Flashcards in Vasculitis and Fibromyalgia Deck (92):
What is Takayasu's arteritis? Where in the body does it usually occur, and whom does it usually affect?
-Large vessel granulomatous vasculitis with massive intimal fibrosis and vascular narrowing.
-Young females (15-30 yo)
What are some of the classic s/sx of Takayasu's arteritis?
-Decreased to absent peripheral pulses
-B symptoms during inflammatory phase
What are the two major phases of Takayasu's arteritis?
What are some major sequelae of Takayasu's arteritis?
What is the characteristic type of inflammation of the vessels in Takayasu's arteritis?
Segmental and patchy granulomatous inflammation of the aorta or its branches
What is the haplotype that is associated with Takayasu's arteritis?
What are the major criteria for Takayasu's arteritis? (5)
-Age less than 40
-Claudication of extremities
-Decreased brachial artery pulse
-BP difference of more than 10 mmHg between arms
-Bruit over subclavian or aorta
What is the gold standard test for Takayasu's arteritis?
Arteriogram showing occlusion or narrowing in the aorta or its main branches
Takayasu's arteritis must occur before what age to meet its diagnostic criteria?
What is the BP difference between arms that is needed in the diagnostic criteria for Takayasu's arteritis?
more than 10 mmHg between arms
What is the gold standard for diagnosing vasculitis?
Who does Kawasaki's disease affect?
Asian children less than 4 yo
What are the s/sx of Kawasaki's disease? (5)
-LAD /peripheral edema
What is the treatment fro Kawasaki's disease?
ASA and IVIG
What are the s/sx of Churg-Strauss syndrome?
What are the labs that are elevated with Churg-Strauss syndrome? (2)
What are the s/sx of granulomatosis with polyangiitis (Wegener's syndrome)?
-Perforation of nasal septum
-Hematuria with red cell casts
What is the classic triad for granulomatosis with polyangiitis (Wegener's syndrome)?
-Focal necrotizing vasculitis
-Necrotizing granulomas in the lung and upper airway
-Focal necrotizing vasculitis
-Necrotizing granulomas in the lung and upper airway
-Necrotizing glomerulonephritis = ?
granulomatosis with polyangiitis (Wegener's syndrome)
What are the abs that are elevated with granulomatosis with polyangiitis (Wegener's syndrome)?
What is the treatment for granulomatosis with polyangiitis (Wegener's syndrome)?
What are the two major vasculitides that affect large arteries?
-Giant cell (temporal) arteritis
Small or small-medium vasculitis: HSP
Small or small-medium vasculitis: SLE
Small or small-medium vasculitis: cryoglobulinemia
Small or small-medium vasculitis: polyarteritis nodosa
Small or small-medium vasculitis: Wegener's
Small or small-medium vasculitis: rheumatoid vasculitis
Small or small-medium vasculitis: Churg-Strauss
Small or small-medium vasculitis: microscopic polyangiitis
Small or small-medium vasculitis: Kawasaki
Small or small-medium vasculitis: vasculitis associated with malignancy
Polyarteritis Nodosa is associated with what infectious disease?
What age group Polyarteritis Nodosa classically affect?
What are the s/sx of Polyarteritis Nodosa? (5)
-Abdominal pain / melena
What vessels does Polyarteritis Nodosa classically involve?
renal and visceral vessels (not pulmonary arteries)
What type of hypersensitivity rxn is Polyarteritis Nodosa?
What are the characteristics bx findings of Polyarteritis Nodosa?
Transmural inflammation of the arterial wall with fibrinoid necrosis
What are the classic arteriogram findings of Polyarteritis Nodosa?
Innumerable microaneurysms and spasms
What is the treatment for Polyarteritis Nodosa? (2)
Who does Buerger's disease (thromboangiitis obliterans) classically affect?
heavy male smokers
What are the bx findings of Buerger's disease (thromboangiitis obliterans)?
Segmental thrombosing vasculitis
What is the treatment for Buerger's disease (thromboangiitis obliterans)?
What are the s/sx of Buerger's disease (thromboangiitis obliterans)? (2)
-Intermittent claudication leading to gangrene / amputation of digits
What are some of the general s/sx that may lead you to suspect a vasculitis?
