diagnosis of SLE requires 4 of 11 criteria are met. Provide the 11 criteria.

A

1) Butterfly rash
2) Photosensitivity
3) Oral or nasopharyngeal ulcers
4) Discoid rash
5) Arthritis
6) Pericarditis/pleuritis
7) Hematologic disease - reticulocytosis, thrombo/leuko/lympho-penia
8) Renal disease - protein >0.5g/day
9) CNS - seizures, psychosis
10) Immunologic - positive anti-ds DNS, ant-Sm Ab
11) ANAs

3
Q

ANAs are typically elevated in what rheumatologic diseases (4)?

A

1) SLE
2) Scleroderma
3) Sjogren syndrome
4) Polymyositis

4
Q

RF is detectable (typically) in what rheumatologic disease?

A

RA (70%), 3% in gen pop.

5
Q

C-ANCA is the lab marker for which rheumatologic disease?

A

Wegener Granulomatosis

6
Q

P-ANCA is the lab marker for which rheumatologic disease?

A

Polyarteritis nodosa

7
Q

Outline the treatment for SLE, highlighting appropriate therapy for mild vs severe disease and acute vs maintenance therapy.

A

Mild: use NSAIDs
Severe: Systemic steroids
Acute: local or systemic corticosteroids
Chronic: Hydroxychloroquine (concern is retinal toxicity)
- cyclophosphamide used for GN if present

8
Q

What are some typical findings of antiphospholipid antibody syndrome (4)? What is the appropriate therapy? What investigative test will provide a false-positive?

A

1) recurrent venous/arterial thrombosis, recurrent fetal loss, thrombocytopenia, livedo reticularis
2) Anti-coagulate
3) Syphilis

9
Q

Discuss the skin involvement, rapidity of onset, visceral involvement level, associated antibody, and prognosis of diffuse scleroderma.

A

1) Skin - widespread involvement
2) Onset - rapid (Raynaud’s first)
3) Visceral involvement - significant (resp, GI, CV, renal)
4) Antibody - Antitopoisomerase 1
5) poor prognosis

10
Q

Discuss the skin involvement, rapidity of onset, visceral involvement level, associated antibody, and prognosis of limited scleroderma.

A

1) Skin - spares trunk
2) Onset - delayed (Raynaud’s first)
3) Visceral involvement - late (resp, CV)
4) Antibody - Anticentromere Ab
5) better prognosis

11
Q

What is the treatment for scleroderma (4)?

A

Treatment aimed at symptoms:

1) NSAIDs for MSK pain
2) H2 blocker or PPI for GERD
3) Avoid cold for Raynaud’s
4) ACEi for renal HTN

12
Q

What are the clinical features of Sjogren syndrome (4)?

A

1) Dry eyes
2) Dry mouth - tooth decay
3) Arthralgias/arthritis
4) Interstitial nephritis and vasculitis

13
Q

What is a clinical test that can be performed for Sjogren syndrome?

A

Schirmer test - filter paper in eye to determine tear production

14
Q

How is Sjogren syndrome treated (4)?

A

1) Pilocarpine for increased secretions
2) Artificial tears
3) Good oral hygiene
4) NSAIDs for arthralgias
- if secondary Sjogren, treated associated rheumatoid disease.

15
Q

Describe the clinical features of rheumatoid arthritis. What joints are most likely to be involved (2)? What are some characterisitc deformities (4)? What is a risk when intubating these patients?

A

1) Joints: typically symmetric distribution. Often wrists and hands first
2) Deformities: ulnar deviation at MCP, boutonniere’s deformity, swan-neck deformity, subcutaneous rheumatoid nodules
3) C1-C2 instability

16
Q

What is required for the Dx of rheumatoid arthritis (4)?

A

1) Inflammatory arthritis in 3+ joints for 6+ weeks
2) High CRP and ESR
3) Positive RF or ACPA
4) Xray shows changes of RA

17
Q

What are the radiographic findings consistent with RA (2)?

A

1) Periarticular osteoporosis

2) Narrowing of joint space

18
Q

Outline the medical management for RA (3)

A

1) Symptom control - NSAIDs, corticosteroids
2) DMARDs - methotrexate > hydroxychloroquine > sulfalazine
3) Second-line: Anti-TNF inhibiting agents (etanercept, infliximab).

19
Q

Describe the clinical features of an acute gouty arthritis (5)?

A

1) Men 40-60
2) Exquisite pain (wakes from sleep). Often 1st MTP
3) Cellulitic changes - erythema, swelling, tender
4) +/- fever
5) desquamation of overlying skin on resolution

20
Q

Describe the clinical features of chronic tophaceous gout (2)

A

1) those with poorly controlled gout for 10-20 years

2) Common locations: extensors of forearms, elbows, knees, achilles, pinna of ear

21
Q

What is seen on joint aspiration of a gouty joint? What is seen on xray?

A

1) Needle-shaped, negatively birefringent urate crystals

2) Punched out erosions with rim of cortical bone

22
Q

How is gout treated (3)? What are the prophylactic medications that can be used (2)?

