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98 Cards in this Set

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  • Back
what is characterized by symmetric inflamm arthritis?
RA (rheumatoid arthritis)=
autoimmune dz of unkown etiology
what is characterized by symmetric arthritis worse in morning, affecting knees, feet, MCP and PIP, ulnar deviation of digits and subQ nodules?
what are si/sx of rheumatoid arthritis?
1. female/male= 3/1
2. HLA-DR4 positive
3. symmetric arthritis worse in morning
4. affecting knees, feet, MCP and PIP joints
5. pleural effusions (serositis)
6. anemia of chronic dz
7. flexion contractures
8. ulnar deviation of digits
9. subQ nodules (present in <50% of pts)
what are the 4 Ss of alopecia?
1. sarcoidosis
2. SLE
3. scleroderma
4. syphyllis
what labs should you check for with RA?
1. RF (rheumatoid factor)= IgM anti-IgG
2. RF present in >70% of RA pts but may appear late in dz course
3. RF not specific for RA, can be + in any chronic inflamm state and may be present in 5-10% of healthy geriatric pts
4. ESR is elevated in >90% of RA cases but is not specific for RA
what may be positive in any chronic inflam state and may be present in 5-10% of healthy geriatric pts?
1. RF= IgM anti-IgG
what is tx for RA?
1. NSAIDs are first line
2. hydroxychloroquine second line
3. prednisone, gold salts and penicillamine for refractory pts--all cause severe side effects
4. TNF antagonists markedly improve sx, even in pts refractory to std therapy
What presents with fever, polyarthritis, serositis (pleuritis and pericarditis), Libman-Sacks endocarditis, skin rashes and thrombosis?
SLE= systemic lupus erythematosus
systemic automimmune disorder
what are si/sx of SLE?
1. female/male = 9:1
2. fever, polyarthritis
3. skin lesions, splenomegaly
4. hemolytic anemia, thrombocytopenia
5. serositis (pleuritis and pericarditis)
6. Libman-Sacks endocarditis
7. renal dz, skin rashes, thrombosis
8. neurologic disorders
what are labs for SLE?
1. ANA sensitive >98%, but not specific (antinuclear antibody)
2. anti-ds-DNA Abs 99% specific
3. anti-Sm (anti-Smith) Abs are highly specific but not sensitive
4. Anti-Ro Abs are positive in 50% of ANA-negative lupus
5. antiribosomal P and antineuronal Abs correlate with risk for cerebral involvement of lupus (lupus cerebritis)
6. antiphospholipid auto-Abs cause false-positive lab tests in SLE
which tests are highly specific for SLE?
1. anti-ds-DNA (99% specific)
2. Anti-Smith Abs
what correslates with risk for lupus cerebritis?
1. lupus cerebritis= cerebral involvement of lupus
2. antiribosomal P
3. antineuronal Abs
what false-positive lab tests are often foudn in SLE?
1. false positive RPR/VDRL tests for syphilis
2. falsely elevated PTT (b/c the lupus anticoagulant Ab binds to phospholipid that initiates clotting in the test tube)
why is PTT falsely elevated in SLE?
1. b/c the lupus anticoagulant Ab binds to phospholipid that initiates clotting in the test tube
what labs are found in SLE, but are not specific?
1. RF= IgM anti-IgG
2. ESR
3. ANA (98% sensitive!)
SLE pts are THROMBOGENIC--why??!
1. despite elevated PTT test...
2. despite the name lupus anticoagulant Ab...
3. SLE pts are thrombogenic b/c antiphospholipid Abs cause coagulation in vivo
name the mnemonic for SLE diagnosis
D=discoid lupus (circular, erythematous macules c/ scales)
O=oral aphthous ulcers (can be nasopharyngeal as well)
A=arthritis (typically hands, wrists, knees)
M=malar rash (classic butterfly macule on cheeks)
I=immunologic criteria (anti-ds-DNA, anti-Sm Ab, anti Ro Ab, anti-La)
N=neurologic changes (psychosis, personality changes, seizures)
E=ESR elevation (not 1 of 11 criteria, but is a frequent lab finding)
R=renal dz (nephritic or nephrotic syndrome)
A=ANA positive
S=serositis (pleurisy, pericarditis)
H=hematologic dz (hemolytic anemia, thrombocytopenia, leukopenia)
what drugs can induce SLE?
1. procainamide
2. hydralazine
3. sulfonamides
4. INH
5. Dilantin
what is discoid lupus?
circular, erythematous macules with scales
what lab differentiates from idiopathic SLE?
antihistone Abs
what is tx for SLE?
