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31 Cards in this Set
- Front
- Back
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Aldendronate
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Type of bisphosphonate, inhibits osteoclast activity
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Calcitonin
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Inhibits bone resorption,
Inhibits PTH |
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Cauda Equina
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S&S:
Hyperreflexia Upward babinski sign Urinary Incontinence Decreased rectal sphincter tone/incontinence |
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Cauda Equina Treatment:
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Glucocorticoids, radiation therapy.
Surgery only if radiation fails |
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Secondary OA
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Secondary to hemachromatosis, Wilsons Disease, acromegaly, congenital hip dislocation
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RA - Labs
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RF positive (80%)
Anemia of Chronic Disease Elevated ESR |
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Feltys
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RA
Splenomegaly Leukopenia (decreased WBC) |
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Treatment of RA
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NSAIDS
DMARDS: MTX, Gold, Hydroxychloroquine, Sulfasalazine, Cyclosporine, Azathioprine. |
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HLA - B27
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Ankylosing spondylitis
Reactive arthritis Psoriatic arthritis IBD arthropathy |
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HLA - DR4, DR1
DR3 |
RA
Sjogrens, SLE, RA |
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Secondary OA: Causes
Loss of proteoglycans and water |
Post trauma, mechanical
Post-inflammatory, infectious scoliosis Endocrine(Hyperparathyroid, hypothyroid, acromegaly) Metabolic(gout, pseudogout, hemochromatosis, Wilsons) Neuropathic - charcots |
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Labs for OA:
CBC, ESR, ANA normal or no? |
CBC, ESR normal
ANA neg synovial fluid - no inflammation |
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Seropositive Rheumatic Diseases:
(4) |
RA
SLE Scleroderma Dermatomyositis |
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Positive Labs of seropositive Rheumatic Diseases:
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ESR (non specific)
ANA Decreased Hb (anemia of CD) |
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Dermatomyositis:
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Dermatomyositis:
Positive CPK, ANA Muscle bx key for diagnosis |
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RA
Physcal exam |
effused joints
tenosynovitis noduls bone-on-bone crepitus |
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RA
Synovial Fluid |
Inflammatory
Leukocytosis - WBC > 10,000 |
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SLE:
Physical exam Labs: |
Rash, photosensitivity
Raynauds, alopecia, cardiac and pulmonary serositis glomerulonephritis CNS LABS: Increased ESR, ANAN Decreased platelets, WBC Decreased complement |
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SLE
Synovial fluid XRay |
Mild inflammation
positive ANA XRay: nondestructive/nonerosive +/- osteoporosis, jt tissue swelling |
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Dermatomyositis:
History and physical |
heliotrope rash (eyelids) - MP eruption
Gottrons papules, macular edema, poikiloderma (mottling pigmentation)on shd, neck and chest Proximal ms weakness PHYSICAL: Rash, proximal ms weakness |
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Treatment for RA
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NSAIDS
Corticosteroids - low dose to bridge gap for DMARD. High dose for vasculitis. Do: DEXA baseline and start bisphosphonates if CS > 3 mo or > 7.5mg/day. |
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SE of Corticosteroids
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Mental confusion, red cheeks, moon face, striae, buffalo hump, HTN, AVN, cataracts, glaucoma, PUD, infection, hypokalemia, hyperglycemia, hyperlipidemia
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Stopping corticosteriods - risk of what?
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Addisons crisis: hyptoension
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Criteria for SLE?
4 of 11 (Clinical and Lab) |
CLINICAL:
Malar rash - butterfly rash, no scar Discoid rash - scarring Photosensitivity Oral/nasal ulcers Arthritis Serositis - pleuritis/pericarditis Neurologic disorder - seizures/psychosis LABS: Renal - proteinuria, cellular casts Hematologic - anemia, low plt, WBC Immunologic disorder- Anti-dsDNA, anti-Sm Ab *ANA* |
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SLE...
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- Autoantibodies causing multi-organ inflammation
- Peripheral polyarthritis, symmetric involvement of small and large joints - Non-erosive OCP can exacerbate. So can anticonvulsants, hydralazine, procainamide. More common in blacks/Asians |
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SLE:
Signs and Symptoms |
Periods of exac and remission
- Systemic: fever, fatigue, lymphadenopathy - Vascular - Raynauds, thrombosis, vasculitis, livedo reticularis -Derm - oral/nasal ulcers, MP rash, alopecia, urticaria, purpura - Ophthalmic: conjunctivitis, cotton wool exudates - GI: pancreatitis, lupus, hepatitis, hepatomegaly - Pulm - interstitial lung disease, pulm HTN, PE, alveolar hemmorhage, pleuritis - MSK - arthralgia, AVN, myositis - Neurologic - depression, h/a, psychosis |
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SLE Investigations:
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- High ANA by immunufluorescence
- anti-dsDNA Ab - anti-Sm Ab |
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SLE Treatment
All meds must be monitored. |
Steroids - for prevention of end organ damage secondary to infl.
Hydroxychloroquine Bisphosphonates, Ca, Vit D MTX, cyclophosphamide Immunosuppressent drugs - for nephritis |
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Antiphospholipid antibody syndrome
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Autoimmune production of antibodies against phospholipid and cardiolipin.
Can occur with SLE. DVT, thrombocytopenia, hemolytic anemia, neutropeis Livedo reticularis, purpura |
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Diagnosis of Antiphospholipid Antibody Syndrome
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Serology: lupus anticoagulant or anticardiolipin antibody positive on 2 occasions 8 wks apart.
Treatment: Warfarin, target IRN 2.5-3.5 Heparin, steroids in pregnancy Catastrophic APS: high dose steroids, anticoag, cyclophosphamide, plasmaphoresis |
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Scleroderma
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Non-inflammatory.
Small vessel vasculopathy and fibrosis with immune system activation. Autoimmunity. Sclerodactyly, digital pitting scars Serology - Anti-topoisomerase 1 Anti-centromere - CREST variant |
