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72 Cards in this Set
- Front
- Back
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What are some manifestations of SLE?
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- arthralgias
- photosensitive rash - malar rash, - oral ulcers - pancytopenia - serositis |
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What causes arthralgias, fatigue, and painful oral and genital ulcers?
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Behçet's syndrome
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What is the most common joints involved in osteoarthritis?
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knee, hip, distal and proximal interphalangeal, and first carpometacarpal
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How long does stiffness usually last with osteoarthritis? Rhematoid arthritis?
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- < 30 min
- > 45 min |
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What is common in the distal inerphalangeal joints in postmenopausal women taking diuretics?
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tophaceous gout
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What are anti–Scl-70 antibodies usually associated with?
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diffuse cutaneous disease and an increased risk for ILD
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Constitutional symptoms and ischemic signs or symptoms in the territory of one or more large arteries in a woman <40 years of age should raise suspicion for what disease?
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Takayasu's arteritis is a chronic, idiopathic, granulomatous inflammatory disease primarily of the aorta and its main branches that affects reproductive-age women.
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How is Polymyalgia rheumatica characterized? How old is the average patient?
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- history of pain and morning stiffness in the axial joints and proximal muscles and an absence of restricted motion, generally without swelling, pain, and warmth of the proximal joints
- > 50 yr old |
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What do you usually see with polymyositis?
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proximal muscle weakness (versus pain & stiffness with PMR)
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What is the drug of choice in the treatment of scleroderma renal crisis?
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short acting ACEI (i.e. captopril)
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What do you see with scleroderma renal crisis?
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- new-onset hypertension,
- slightly increased creatinine, - decreased platelets, and - anemia with associated lower-extremity edema |
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What is the gold standard for diagnosing giant cell arteritis?
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Temporal artery biopsy
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Describe the clinical manifestations of giant cell arteritis?
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- headache
- optic nerve ischemia - accompanying polymyalgia rheumatica - scalp tenderness -jaw claudication - carotidynia -ESR will be normal or low |
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What can a small percentage of patients taking anti–tumor necrosis factor agents develop?
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drug-induced SLE
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What is methotrexate therapy for Rheumatoid arthritis associated with?
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developing large B-cell, non-Hodgkin's lymphoma
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How is adult-onset Still's disease characterized?
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- daily high fever spikes
- salmon colored rash - arthritis |
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In the absence of an infection, when should adult-onset Still's disease be suspected?
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ferritin levels >3000 ng/mL with signs and symptoms compatible with this condition (fever, rash & arthritis)
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What should be suspected in an immunosuppressed patient with elevated LDH and evidence of lung infection?
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Pneumocystis jiroveci infection
(diagnose with sputum induction) |
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How is mildly to moderately symptomatic pneumocystis pneumonia treated?
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- First line: 21 days of Bactrim
- Second line: 21 days of clindamycin and primaquine - Third line: 21 dys of atovaquone (steroids used in mod-severe disease) |
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What prophylaxis can be used for pneumocystis pneumonia if allergic to trimethoprim–sulfamethoxazole?
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inhaled pentamidine or dapsone
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Should angiotensin-converting enzyme inhibitor therapy continue with scleroderma renal crisis even if hemodialysis required?
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yes
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What therapy is contraindicated in patients receiving ACEI?
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plasmaphoresis
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When does minocycline-induced lupus usually manifest itself? What disease does it mimic?
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- 18 months after initiating therapy
- autoimmune hepatitis |
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How should Parvovirus B19–related arthritis be treated?
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Self-limited
resolved within 1-2 months NSAIDs usually help |
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How do you treat polymyalgia rheumatica?
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prednisone
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What are patients with with a long history of Raynaud's phenomenon and diffuse or limited cutaneous scleroderma at risk for?
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pulmonary vascular disease, particularly isolated pulmonary hypertension
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What may high-dose corticosteroid therapy in the setting of scleroderma be associated with?
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normontensive renal crisis
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How should patients taking prednisone, ≥5 mg/d, for more than 3 months be treated, if no contraindications?
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Calcium, Vitamin D, bisphosphonate
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What does therapy for scleroderma involve?
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systematic management of end-organ involvement (CCB for Raynaud's and omeprazole for reflux)
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What is synovial fluid leukocytosis with needle-shaped negatively birefringent crystals consistent with?
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monosodium urate crystals indicating acute gouty arthritis
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What does unexplained prolonged activated partial thromboplastin time raise suspicion for?
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antiphospholipid antibody syndrome
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What does rheumatoid arthritis predisposes patients to?
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secondary osteoarthritis
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What is the leukocyte count of noninflammatory clear synovial fluid?
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< 2,000/uL
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What is the leukocyte count in the setting of septic arthritis?
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>50,000/μL
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In whom does osteonecrosis commonly develop?
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Patients with SLE, rarely with RA
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A patient with SLE & hx of miscarriage presents with severe left shoulder pain. Physical exam does not illicit pain. What should be done to evaluate patient?
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CT abdomen to rule out splenic infarct. Pain in shoulder can be referred.
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How often can corticosteroid injections be given intraarticularly?
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no more than every 4 months
(Because repeated use of these agents may cause cartilage and joint damage resulting in disease progression) |
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What is a common cause of diarrhea in patients with scleroderma and how is treated?
