Systemic Inflammation Rheumatic Disorders

Question 1

Cigarette smoking is the best documented environmental risk factor for what systemic inflammation rheumatic disorder?

Answer 1

Rheumatoid Arthritis

Question 2

What is the peak onset for Rheumatoid Arthritis?

Answer 2

35 and 75 years old

Question 3

Rhematoid Arthritis continues to result in SUBSTANTIAL morbidity for most patients primarily related to what?

Answer 3

increased cardiovascular burden

Question 4

Rheumatoid arthritis typically spares what?

Answer 4

Spares the thoracolumbar spine and DIP joints

Question 5

What is the pathogenesis of rheumatoid arthritis?

Answer 5

Synovial hyperplasia
Chronic inflammation
Pathological immune response

Question 6

What are the key features in rheumatoid arthritis?

Answer 6

Symptoms >6 weeks duration
Palpable synovial swelling – tender, boggy feeling
Fatigue is profound
Symmetrical and polyarticular (>3 joints)
Stiffness – will be stiff for a long period of time in the morning, will take awhile to get going

Question 7

What is the most characteristic feature of rheumatoid arthritis?

Answer 7

joint destruction

Question 8

What is the most frequent extra-articular manifestation of rheumatoid arthritis?

Answer 8

nodules

Question 9

Felty’s Syndrome triad consists of what?

Answer 9

leukopenia
Splenomegaly
Erosive deforming RA

Question 10

What is an extremely rare manifestation of RA

Answer 10

renal involvement

Question 11

What lab finding is very specific for RA?

Answer 11

anti-CCP (Anti-cyclic citrullinated peptide)

Question 12

Chronic connective tissue disorder characterized by immune-mediated destruction of exocrine glands

Answer 12

Sjogren’s Syndrome

Question 13

What condition is a well recognized extra-articular manifestation of Rheumatoid Arthritis

Answer 13

Sjogren’s Syndrome

Question 14

Which condition is associated with 33-44x increased risk for lymphoma?

Answer 14

Sjogren’s Syndrome

Question 15

What are two tests used in Sjogren’s Syndrome?

Answer 15

Schirmer-I test or Rose Bengal Score

Question 16

Joint inflammation <17 years old

Answer 16

Juvenile Arthritis

Question 17

What antibodies are associated with Sjorgen syndrome?

Answer 17

Type A (anti-RO-SS-A) in 60%
Type B (Anti-LA-SS-B) in 30%

Question 18

What is the most common rheumatic disease?

Answer 18

Juvenile Arthritis

Question 19

What are the three main types of JRA (based on onset)?

Answer 19

Systemic onset
Pauciarticular
Polyarticular

Question 20

What is the key factor in systemic onset juvenile arthritis?

Answer 20

fever (Quotidian)

Question 21

Describe a Quotidian fever

Answer 21

> 39 degrees
Intermittent
Daily or twice daily fever

Question 22

What sign/symptom are you likely to see in Pauciarticular type juvenile arthritis?

Answer 22

Uveitis

Question 23

Which type is most likely to end up with adult rheumatoid arthritis?

Answer 23

Polyarticular juvenile arthritis

Question 24

In Psoriatic Arthritis, which manifestation typically comes first?

Answer 24

Psoriasis precedes arthritis - 67%

Question 25

Which disease process presents as destructive, erosive polyarthritis affecting the hands and feet

Answer 25

Psoriatic Arthritis

Question 26

You may see "telescoping of digits" or "pencil in a cup" lesion in what disease process?

Answer 26

Psoriatic Arthritis

Question 27

What disease process is described below? Primarily affects boys 8 years and older Affects large joints of lower extremities Heel pain and achilles tendinitis Sacroilitis – 90% of cases

Answer 27

Enthesitis Related Arthritis

Question 28

Which disease process is described below: Autoimmune multisystem disease More common in females 9:1 Peak age 15-25 Major late cause of a death is cardiovascular disease

Answer 28

Systemic Lupus Erythematosus

Question 29

What are the four different types of Systemic Lupus Erythematosus?

Answer 29

Discoid Subacute cutaneous Drug induced Systemic

Question 30

What is a major late cause of death in SLE?

Answer 30

cardiovascular disease

Question 31

Name some features of SLE

Answer 31

Jaccoud’s arthropathy Malar rash Hair is thin and fragile Nephritis Raynaud’s phenomenon Photosensitive skin eruptions Serositis Pneumonitis Myocarditis Miscarriages

Question 32

Which type of SLE is limited to the skin?

Answer 32

Discoid

Question 33

Which type of SLE will you see a prominent, widespread non-scarring skin lesions with marked photosensitivity, gets worse with sun exposure, and CNS and renal involvement rare

Answer 33

Subacute cutaneous

Question 34

Which type of SLE will you get a lupus-like reaction after taking a drug/medication?

Answer 34

Drug Induced

Question 35

What is a common medication you will see that causes drug induced SLE?

Answer 35

Procainamide

Question 36

Malar rash and Interarticular dermatitis are likely to indicate which disease?

Answer 36

Systemic Lupus

Question 37

Which two lab findings are specific for SLE?

Answer 37

Anti-ds DNA Anti-Sm

Question 38

What is a common lab finding in SLE but is not specific?

Answer 38

ANA

Question 39

A history of thrombosis in a patient thought to be otherwise at low risk of such an event often prompts the search for what disease?

Answer 39

Antiphospholipid Syndrome

Question 40

Name three common presentations for Antiphospholipid Syndrome?

Answer 40

A history of thrombosis in a patient thought to be otherwise at low risk Recurrent spontaneous abortions Refractory thrombocytopenia

Question 41

What is Catastrophic APL syndrome?

Answer 41

Refers to the fulminant organ failure from widespread thromboses