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196 Cards in this Set
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Rheum morning stiffness, fatigue, malaise with redness, heat and or swelling of joint [joint inflammation vs. noninflammatory pain] |
joint inflammation |
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Rheum pain from direct palpation of joint line... pain from passive ROM... pain from active resisted ROM... |
OA or joint associated pathology (meniscus tear) arthritic condition tendon pathology |
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Rheum workup for acute monoarticular arthritis... chronic inflammatory monoarticular arthritis is concerning for... |
aspirate joint to evaluate infection. mycobacterial, fungal, B. burgdorgeri infection. |
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Rheum False elevations of ESR (3) |
DM, ESKD, pregnancy |
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Rheum which changes quicker as direct measure of inflammation (ESR or CRP) |
CRP is direct measure of inflammation |
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Rheum avoid this test with marginal signs and symptoms of rheumatic disease |
ANA - low titer is seen in healthy persons |
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Rheum Why is radiography important to establish inflammatory arthritis? |
eval bony erosions |
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Rheum Radiography and OA... 3 big reasons joint aspiration is useful... |
to eval severity of joint space loss and other bony changes 1. inflamm vs noninflamm 2. eval infectious arthritis 3. eval crystals |
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Rheum Joint aspiration with WBC <2000 and WBC >50000 |
<2000 - noninflammatory >50000 - possible infection |
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Rheum measure of rheumatic disease activity and patient progress |
DAS and HAQ Disease activity score Health assessment questionairre |
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Rheum How to reduce risk of NSAID gastropathy? (2) When to avoid celebrex... |
cox 2 inhibitor NSAID with PPI avoid celebrex with CAD |
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Rheum If patient is on long term steroids, then... |
Ca, Vit D and bisphosphonate to prevent osteoporosis |
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DMARD gold standard drug for RA... monitor these 2 labs and why? 2 groups who should avoid this drug... |
methotrexate - folic acid blocker check LFT and CBC every 2-3mo due to drug induced hepatitis and macrocytic anemia pregnant and etoh drinkers |
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DMARD Which drug needs regular eye exams for retinal toxicity... |
hydroxychloroquine |
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DMARD Leflunomide and pregnant or who develop leflunomide toxicity must... |
8 day course of cholestyramine elimination therapy. |
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DMARD if using biologic DMARD, then monitor for... If taking biologic DMARD and develop active infection that requires Abx... |
opportunistic infections or infectious complications. hold biologic DMARD |
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DMARD Must test patients for this if receiving biologic DMARD... |
surveillance for latent Tb with Tb skin testing or interferon gamma release. |
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DMARD Caveat for biologic DMARD... |
do not combine biologic DMARDs: increased risk of infection and minimal efficacy |
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DMARD best combo to reduce RA symptoms and structural damage... |
tumor necrosis factor alpha inhibitor and MTX |
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DMARD biologic DMARD that suppress psoriatic arthrtis and improve joint symptoms in ankylosing spondylitis... |
tumor necrosis factor alpha inhibitor |
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Rheum drug for repeated gouty attacks or have tissue deposits of urate (tophi)... risk... |
urate lowering drugs increase risk of gouty attacks for 3-6mo or longer after initiation so add concurrent prophylaxis with anti-inflammatory like colchicine |
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Rheum urate lowering drug that must be stopped if develop rash... |
allopurinol - steven johnson |
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RA heritable risk factor for RA: |
shared epitope - part of an antigen that is recognized by the immune system, specifically by antibodies |
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RA 2 antibodies associated with increased risk of RA: strong RF for developing RA that decreases after cessation... |
RF and anti-cyclic citrullinated peptide Ab smoking |
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Rheum SYMMETRIC polyarthritis involving small and large joint with prolonged morning stiffness >60 min... bilat carpal tunnel is seen in...