2. hydroxychloroquine
3. prednisone
4. cyclophosphamide
what is an especially poor Px indicator with SLE?
renal dz
otherwise, variable Px, 10-yr survival is excellent
what is an autoinflam disorder a/c HLA-DR3?
Sjogren's syndrome!!
what is classic triad of sjogren's syndrome?
1. keratoconjunctivitis sicca (dry eyes)
2. xerostomia (dry mouth)
3. arthritis (usually less severe than pure RA)
what are systemic si/sx of Sjogren's syndrome?
1. pancreatitis
2. fibrinous pericarditis
3. CN V sensory neuropathy
4. renal tubular acidosis
5. 40x increase in lymphoma incidence
what may present with pancreatitis, fibrinous pericarditis, CN V sensory neuropathy, renal tubular acidosis and increased lymphoma incidence?
Sjogren's syndrome= autoinflam disorder a/c HLA-DR3
what is dx of Sjogren's syndrome?
1. concomitant presence of 2 of the triad is dx:
keratoconjuctivitis sicca, xerostomia, arthritis
what labs should you check for with Sjogren's Syndrome?
1. ANA positive
2. anti-Ro/anti-La Abs (SSA/SSB ABs)
3. 70% are RF posititve
what is tx for Sjogren's syndrome?
1. steroids
2. cyclophosphamide for refractory disease
what is Behcet's syndrome?
multisystem inflamm disorder that chronically recurs
what are si/sx of Behcet's syndrome?
1. painful oral and genital ulcers
2. arthritis
3. vasculitis
4. uveitis
5. neruologic dz
what is characterized by painful oral and genital ulcers, also arthritis, vasculitis, and neurologic dz?
Behcet's sx= multisystem inflamm disorder that chronically recurs
how do you tx Behcet's sx?
prednisone during flare-ups
what are the seronegative spondyloarthropathies?
RAPE plus W, B, AAU:
R=Reiter's sx (reactive arthritis)
A=ankylosing spondylitis
P=psoriatic arthritis
E=enteropathic arthritis (arthritis a/c IBD)

Whipple's dz=bowel bz caused by Tropheryma Whipplei

Behcet's dz=immune dz c/ painful oral and genital ulcers, and neurologic sx

AAU=anterior uveitis
what is osteoarthritis characterized by?
1. noninflamm arthritis
2. caused by joint wear and tear
3. m/c arthritis, wearing away of joint cartilage
4. osteophytes (bone spurs) and asymmetric pt space loss
5. affects PIP and DIP joints
6. Heberden's nodes (DIP swelling secondary to osteophyles)
7. Bouchard's nodes (PIP swelling secondary to osteophytes)
what is the m/c arthritis?
1. osteoarthritis
2. non-inflamm arthritis casued by joint wear and tear
what are si/sx of osteoarthritis?
1. pain and crepitiation c/ jt motion
2. decreased ROM in jts
3. may have radiculopathy d/t cord impingement
4. affects PIP and DIP
what is seen on x-ray with OA?
1. osteophytes (bone spurs)
2. asymmetric joint space loss
what is seen on PE c/ OA?
1. Heberden's nodes (DIP swelling secondary to osteophytes--bone spurs)
2. Bouchard's nodes (PIP swelling secondary to osteophytes)
what affects MCP and PIP joints?
what affects DIP and PIP joints?
what is tx for OA?
2. muscle relaxants
3. jt replacements (third line)
4. isometric exercise to strengthen muscles around joint
what is ankylosing spondylitis?
1. rheumatologic dz usually in HLA-B27 positive males
2. male/female= 3/1
3. dz of the axial skeleton, manifested clinically by pain and progressive stiffening of the spine
4. must affect the sacroiliac joint!!
what characterizes the seronegative spondyloarthropathies?
1. onset usually before age 40
2. infamm arthritis of the spine or lg peripheral jts
3. uveitis
4. absence of autoantibodies in the serum for RF (rheumatoid factor)
5. strong a/c HLA-B27
what are si/sx of ankylosing spondylitis?
1. sacroilitis
2. spinal dz--complete fusion of adjacent vertebral bodies causing "bamboo spine"
3. uveitis
4. heart block
5. if sacroiliac joint is not affected, it is not AS!!
what joint must be affected for it to be ankylosing spondylitis?
1. sacroiliac joint!!!
2. spinal dz--complete fusion of adjacent vertebral bodies causeing "bamboo spine"
what is dx for ankylosing spondylitis?