A
  • Acute:
    1) NSAIDs
    2) Colchicine - lots of SE
    3) Corticosteroids - prednisone 7-10 days, or intra-articular injection
  • Prophylactic:
    1) Uricosuric agent if urine uric acid excretion less than 800mg/day
    2) Allupurinol if urine uric acid excretion >800mg/day
23
Q

What patient population is affected by pseudogout?

A

elderly with degenerative joint disease

24
Q

What are the most common joints affected by pseudogout (2)? What is seen on aspiration of the joint? What is seen on xray?

A

1) knees and wrists (monoarthropathy)
2) positively birefringent rhomboid crystals (calcium pyrophosphate)
3) chondrocalcinosis

25
Q

What is the appropriate treatment for pseudogout (3)?

A

1) NSAIDs
2) Colchicine for prophylaxis
3) Intra-articular steroid injection

26
Q

What are the clinical features of polymyalgia rheumatica (4)?

A

1) hip and shoulder pain bilaterally - bad morning stiffness
2) Constitutional Sx - fever, depression, fatigue
3) Joint swelling/synovitis
4) SSx of temporal arteritis

27
Q

How is polymalgia rheumatica diagnosed? How is it treated?

A

1) diagnosis is clinical (ESR usually high)

2) Corticosteroids for 2+ years.

28
Q

What are the clinical features of fibromyalgia (3)?

A

1) Stiffness
2) Disrupted sleep
3) Depression and anxiety

29
Q

How is fibromyalgia diagnosed (3)?

A

1) pain includes axial pain for >3 months
2) Pain in 11 of 18 trigger spots
3) r/o other causes

30
Q

Outline the treatment for fibromyalgia (4)

A

1) Increase activity level
2) Amitriptyline or SNRI
3) Local anesthetic at trigger points
4) CBT, psych

31
Q

What are the clinical features of ankylosing spondilitis (4) What antigen is it associated with?

A

1) Associated with HLA-B27 antigen
2) Male predominance
3) Bilateral sacroiliitis
4) Enthesitis (tendon inflammation) - achilles, supraspinatous
5) Extra-articular - anterior uveitis, AV heart block, aortic insufficiency

32
Q

What is seen on xray in ankylosing spondylitis?

A

Bamboo spine - fusion of lumbar spine

33
Q

How is ankylosing spondylitis treated (4)?

A

1) NSAIDs
2) Anti-TNF agents (etanercept, infliximab)
3) Mobility exercises
4) Surgery if severe

34
Q

Describe the clinical picture of a reactive arthritis (2). What are the common organisms that cause it?

A

1) Recent enteric or urogenital infection (1-4 weeks prior)
2) Assymetric oligoarthritis affecting lower extremities
3) Salmonella, shigella, campylobacter, chlamydia, yersinia

35
Q

How is reactive arthritis diagnosed? How is it treated (3)?

A

1) Clinical diagnosis, tap joint effusion to rule out crystals
2) NSAIDs > Sulfasalazine > Azathioprine

36
Q

What are two clinical findings of psoriatic arthritis? What joints are typically affected? What is the treatment (3)?

A

1) Sausage digits (dactylitis), nail pitting
2) Small joints
3) NSAIDs > methotrexate > anti-TNF

37
Q

What are some clinical features of temporal/giant cell arteritis (5)?

A

1) Constitutional symptoms
2) Headache (severe)
3) Blindness - ophthalmic artery involvement
4) Claudication of tongue/jaw
5) Lack of temporal pulse

38
Q

Provide three serious sequelae of giant cell arteritis.

A

1) Aortic aneurysm
2) Aortic dissection
3) Blindness

39
Q

How is temporal arteritis confirmed?

A

Biopsy of temporal artery

40
Q

How is temporal/giant cell arteritis treated (3)?

A

1) If vision loss present - high-dose IV steroids
2) If no vision loss - oral prednisone
3) Follow ESR, treat for 2-3 years
- treat presumptively, don’t wait for biopsy results

41
Q

What vessels are affected in Takayasu arteritis? What is the treatment?

A

1) Aortic arch and branching vessels.

2) Steroids - prednisone

42
Q

What are two findings in Churg-Strauss syndrome? What does it affect?

A

1) eosinophilia, p-ANCA

2) Vasculitis involving multiple organ systems

43
Q

What two systems are commonly affected in Wegener’s granulomatosis? How is it diagnosed (4)? How is it treated (2)?

A

1) Lung and kidney
2) High ESR, c-ANCA, CXR nodules, lung biopsy confirms
3) Cyclophosphamide and corticosteroids

44
Q

What systems are affected by polyarteritis nodosa (2)? How is it diagnosed (3)? How is it treated (2)?

A

1) Medium sized vessels of NS and GI
2) ESR high, p-ANCA, biopsy
3) corticosteroids, then cyclophosphamide if severe

45
Q

What is seen in Buerger Disease (Thromboangiitis obliterans) (4)?

A

1) Affects young male smokers
2) Segmental inflammation of small/medial vessels of extremities
3) May lead to autoamputation and gangrene
4) Raynaud’s phenomena may be seen
- Tx: stop smoking