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40 Cards in this Set

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-normal WBC count
-may have increased sed rate or + RF
-Dx by H&P and Xray
OA
-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
-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
-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
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
-hyperuricemia: >6-7mg/dl(normal 2-7)
-aspiration of joint fluid shows negatively birefringent monosodium urate crystals
Gouty Arthritis
-serum urate level NOT elevated
-aspiration of joint fluid shows positively birefringent calcium pyrophosphage crystals
Pseudogout
-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
-generic ANAs
-anti-dsDNA antibodies
-anti-Smith antibodies
-C-reactive protein is low even when sed rate >100
SLE
-anti-centromere antibodies
Limited Scleroderma
-anti-SCL-70 antibodies
Diffuse Scleroderma
-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
-markedly elevated sed rate (50-100mm/hr)
Polymyalgia Rheumatica
-↑ 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
-widespread pain for >3mo
-at least 11 of 18 known trigger points
Fibromyalgia
-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
-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
-Serum ACE levels: double normal value
-hypercalcemia & hypercalciuria
-Kvein-Siltzbach test (similar to PPD)
Sarcoidosis
-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
-treat early and empirically with antibiotics effective against gram - organisms
-Rocephin(ceftriaxone)
-Nafcillin IV + Gentamycin IV
SA
-rash/arthritis: po Vibramycin(doxycycline) or Amox(amoxicillin)
-carditis/meningitis: Rocephin IV(ceftriaxone)
Lyme Disease
-NSAIDS and exercise
-rarely, systemic or intra-articular steroids
-DMARDs if no response to NSAIDS:
Azulfidine(sulfasalazine),Rheumatrex(methotrexate),Imuran(azathioprine)
Reactive Arthritis
-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
-NSAIDs
-Intra-articular steroid injections
-Enbrel(etanercept)
-DMARDs: Rheumatrex, Azulfidine(sulfasalazine)
Psoriatic Arthritis
-NSAIDs;however, ASA is contraindicated
-Cochicine
-Steroids
Gouty Arthritis
-NSAIDs
-Cochicine
-intra-articular steroids
Pseudogout
-NSAIDs
-Corticosteroids(glucocorticoids)
-DMARDs:Rheumatrex(methotrexate),Imuran(azathioprine)
Rheumatoid Arthritis
-avoid sun
-NSAIDs and steroids
-DMARDs: Rheumatrex(methotrexate), Imuran(azathioprine)
SLE
-calcium channel blockers:long acting Adalat CC(nefidipine)
-angiotensin II receptor blockers: Cozaar(losartan)
Raynaud's Phenomenon
-H2 blockers:Tagamet(cimetidine)
-Proton pump inhibitors:Prilosec(omeprazole)
GERD
-ACE inhibitors:Capoten(captopril)
Hypertension
-avoid medications with anticholinergic effects:
-atropine,scopolamine
-antihistamines-Benadryl(diphenhydramine)
-antipsychotics-Thorazine(chlorpromazine)
-Tricyclic antidepressants-Elavil(amitriptyline)
-Marijuana
Avoid for Sjogren's Syndrome
-Hypotears
-HydroEye caps
Keratoconjunctivitis sicca
-stimulate saliva
-Evoxac(cevimeline)-cholinergic agent
-Fluoride treatment
Xerostomia
-without h/o Temporal arteritis: low dose steroids
-with h/o Temporal arteritis: high dose steroids
Polymyalgia Rheumatica
-steroids(glucocorticoids:prednisone po or methyprednisone IV)
-DMARDs: Rheumatrex (methotrexate), Imuran (azathioprine)
Polymyositis/Dermatomyositis
-stretching, low intensity aerobic exercise
-muscle relaxant:Flexaril
-Tricyclic anti-depressants: Elavil
-SSRIs: Prozac
-TCA + SSRI
Fibromyalgia
-biphosphonates
Paget's disease
-Hormone replacement therapy
-SERM: Evista(raloxifene)
-biphosphonates
-miacalcin(salmon calcitonin)
Osteoporosis
-colchicine: for arthritis
-steroids: po for hypercalcemia
-biphosphonates: for anyone on long term steroids
-Rheumatrex
Sarcoidosis