1. x-ray signs of spinal fusion
2. negative RF
3. positive HLA-B27
what is tx for AS?
2. strengthening of back muscles
what presesnts as nongonococcal urethritis, conjuctivitis (uveitis), rmucocutaneous lesions, and aseptic arthritis?
1. Reiter's syndrome
2. usually seen in males
what is circinate balanitis?
1. seen in Reiter's syn/reactive arthritis
2. serpiginous, moist plaques on glans penis
what is keratoderma blennorrhagicum?
1. seen in Reiter's syn/reactive arthritis
2. crusting papules with central erosion
3. looks like mollusk shell
what is the clinical tetrad of reactive arthritis/Reiter's syn?
1. urethritis
2. conjuctivitis (or uveitis)
3. mucocutaneous lesions
4. aspetic arthritis
what are classic derm sx of reactive arthritis/Reiter's sx?
1. circinate balanitis (serpiginous, moist plaques on glans penis)
2. keratoderma blennorrhagicum (crusting papules c/ central erosion, looks like mollusk shell)
what is tx for Reiter's sx/reactive arthritis?
1. NSAIDs (for arthritis)
2. erythromycin (for Chlamydia coverage)
3. Tetracycline (for reactive arthritis a/c C trachomatis)
what present c/ nail pitting, DIP jt involvement, and "sausage" appearance of fingers and toes?
1. psoriatic arthritis
2. occurs in up to 10% of pts c/ psoriasis
what is psoriatic arthritis characterized by?
1. nail pitting and DIP jt involvment
2. occurs in up to 10% of pts c/ psoriasis
3. psoriatic flares may exacerbate arthritis and vice versa
4. tx c/ UV light for psoriasis and gold/penicillamine for arthritis
how do you tx psoriatic arthritis?
2. gold/penicillamine for arthritis
what can cause monoarticular arthritis?
1. disseminated gonococcal infxn
what are the CREST sx of scleroderma?
C=calcinosis (subcutaneous calcifications, often in fingers)
R=raynaud's phenomenon, often the inital sx
E=esophageal dysmotility d/t lower esophageal sphincter sclerosis--causes reflux
S=sclerodactyly=fibrosed skin causes immobile digits and rigid facies
T=telangiectasias occur in mouth, on digits, face and trunk
what is scleroderma?
1. systemic fibrosis affecting virtually every organ
2. female/male= 4/1
3. can be diffus dz or more benign CREST syndrome
what may also present with flexion contractures, biliary cirrhosis, lung/cardiac/renal fibrosis?
1. scleroderma
what labs are seen with scleroderma?
1. positive ANA in 95%
2. anti-Scl-70 has low sensitivity, but high specificity
3. anti-centromere is 80% sensitive for CREST sx
what is raynaud's dz?
1. cyanosis of the fingers d/t arterial vasoconstriction
2. may cause area of infarction
what presents as an idiopathic, diffuse dz c/ incidental findings on CXR?
1. sarcoidosis
2. AA are 3x more likely to decelop than causcasians
what is sarcoidosis characterized by?
1. idiopathic, diffuse dz
2. presenting in 20-40s
3. 50% of pts present c/ incidental findings on CXR and are aSx
4. other presentations include: fevers, chills, night sweats, wt loss, cough, dyspnea, rash, arthralgia, blurry vision (uveitis)
what is seen on CXR c/ sarcoidosis?
1. b/l hilar adenopathy
how does sarcoid present systemically?
1. cns= CN palsy, classically CN VII (can be b/l)
2. eye= uveitis (can be b/l), requires aggressive tx
3. cardiac= heart blocks, arrhythmias, constrictive pericarditis
4. lung= typically a restrictive defect
5. GI= increased AST/ALT, CT shows granulomas in liver, cholestasis
6. renal= nephrolithiasis d/t hypercalcemia
7. endocrine= DI
8. hematologic= anemia, thrombocytopenia, leukopenia
9. skin= various rashes, including erythema nodosum
noncaseating granulomas on biopsy is very suggestive of what?
*50% of pts have and increased ACE level
50% of what pts have an increased ACE level?
what is tx for sarcoidosis?
1. prednisone (1st line)
2. 50% pts spontaneously remit, so only tx if: eye/heart involvement or if dz does not remit after months
what presents with overlapping SLE, scleroderma and polymyositis but characterized by post. anti-U1 RNP Ab that defines the dz?
mixed connective tissue dz (overlap dz)= commonly onsets in women in teens and 20s
*dx= anti-U1 RNP Ab
what is mixed connective tiessue dz (overlap dz)?