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RA. carpal tunnel syndrome is the most common neurologic complication of RA. It is often the presenting symptom of RA |
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RA Xrays reveal... MRI reveals... |
periarticular osteopenia, erosions, and symmetric joint narrowing. bone erosions earlier in the course. |
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RA leg ulcers related to RA... Most common cause of death in RA... |
Felty syndrome CAD |
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RA follow up other than symtoms and physical exam... follow up test that shows treatment is failing... |
check acute phase reactants xray shows erosions, joint space narrowing, or progressive joint damage FOLLOW UP XRAYS CAN ALSO SHOW TREATMENT IS WORKING |
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RA initial monotherapy for RA (2 options) for any duration or degree of activity.... |
MTX or leflunomide |
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RA initial therapy for moderate or high disease activity... |
add tumor necrosis factor alpha inhibitor to MTX |
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RA combo of MTX with tumor necrosis factor alpha inhibitor... |
reduction in disease activity and xray progress |
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RA if trying to get pregnant… 2 safe meds during pregnancy... |
stop MTX and leflunomide at least 3mo before conception hydroxychloroquine and sulfasalazine |
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OA most important modifiable risk factor for OA of the knee... |
obesity (encourage wt loss and exercise) |
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OA Primary OA affects (3)
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axial skeleton, wt bearing joints, hands |
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OA flares of joint inflammation involving proximal and distal interphalangeal joints associated with redness, swelling and severe pain... |
erosive OA |
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OA calcification of spinal ligaments which cause large, flowing osteophytes with little disc space narrowing and no sacroilitis.... How is this different from ankylosing spondylitis... |
DISH - diffuse indiopathic skeletal hyperostosis NO flowing osteophytes on imaging. |
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OA short or long: morning stiffness... joint inflammation on physical exam... |
short, less than 30min of morning stiffness. OA has minimal or absent joint inflammation |
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OA Xray findings and severity of symptoms |
poor correlation |
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OA First line of analgesic treatment for OA especially elderly... Avoid this treatment if PVD or cardiac risk factors... 2nd line of treatment for elderly if first fails... |
tylenol NSAIDS should be avoided due to heart risk use ultram if tylenol fails |
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OA single joint or few joints that cause pain disproportinate to other joints and limit function
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steroid injection |
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OA joint replacement is based on: Sx and quality of life OR xray severity of OA |
symptoms and quality of life |
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Rheum widespread pain and tenderness with altered sensory processing; patients with allodynia and hyperalgesisa |
FM |
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FM related comorbidities of FM (3) that need to be addressed with established treament modalities... |
pain, sleep disruption, mood disorder |
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FM 3 cornerstone treatments: |
regular aerobic exercise physical therapy cognitive behavioral therapy |
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FM 3 medications that help: Avoid this med... |
serotonin-NE reuptake inhibitor (duloxetine) anti-epileptic meds (lyrica) Tricyclic antidepressant (amitriptyline) AVOID opiods
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Rheum spectrum of inflammatory disorders with inflammation and calcification of entheses and new bone formation |
spondyloarthritis. spondylo - vertebra or spinal column |
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Spondyloarthritis genetic factor... 95% of this condition has this genetic factor... |
HLA-B27 ankylosing spondylitis |
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Spondyloarthritis GI and GU tract infections are implicated in development of... |
reactive arthritis |
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Spondyloarthritis worsening of psoriatic arthritis or reactive arthritis is associated with.... so check.... |
HIV HIV test |
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Spondyloarthritis Progressive inflammatory back pain and stiffness in men that starts between 20-30yo... Patient with above advanced disease with new back pain... |
ankylosing spondylitis ankylosing - fused check spinal xray to eval new fracture. at high risk for vertebral fracture without injury or trauma |
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Spondyloarthritis pain of low back, buttocks or posterior thighs. inflammation and bone changes ascend the spine producing stooped posture with limited mobility of spine and chest... Diagnosis... |
ankylosing spondylitis MRI of sacroiliac |
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Spondyloarthritis enthesis, dactylitis, tenosynovitis, arthritis of DIP, asymmetric oligoarthritis and spondylitis... Mild or localized treatment... treatment if disease is diffuse... |
psoriatic arthritis enthesis - inflammation of sites where ligaments and tendons insert into bone dactylitis - sausage digit or toe tenosynovitis - inflammatin of synovium or sheath that surrounds tendon. mild is NSAIDs diffuse is MTX |
