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40 Cards in this Set
- Front
- Back
-normal WBC count
-may have increased sed rate or + RF -Dx by H&P and Xray |
OA
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-blood culture + in 50% of cases
-synovial fluid: -decreased glucose -increased protein & lactate -WBC count >10,000/ul, can exceed 50,000/ul with 90% neutros |
SA
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-serum IgM response gradually replaced by IgG
-detected with ELISA and confirmed by WB -slight WBC increase -normal or slight increased sed rate -neutrophils in joint fluid, cx may be negative -Xray shows tissue swelling -neuro sx - pleocytosis and increased CSF protein |
Lyme Disease
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-IHC studies of synovium reveal antigenic material of infecting organisms but no viable organisms
-increased sed rate -increased C-reactive protein -synovial fluid: turbid, WBC count >5,000/ul, mostly neutros,low viscosity, glucose not greatly reduced |
Reactive Arthritis
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X ray features:
-pencil in cup deformity -acro-osteolysis = resorption of distal bone tuft of distal phalynx -joing space loss - dramatic in interphalangeal joints |
Psoriatic Arthritis
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-hyperuricemia: >6-7mg/dl(normal 2-7)
-aspiration of joint fluid shows negatively birefringent monosodium urate crystals |
Gouty Arthritis
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-serum urate level NOT elevated
-aspiration of joint fluid shows positively birefringent calcium pyrophosphage crystals |
Pseudogout
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-synovial fluid leukocytosis (WBC count >2000cells/cub.mm)
-RF found in 80% -increased sed rate -increased C-reactive protein -anemia of chronic dz |
Rheumatoid Arthritis
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-generic ANAs
-anti-dsDNA antibodies -anti-Smith antibodies -C-reactive protein is low even when sed rate >100 |
SLE
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-anti-centromere antibodies
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Limited Scleroderma
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-anti-SCL-70 antibodies
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Diffuse Scleroderma
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-anti-SS-A Abs (anti-Ro)
-anti-SS-B Abs (anti-La) -Schirmer's Test: moisten <5mm -Rose Bengal Test -Whole Saliva Sialometry -Salivary gland biopsy -increased sed rate -may have + RF |
Sjogren's Syndrome
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-markedly elevated sed rate (50-100mm/hr)
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Polymyalgia Rheumatica
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-↑ serum CPK-MM
-↑ Aldolase -↑ ALT & AST (liver tests) -↑ LDH (lactate dehydrogenase) -Biopsy shows muscle fibers in various stages of vacuolization and necrosis Destroyed fibers replaced by fibrous connective tissue and fat -Positive for Jo-1 antibody -↑ sed rate -Urine dip is positive for hemoglobin, but it is really myoglobin (rhabdomyolysis) |
Polymyositis/Dermatomyositis
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-widespread pain for >3mo
-at least 11 of 18 known trigger points |
Fibromyalgia
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-serum calcium & phosphorous normal
-inc'd alk phos during increased osteoblastic activity -inc'd urine calcium during osteolytic phage -inc'd urine hydroxyproline in active disease -Xray shows thickened, radiopaque bones with multiple fissure fractures in long bones |
Paget's Disease
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-serum calcium, phosphorous, parathyroid hormone (PTH), and alk phos are all normal
-Dual Energy X-ray Absorptiometry (DEXA) Scan -osteopenia on plain Xray films |
Osteoporosis
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-Serum ACE levels: double normal value
-hypercalcemia & hypercalciuria -Kvein-Siltzbach test (similar to PPD) |
Sarcoidosis
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-APAP
-NSAIDS -Capsaicin cream (Zostrix) -Oral chondroitin sulfate or glucosamine -intra-articular steroid injection -intra-articular injection of hyaluronic acid derivatives(Synvisc,Hyalgen) -Surgery |
OA
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-treat early and empirically with antibiotics effective against gram - organisms
-Rocephin(ceftriaxone) -Nafcillin IV + Gentamycin IV |
SA
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-rash/arthritis: po Vibramycin(doxycycline) or Amox(amoxicillin)
-carditis/meningitis: Rocephin IV(ceftriaxone) |
Lyme Disease
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-NSAIDS and exercise
-rarely, systemic or intra-articular steroids -DMARDs if no response to NSAIDS: Azulfidine(sulfasalazine),Rheumatrex(methotrexate),Imuran(azathioprine) |
Reactive Arthritis
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-topical steroids: Kenalog(triamcinolone) cream
-topical coal tar preps:Psorigel -Vit. D der.:Donovex(calcipotriene)ointment -Vit. A der.(retinoids):Soriatane(acitretin) caps -PUVA -Rheumatrex(methotrexate) -Enbrel(etanercept) |
Psoriasis
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-NSAIDs
-Intra-articular steroid injections -Enbrel(etanercept) -DMARDs: Rheumatrex, Azulfidine(sulfasalazine) |
Psoriatic Arthritis
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-NSAIDs;however, ASA is contraindicated
-Cochicine -Steroids |
Gouty Arthritis
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-NSAIDs
-Cochicine -intra-articular steroids |
Pseudogout
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-NSAIDs
-Corticosteroids(glucocorticoids) -DMARDs:Rheumatrex(methotrexate),Imuran(azathioprine) |
Rheumatoid Arthritis
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-avoid sun
-NSAIDs and steroids -DMARDs: Rheumatrex(methotrexate), Imuran(azathioprine) |
SLE
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-calcium channel blockers:long acting Adalat CC(nefidipine)
-angiotensin II receptor blockers: Cozaar(losartan) |
Raynaud's Phenomenon
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-H2 blockers:Tagamet(cimetidine)
-Proton pump inhibitors:Prilosec(omeprazole) |
GERD
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-ACE inhibitors:Capoten(captopril)
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Hypertension
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-avoid medications with anticholinergic effects:
-atropine,scopolamine -antihistamines-Benadryl(diphenhydramine) -antipsychotics-Thorazine(chlorpromazine) -Tricyclic antidepressants-Elavil(amitriptyline) -Marijuana |
Avoid for Sjogren's Syndrome
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-Hypotears
-HydroEye caps |
Keratoconjunctivitis sicca
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-stimulate saliva
-Evoxac(cevimeline)-cholinergic agent -Fluoride treatment |
Xerostomia
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-without h/o Temporal arteritis: low dose steroids
-with h/o Temporal arteritis: high dose steroids |
Polymyalgia Rheumatica
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-steroids(glucocorticoids:prednisone po or methyprednisone IV)
-DMARDs: Rheumatrex (methotrexate), Imuran (azathioprine) |
Polymyositis/Dermatomyositis
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-stretching, low intensity aerobic exercise
-muscle relaxant:Flexaril -Tricyclic anti-depressants: Elavil -SSRIs: Prozac -TCA + SSRI |
Fibromyalgia
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-biphosphonates
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Paget's disease
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-Hormone replacement therapy
-SERM: Evista(raloxifene) -biphosphonates -miacalcin(salmon calcitonin) |
Osteoporosis
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-colchicine: for arthritis
-steroids: po for hypercalcemia -biphosphonates: for anyone on long term steroids -Rheumatrex |
Sarcoidosis
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