1. commonly onsets in women in teens and 20s
2. overlapping SLE, scleroderma and polymyositis
3. characterized by positive anti-U1 RNP Ab
how do you tx MCTD (overlap dz)?
1. dx=anti-U1 RNP Ab
2. tx=steroids, azathioprine
what is a monoarticular arthritis d/t urate crystal deposits in jt?
1. gout!!!
what causes gout?
1. develops after 20-30 yr of hyperuricemia
2. often precipitated by sudden changes in serum urate levels (if gout in teens--likely genetic)
3. however, most people c/ hyperuricemia never get gout
do most people c/ hyperuricemia get gout?
what are two basic causes of gout for pathophys?
1. overproduction of uric acid (can ge be genetic or acquired--alcohol, hemolysis, neoplasia, psoriasis)
2. underexcretion of urate via kidney (<800 mg/dL urine urate) can be idiopathic or d/t kidney dz, drugs (ASA, diuretics, alcohol)
what are si/sx of gout?
1. painful monoarticular arthritis affecting distal jts
2. often 1st MTP jt= podagra
3. hyperuricemia
4. positive response to colchicine
what is podagra?
1. painful monoarticular arthritis in gout
2. affecting the first metatarsophalangeal joint
what is the dx of gout?
1. clinical triad of monoarticular arthritis
2. hyperuricemia
3. post. response to colchicine
4. confirme with needle tap of jt--see crystals
what is acute tx for gout?
1. colchicine
2. NSAIDS (NOT aspirin!!)
what is chronic tophaceous gout?
1. gout c/ significant jt deformation
2. presents with classic rat-bite appearance to jt on x-ray
3. may have toothpaste-like discharge from jt
what is maintenance tx for gout?
1. do not start unless pt has more than 1 attack
2. overproducers--give allopurinol (inhibits xanthine oxidase)
3. underexcreters--give probenecid/sulfinpyrazone
4. always start while pt is taking colchicine b/c sudden decrease in serum urate precipitates an acute attack
what is tx for overproducers of uric acid?
1. allopurinol
2. to inhibit xanthine oxidase
what is tx for underexecreters of urate?
1. probenecide/sulfinpyrazone
why should you start taking maitentance tx while the pt is still taking colchicine?
1. b/c a sudden decrease in serum urate precipitates an acute attack
what is pseudogout?
1. crystal deposition in joints and articular cartilage (choncrocalcinosis)
2. caused by calcium pyrophosphate dihydrate (CPPD)
3. often affects larger, more porximal jts
what is casued by CPPD?
1. pseudogout
2. caused by calcium pyrophosphate dihydrate crystal depostion in jts and articular cartilage
3. mimics gout closely
what may pseudogout be primary or secondary to?
1. metabolic dz (hyperparathyroidism, Wilson's dz, DM, hemochromatosis)
what is dx of "P"seudogout?
1. "P"ositiviely birefringent crystals
2. pleomorphic, rectangular
3. axis of slow vibration is from bottom R to top L
what is dx of gout?
1. needlelike
2. negatively birefringent crystals
3. axis of slow vibration is from bottom L to top R
4. synovial fluid microscopy under polarized light
what may follow a Neisseria gonorrhea infxn...?
1. septic arthritis/monoarticular arthritis
2. otherwise m/c cause is S. aureus
what is m/c cause of septic arthritis?
1. S.. aureus
2. Strep spp. and gram-negative rods (GNR) less common
3. Neisseria gonorrhea in sexually active pt
what is dx for septic arthritis?
1. jt fluid Gram stain
2. culture
3. swabbing all orifices for N. gonorrhea
4. sending fluid for crystals
what is jt fluid WBC in pyogenic septic arthritis vs. arthritis d/t N. gonorrhea?
1. WBC ct in pyogenic septic arthritis (S. aureus, Strep GNR) typically is >50,000
2. in arthritis d/t N. gonorrhea it is often <50,000
what is tx for septic arthritis?
1. abx targeted at N. gonorrhea or
2. Staph, Strep, and GNR depending on gram stain culture results
what is polymyalgia rheumatica characterized by?
1. inflamm condition that typically occurs in elderly females (age >50)
2. very high ESR
3. pain and stiffness of shoulder and pelvic girdle
4. may occur with giant cell arteritis--do a bx!!
what often occurs c/ polymyalgia rheumatica?
1. giant cell arteritis