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Spondyloarthritis inflammatory peripheral arthritis and sacroliitis is seen in... Long term Treatment... |
inflammatory bowel disease sulfasalazine is best long term treatment for IBD associated arthritis (will treat both gut and arthritis) |
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Spondyloarthritis detection of pathogens such as C trachomatis in patients with arthritis, urethritis, conjunctivitis, and/or enthesis... Treatment... If conservative treatment fails... |
reactive arthritis NSAIDS and steroid injections sulfasalazine |
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Rheum inflammatory back pain who are younger than age 45yo |
spondyloarthritis |
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Spondyoloarthritis these 2 tests are usually negative |
RF and anti-cyclic citrullinated peptide. antiCCP
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Spondyloarthritis reactive or psoriatic arthrits with severe skin manifestations. consider... |
HIV |
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Spondyloarthritis imaging for suspected spondyloarthritis |
AP xray of pelvis |
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Spondyloarthritis If plain xray is negative, and spondyloarthritis is still suspected... What other lab test is important to diagnosis of spondyloarthritis... |
MRI to detect inflammation of sacroiliac joints HLA-B27, but does not differentiated between spondylarthropathies |
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Spondyloarthritis First line treatment... |
NSAIDs (not ASA) |
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Spondyloarthritis treatment for peripheral arthritis but not axial manifestation… If axial disease, then treat with…. |
nonbiologic DMARD - MTX axial than start TNF-alpha inhibitor |
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Spondyloarthritis treatment for severe or persistent axial, peripheral, or extraarticular manifestations... |
tumor necrosis factor alpha inhibitor |
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Spondyloarthritis reactive arthritis caused by enteric infection. do not give this... |
Abx, unless there is active infection |
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SLE Who gets it? white vs nonwhite. female vs male. |
more nonwhite and female (during reproductive years) |
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SLE Kidney dysfunction seen in Asymptomatic SLE... |
nephritis, so monitor kidney labs and urine protein |
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SLE arterial or venous thrombosis and pregnancy loss, livedo reticularis, low PLT, valvular heart disease, microangiopathic kidney insuff..... 3 antibodies... |
antiphospholipid syndrome (anticardiolipin, anti b2 glycoprotein I, lupus anticoag) |
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SLE If considering lupus and + ANA, then... which test is low... |
check the other antibodies complement level |
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SLE Which 2 Ab are most specific for SLE? |
Anti-DS DNA is better than anti-smith |
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SLE Fever, rash, arthritis, cytopenia.... normal complement levels with low Anti DS DNA and low Anti-Smith DNA... [ANA antibody, Antihistone Antibody, anti SS DNA antibodies are present] |
drug induced lupus |
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SLE Certain drugs that cause drug induced lupus WITH anti DS DNA antibody and rare kidney and neurologic involvement... Treatment... |
drug induced lupus due to tumor necrosis factor alpha inhibitor: remicade - imab humira - imab enbrel - etenercept STOP tumor necrosis agent |
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SLE treatment for arthralgia related to SLE... prevents lupus flares and increases long term survival and may reduce organ damage, thrombosis and bone loss... |
NSAIDs hydroxychloroquine |
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SLE Patient presents with HTN, peripheral edema, and proteinuria... lupus nephritis treatment or severe resistant SLE disease.... |
check renal biopsy to eval lupus nephritis. Need biopsy before starting treatment.
cyclophosphamide, but associated with serious toxicity |
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SLE induction therapy for lupus nephritis with less side effects... |
mycophenolate mofetil |
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SLE pregnant SLE with flares.. |
hydroxychloroquine
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SLE increased risk for this condition when pregnant, but gets confused with... |
pre-eclampsia lupus nephritis |
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SLE SLE and antiphospholipid Ab with history of recurrent early pregnancy loss single late pregnancy loss are treated with this combo... |
low dose ASA and heparin |
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SLE maternal anti-Ro/SSA and Anti-La/SSB antibodies are at risk for... |
neonatal lupus erythermatosus: reversible red rash, elevated LFTs, and low PLT that resolve in 6mo once maternal Ab cleared |
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SLE early diagnosis deaths related to... late death related to.... (bimodal distribution of death) So if patient presents chest pain and tachycardia... |
active disease or infection accelerated atherosclerosis and infection complications due to immunosuppression check EKG to eval early heart disease |
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Systemic Sclerosis LIMITED cutaneous systemic sclerosis with skin disease to face and distal extremities are at risk for.... Yearly Screening test in all scleroderma patients without advanced ILD... |
pulm arterial HTN PFT with decrease in DLCO that corrects with alveolar volume |
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Systemic Sclerosis DIFFUSE cutaneous systemic sclerosis are at risk for (3)... PFT reveals... test to eval pulm complication...