What is mononeuritis multiplex?
Death of vasavesorum of nerves lead to nerve deficits
What diseases /drugs need to be r/o prior to diagnosing vasculitis?
-Cocaine / amphetamines
Which classically involves the lungs: PAN or MPA?
Which is ANCA positive: PAN or MPA?
What are the organs that are commonly involved in MPA?
skin (palpable purpura)
True or false: there are no granulomas with MPA
What is the classic angiogram findings of polyarteritis nodosa?
String of pearls
What are the four criteria for diagnosing HSP?
-Less than 20 years
-Granulocytes in walls of arterioles or venules
HSP occur below what age (according to the classification criteria)?
What is the classic triad of symptoms for HSP?
-Abdominal pain/ melena
What is the ab that is deposited with HSP?
What happens to the severity of HSP as kids age?
Worse--need to monitor teenagers
HSP classically occurs after what?
A viral infection
What is cryoglobulinemia? What are the clinical features of it (3)?
-Immunoglobulins that undergo reversible precipitation in the cold
-Acral cyanosis, ulcerations/ necrosis, raynaud's phenomenon
What are the clinical features of cryoglobulinemia that are related to immune complex deposition? (4)
What are the 4 diagnostic criteria for Wegener's granulomatosis (GPA)?
-Nasal or oral inflammation
-Abnormal chest radiograph (nodules / cavities)
-Granulomatous inflammation on bx
What are the CXR findings of GPA?
What are the UA findings of GPA?
Sediment with more than 5 RBCs / hpf or RBC casts
What are the nasal / oral mucosal findings of GPA?
Nasal or oral inflammation, causing a nasal deformity
What is polymyalgia rheumatica?
a syndrome with pain or stiffness, usually in the neck, shoulders, upper arms, and hips, but which may occur all over the body. The pain can be very sudden, or can occur gradually over a period. Most people with PMR wake up in the morning with pain in their muscles; however, cases have occurred in which the person has developed the pain during the evenings or has pain and stiffness all day long.
What are the symptoms of polymyalgia rheumatica?
-Pain and stiffness in the shoulders and hips, often with B symptoms
Does polymyalgia rheumatica cause muscular weakness?
What is ocular findings is associated with polymyalgia rheumatica?
What are the ESR, CRP, and CK findings of polymyalgia rheumatica?
Elevated ESR and CRP
Who is classically affected with polymyalgia rheumatica?
Women over 50 years, usually of northern european descent
What is the treatment /prognosis for polymyalgia rheumatica?
Rapid response to low doses of corticosteroids
What are the classic s/sx of giant cell arteritis?
-Temporal artery abnormality
What are the three labs that are classically elevated with giant cell arteritis?
What is the treatment for giant cell arteritis?
What is the severe cardiac sequelae of giant cell arteritis?
What are the histological findings of giant cell arteritis?
Focal granulomatous inflammation of the vessels with giant cells
What is the most commonly affected vessel with giant cell arteritis?
Branches of Carotids
What, generally, is fibromyalgia?
Chronic, widespread musculoskeletal pain associated with stiffness, paresthesias, and poor sleep
What is the treatment for fibromyalgia? (3)
Having a first degree relative with fibromyalgia imparts a (__)x greater risk of having it.
What is the proposed pathogenesis of Fibromyalgia?
Deficits in GABAergic and glutamatergic mechanisms
What are the associated diseases with FM?
What are some of the common complaints of FM patients?
When should SLE be screened for with fibromyalgia?
Only if history and physical suggests inflammatory systemic rheumatic disease
What is the ROS like with fibromyalgia?
What are the endocrine disorders that may have similar s/sx of FM?
-Vit D deficiency
Do patients feel better immediately after stopping a statin with statin-induced myopathy?
What should be done with a new diagnosis of FM?
Just like somatic disorder:
-Reassure no infx or other disease
-Stress and mood management
What are the two treatments for restless leg syndrome? MOA?
-Ropinirole -dopamine agonist
What is the MOA of bupropion?
Dopamine reuptake inhibitor
What are the three medications that should NOT be used with fibromyalgia?