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Flashcards in Vasculitides and diseases of connective tissue Deck (18)
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1

What are the main s/s of SLE (clinical presentation)?

Rash over sun-exposed areas

Joint symptoms in 90% of pts

Anemia, leukopenia, thrombocytopenia

2

What are some complications of SLE that require hospitalization?

Glomerulonephritis

Pleuritis

Pericarditis

Seizures or psychosis

3

What are the treatments of SLE?

1. Hydroxychloroquine

2. NSAIDs

3. Corticosteroids

4. Rituximab

For nephritis: mycophenolate, cyclophosphamide, azathioprine

For arthritis: methotrexate, belimumab

purple book 8-16

4

What is this?

A type of interstitial lung disease of unknown etiology characterized in about 90% of patients by granulomatous inflammation of the lung, with onset in the 20s-30s.

sarcoidosis

 

CURRENT

5

What is the treatment for sarcoidosis, and when is it indicated?

Oral prednisone

Indications:

  • Disabling constitutional symptoms
  • Hypercalcemia
  • Iritis, uveitis
  • Arthritis
  • CNS involvement
  • Cardiac involvement
  • Granulomatous hepatitis
  • Cutaneous lesions
  • Progressive pulmonary lesions

CURRENT, UpToDate

6

What is the clinical presentation of rheumatoid arthritis?

Insidious onset pain, swelling of joints >1hr morning stiffness

Joint deformities: ulnar deviation, swan neck, boutonnière, cock-up (toes)

C1-C2 instability

Constitutional: low-grade fever, weight loss, malaise

Extra-articular manifestations: rheumatoid nodules, interstitial lung disease, pericarditis, vasculitis, scleritis, anemia of chronic disease, glomerulonephritis

purple book 8-3

7

What are the treatments for rheumatoid arthritis?

DMARDs - methotrexate, etanercept, adalimumab, infliximab, rituximab

Hydroxychloroquine

8

What are some complications of rheumatoid arthritis?

  • Damage to the lung tissue (rheumatoid lung)
  • Increased risk of hardening of the arteries
  • Spinal injury when the neck bones become damaged
  • Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
  • Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead to congestive heart failure

MedlinePlus

9

What are the clinical manifestations of septic arthritis?

  • Acute onset monoarticular arthritis with pain, swelling, warmth
  • Knee most common location
  • Constitutional symptoms: fever, sweats, malaise, myalgia

 

purple book 8-9

10

How is septic arthritis treated?

  • Surgical drainage
  • Prompt empiric abx guided by Gram stain after surgical drainage
  • If gram pos, e.g. S. aureus: vancomycin
  • If gram neg, e.g. N. gonorrhea: ceftriaxone or cefotaxime
  • E. coli, Pseudomonas: cefepime or pip-tazo

purple book 8-9

11

What are the clinical manifestations of gout?

  • Sudden onset, frequently nocturnal, of painful monoarticular arthritis, especially of MTP of great toe
  • Chronic tophaceous gout: solid monosodium urate crystal deposition in tissue and joints
  • Renal: uric acid stones, urate nephropathy (interstitial deposits)

purple book 8-5

12

What are the treatments for gout?

(acute, chronic, dietary)

  • Acute: NSAIDs, colchicine, prednisone
  • Chronic: allopurinol, febuxostat, pegloticase, probenecid
  • Decrease intake of meat, EtOH, seafood; increase low-fat dairy products

purple book 8-5

13

What is pseudogout and how is it treated??

  • Acute calcium pyrophosphate dihydrate deposition-induced mono- or oligoarticular arthritis, indistinguishable from gout except via synovial fluid exam for crystals
  • Treat like gout

purple book 8-6

14

What are the clinical manifestations of polymyalgia rheumatica?

  • Aching and morning stiffness in the shoulders, hip girdle, neck, and torso in patients over the age of 50
  • Symptoms are usually symmetric
  • Pain – Shoulder pain is more common at presentation (70 to 95 percent of patients) than hip and neck involvement (50 to 70 percent), and may dominate the presenting symptomatology
  • Synovitis and bursitis

 

UpToDate

15

How is polymyalgia rheumatica treated?

prednisone

 

UpToDate

16

What is a complication of polymyalgia rheumatica?

Giant Cell Arteritis, which is much more serious than PR.

  • Polymyalgia rheumatica occurs in about 50 percent of people with giant cell arteritis.
  • Approximately 15 to 30 percent of people with polymyalgia rheumatica have giant cell arteritis.
  • Some people with one disorder later develop symptoms of the other.

UpToDate

17

What is hypersensitivity vasculitis?

  • Use of a possible offending drug in temporal relation to the symptoms
  • Palpable purpura
  • Maculopapular rash
  • Biopsy of a skin lesion showing neutrophils around an arteriole or venule
  • Associated clinical s/s: fever, urticaria, arthralgias, lymphadenopathy, low serum complement levels, and an elevated ESR

UpToDate

18

What is the treatment for hypersensitivity vasculitis?

  • Withdraw offending agent
  • Maybe NSAIDs and/or prednisone

 

UpToDate, purple book 8-20