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interstitial lung disease serositis - inflam of lining of organs scleroderma renal crisis restrictive process with equal decrease in FEV1 and FVC and low DLCO NON contrast high resolution chest CT |
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Systemic Sclerosis this occurs in most patients with systemic sclerosis... Treatment for systemic sclerosis with joint and muscle involvement.... |
Raynaud phenomenon methotrexate |
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Systemic Sclerosis subset of LcSSC that leads to pulmonary arterial HTN (LIMITED cutaneous systemic sclerosis)... diagnosis of PAH (1st part of workup combo)... Before starting treatment of PAH, do this... |
CREST - calcinosis, Reynaud, esophageal dysmotility, sclerodactyly and telengectasia PFT and 2decho R heart cath before starting treatment for PAH |
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Systemic Sclerosis most common GI problem associated with systemic sclerosis... |
esophageal dysFN with may antedate skin disease |
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Systemic Sclerosis cause of iron def anemia with systemic sclerosis (2) Need to perform... |
enteric telangiectasia (small dilated blood vessels near skin or mucosa) and gastric antral venous ectasia (dilation) which cause blood loss (GAVE) check EGD to eval GAVE |
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Systemic Sclerosis scleroderma renal crisis TREATMENT who develop HTN or unexplaned azotemia (high BUN and Cr)... |
ACE inhibitor |
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Systemic Sclerosis scleroderma renal crisis in setting of kidney failure... |
continue ACE inhibitor. could get better even on HD |
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Systemic Sclerosis primary cause of morbidity or mortality of systemic sclerosis... PROCEDURE to evaluate.... |
ILD and/or PAH high resolution chest CT to eval ILD with or without alveolitis |
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Systemic Sclerosis treatment of pulm alveolitis and why? |
pulm alveolitis may precede ILD. start cyclophosphamide |
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Systemic Sclerosis screening test for PAH if there is no significant ILD... |
PFT to check decreased DLCO corrected for alveolar volume in absence of ILD |
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Systemic Sclerosis If PAH is suspected, why perform R heart cath to eval pulm artery pressure before starting treatment? |
2decho can overestimate pulm artery pressure |
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Systemic Sclerosis treatment for PAH in systemic sclerosis: 3 |
phosphodiesterase-5 inhibitor (viagra) prostacyclin analogues (iloprost) endothelin receptor blockers (bosentan) |
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Systemic Sclerosis woody skin induration of extremities but SPARES HANDS and FACE and NO Raynaud phenomenon... |
eosinophilic fasciitis |
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Systemic Sclerosis localized scleroderma to torso and proximal extremities that occur without visceral disease and Raynaud phenomenon... |
morphea |
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Systemic Sclerosis woody induration of extremities but spares hands and face with peripheral eosinophilia |
eosinophilic fasciitis |
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Systemic Sclerosis fibrosis of skeletal and cardiac muscle that occurs after MRI with gad in patient with kidney dysfunction... |
nephrogenic systemic fibrosis |
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Systemic Sclerosis pregnancy and systemic sclerosis is associated with...2 pregnant and scleroderma renal crisis treatment... |
high risk and low birth weight ACE inhibitor even though risk of fetus malformation because SRC has high mortalitiy |
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Sjogren targets these organs.... 2 classic symptoms... |
exocrine glands dry eyes and dry mouth |
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Sjogren Sjogren can occur secondary to 2 other connective tissue disorders... |
RA SLE |
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Sjogren 50% of Sjogren have this involvement... |
extraglandular (multiple different organ symptoms) |
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Sjogren 44-fold increased risk of developing this... (So do this)... |
B cell lymphoma biopsy enlarged glands |
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Mixed connective tissue characterized by overlapping clinical features of 3 conditions with this antibody... |
SLE polymyositis systemic sclerosis anti-U1-ribonucleoprotein Ab
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Mixed connective tissue 4 typical findings... |
raynaud swollen hands arthritis fatigue |
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Mixed connective tissue most frequent cardiac manifestation... Main cause of death... needs this evaluation... |
pericardial effusion Pulm Art HTN R heart cath |
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Mixed connective tissue treatment... |
tailored to individual symptoms if PAH (cyclophosphamide) |
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Crystal most common inflammatory arthritis in USA… 2 findings for diagnosis... |