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- small bowel bacterial overgrowth
- empiric antibiotics (Cipro for 10 days) |
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What is is associated with dactylitis and asymmetrical distal interphalangeal joint inflammation?
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Psoriatic arthritis
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How should a patient with severe, active, erosive rheumatoid arthritis despite full-dose methotrexate therapy be treated?
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Combination therapy with methotrexate and anti–tumor necrosis factor agents
- most likely regimen to improve function, limit further damage |
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What are dermatomyositis , inclusion body myositis and polymyositis in older patients associated with?
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malignancy
Should repeat screening every 6-12 months |
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What should Asian patients in particular be screened for if they have dermatomyositis, polymyositis or inclusion body myositis?
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nasopharyngeal cancer
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When can colchicine be discontinued in patients with gout?
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When urate levels controlled (6) and no attack in 6 months. Should continue with allopurinol while allopurinol dose is being titrated
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What is an inflammatory dermatitis characterized by erythema, telangiectasias, papules, pustules, and sebaceous hyperplasia that affects the central face, including the nasolabial folds?
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Rosacea
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What should be considered if you see linear calcium deposits in the articular spaces?
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calcium pyrophosphate dihydrate crystal deposition (CPPD)
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What clinical features should raise suspicion for CPPD?
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Involvement in atypical locations, such as the wrist, elbow, metacarpophalangeal, or shoulder joints, in the absence of an inciting trauma
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What typically causes pain 2 cm to 3 cm distal to the medial knee joint margin overlying the anterior tibia?
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anserine bursitis
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How is pseudogout characterized?
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presence of calcium pyrophosphate crystals on synovial fluid analysis and chondrocalcinosis on radiography
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What should be suspected when you see apple-green birefringence on fluorescence microscopy of a renal biopsy specimen?
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renal amyloidosis
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How is renal amyloidosis treated?
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optimal control of underlying inflammatory disease?
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What is an uncommon but potentially severe side effect of chronic inflammatory diseases, such as rheumatoid arthritis and chronic infection?
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amyloidosis
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How should a “closed-space” joint infection be treated?
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with IV antibiotics even if cultures are negative ... may require repeated drainage
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what is the common presentation of dermatomyositis?
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Periungual erythema and malar erythema consisting of a light purple (heliotrope) edematous discoloration of the upper eyelids and periorbital tissues
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What disease should be considered with Gottron's sign?
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dermatomyositis
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What should be considered in a patient on chronic steroid therapy with worsening proximal muscle weakness, particularly in the lower extremities, after a decrease in or normalization of muscle enzyme levels?
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corticosteroid-induced myopathy
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What can be used to alleviate pain in osteoarthritis of the hip and knee in patients in whom nonsteroidal anti-inflammatory drugs are contraindicated or do not provide adequate pain relief?
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tramadol
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What should be considered in patients with upper- and lower-extremity weakness and gait abnormalities associated with rheumatoid arthritis?
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cervial spine impingement
- order MRI cervical spine |
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What are symptoms characteristic of rheumatoid vasculitis?
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fever, leg ulcers, mononeuritis multiplex, and other occlusive vascular problems
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What should be considered in a patient currently on colchicine and experiencing acute onset of a painful myopathy with diminished reflexes and an elevated creatine kinase level?
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acute colchicine myotoxicity and neurotoxicity
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What should be suspected in a patient with uveitis, diplopia, asymmetrical inflammatory arthritis, and weight loss?
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Whipple's disease (mimics systemic autoimmune disorder)... perform small bowel biopsy
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How do you treat polymyalgia rheumatica?
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prednisone, 15 mg/d
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How do you treat giant cell arteritis?
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Prednisolone, 1 mg/kg/d,
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What is a potential adverse event of hydroxychloroquine?
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retinal toxicity (need opthalmologic exam every 6-12 months)
- avoid in patients with glucose-6-phosphate deficiency |
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What are the Laboratory findings in cryoglobulinemic vasculitis?
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- circulating cryoglobulins
- rheumatoid factor positivity, - hypocomplementemia - an elevated erythrocyte sedimentation rate |
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In what settings do cryoglobulins occur?
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- hepatitis C virus infection,
- plasma cell or lymphoid neoplasms, - chronic infection - inflammatory diseases |
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What other disease is Sjogren's syndrome associated with?
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non-Hodgkin's lymphoma and other lymphoproliferative conditions.
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What is a common presenting feature of polyarteritis nodosa?
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Mononeuritis multiplex
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What are some extra-articular manifestations of ankylosing spondylitis?
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- aortic insufficiency
- upper-lobe pulmonary fibrocystic disease, - amyloidosis - cardiac conduction disease, - recurrent uveitis. |
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What is eelapsing polychondritis is characterized by? What is the most common presenting feature?
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- inflammation and destruction of cartilaginous structures (think saddle nose deformity)
- auricular pain and swelling |
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What medication does peripheral joint disease in psoriatic arthritis respond to?
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methotrexate and sulfasalazine
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What does psoriatic spinal inflammation respond to?
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anti–tumor necrosis factor therapy
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In asthmatic patients with nasal polyps and aspirin allergy, what can be used if they seem to have cross-reactivity with NSAIDs?
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Nonacetylated salicylate agents (Salsalate)
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