gout joint fluid with monosodium crystals with needle shape and negative birefringement crystals and uric acid tophi |
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Crystal Treatment of gout is based on this... Not this... |
address inflammation only. Not lowering urate levels |
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Crystal Acute Gout treatment (3)... Gout patient presents with fever, redness, and pain of gouty joint with aspirate WBC >50000.... |
NSAIDs steroids colchicine - less effective when started later Start vanc and zosyn to treat infectious arthritis with gout flare |
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Crystal 2 or more acute gout attacks in 1yr or have tophi… Rule out superimposed infection with this acute gout treatment... |
urate lowering therapy (allopurinol or febuxostat) steroids. |
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Crystal If starting allopurinol or febuxostat for gout prophylaxis, then... What immunosuppression agent is contraindicated if using allopurinol or febuxostat... |
start low dose colchicine because urate lowering initially increases risk for acute attack. Azathioprine. allopurinol will inhibit metabolization of azathioprine |
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Crystal HyperPTH, hypothyroid, hemochromatosis, hypophosphatasia, hypomagnesemia and familial hypocaliuric hypercalcemia is associated with... |
Ca pyrophosphate deposition disease (PSEUDOGOUT) |
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Crystal asymptomatic chondrocalcinosis, PSEUDOGOUT, degenerative cartilage disease, and chronic inflammatory arthritis in older patient in ATYPICAL JOINTS... Diagnosis... |
Calcium pyrophosphate deposition disease diagnosis is observing OA features in atypical OA locations |
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Crystal Acute pseudogout treatment (3)... severe pseudogout treatment... |
suppress inflammation... NSAIDs steroids (oral or intraarticular) colchicine severe pseudogout - intraarticular steroid like triamcinolone |
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Crystal over 50yo with severe destructive large joint arthropathy (Milwaukee shoulder)... [joint aspirate with small, nonbirefringent crystals that aggregate after alizarin red or tetracycline] |
Basic Calcium Phosphate Deposition Disease (hydroxyapatite) |
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Crystal Treatment for BCP (3)... |
NSAIDs Steroids Colchicine |
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Infectious arthritis why important to rapidly diagnose and treat infectious arthritis? Aspiration with >50000 synovial WBC (2 specific causes)... |
preserve joint function and reduce morbidity and mortality infectious or crystal athropathy |
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Infectious arthritis gold standard for diagnosis... if false negative.... |
positive joint fluid culture is gold standard. Can have negative cultures if fluid is taken after antibiotics were started |
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Infectious arthritis Most common cause... |
S aureus |
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Infectious arthritis If sickle cell anemia, prone to.... If IVDA, prone to... |
Salmonella Pseudomonas |
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Infectious arthritis most common in young sexually active adults... presenting symptom... joint culture FINDING.... |
Gonococcal tenosynovitis NOT systemic features like fever or skin findings usually negative joint aspiration culture |
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Infectious arthritis chronic inflammatory arthritis in setting of clinical and serologic documentation of lyme disease… T/F: serologic test is ALWAYS positive in acute Lyme disease... |
Lyme arthritis False, serology is often negative |
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Infectious arthritis synovial fluid aspiration or open debridement along with gram stain and culture... |
prosthetic joint infection |
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Infectious arthritis treatment for proven or suspected gonococcal arthritis and why? |
IV rocephin or equivalent to treat for possible disseminated infection |
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Infectious arthritis Bacterial infected joints require… septic arthritis that fails empiric antibiotics... |
drainage by daily needle aspiration tubercular arthritis |
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Rheum symmetric proximal weakness with little or no pain. acute or subacute onset with disease progress.. (2) |
dermatomyositis polymyositis |
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Rheum older patient with weakness in both proximal and distal muscle groups. slow progress... |
inclusion body myositis |
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Rheum gottron papules - purple papules over extensor surfaces of metacarpophalengeal joints, PIJ, elbows, and knees... |
pathognomonic for dermatomyositis |
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Rheum Heliotrope rash, V sign, shawl sign... |
characteristic rashes of dermatomyositis heliotrope - pink/purple color |
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Rheum extramuscular manifestations are rare in this idiopathic inflammatory myopathy...
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inclusion body myositis |
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Rheum 65% of polymyositis and dermatomyositis have this extramuscular manifestation which is occasionally asymptomatic... Associated antibody.... |
Interstitial lung disease screened with CT scan. Anti-Jo-1 antibody |
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Rheum Why US or MRI for inflammatory myopathy? |
pattern of muscle can aid in diagnosis and find site for biopsy |
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Rheum How to differentiate neuropathy vs inflammatory myositis? |
Nerve conduction study can exclude neuropathic diseaes |
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Rheum muscle biopsy with lymphocytic muscle infiltration with necrosis and regeneration... |
gold standard to diagnose inflammatory myopathy |
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Rheum initial treatment for dermatomyositis and polymyositis (2) |
high dose steroids; Physical therapy to maintain strength |
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Rheum Which inflammatory myositis is resistant to treatment? Method to reduce deterioration... (2) |
inclusion body myositis steroids or IV IG |
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Rheum malignancy associated with inflammatory myopathies...
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adenoca, especially ovarian |
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Rheum worst prognostic factor for mortality in inflammatory myopathy... |
older age |
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Vasculitis Giant cell arteritis is suspected... Treatment for PMR... Suspected temporal arteritis with neg biopsy... |
start treatment before biopsy to avoid vision loss. low dose steroids (prednisone) repeat biopsy on other temporal artery |
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Vasculitis affects aorta and major branches as well as pulm arteries in YOUNGER WOMEN... Diagnosis... TREATMENT.... |
Takayasu arteritis CT angio or MR angio of aorta and major branches high dose steroids |
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Vasculitis 3 large vessel vasculitis |
giant cell takayasu PMR |
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Vasculitis 50% of newly acquired Hepatitis B infection occur in this setting... Treatment if Hep B is involved... |
polyarteritis nodosa steroids and entecavir (anti-viral) |
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Vasculitis fever, arthralgia, myalgia, abd pain, wt loss, peripheral neuropathy... |
polyarteritis nodosa |
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Vasculitis Treatment for polyarteritis nodosa... if fail 1st treatment or have significant kidney or GI or cardiac or neuro involvement... |
high dose prednisone cyclophosphamide |
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Vasculitis medium to small arteries in children and some adults with HIV.... [fever, rash, conjunctivitis, ACS] responds to... |
Kawasaki high dose salicylates and IV IG |
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Vasculitis 2 medium sized vessel vasculitis... |
polyarteritis nodosa Kawasaki disease |
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Vasculitis small to medium size vessels (3) |
Wegener microscopic polyangiitis Churg Strauss |
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Vasculitis granulomatosis with polyangiitis.... affects...(2) Antibody... |
also called Wegener upper and lower resp tract and kidneys antiproteinase-3 (c-ANCA) |
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Vasculitis microscopic polyangiitis affects lungs and kidneys and associated with this Ab... |
myeloperoxidase (p-ANCA) |
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Vasculitis Treatment for microscopic polyangiitis and granulmatosis with polyangiitis (2 combos) |
high dose steroids with 3-6mo of cyclophosphamide or steroids with rituximab |
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Vasculitis eosinophilia with rhinitis, sinusitis, asthma... |
Churg Strauss |
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Vasculitis cutaneous purpura, mononeuritis multiplex, immune complex glomerulonephritis... |
cryoglobulinemic vasculitis |
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Vasculitis When do you see vasculitis with cryoglobulins? |
type 2 seen in HIV and ACTIVE HCV (elevated HCV RNA) |
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Vasculitis % of HCV develop cryoglobulin associated syndrome... % of type 2 cryoglobulin syndromes have active HCV... |
5% with HCV 80% active HCV |
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Vasculitis purpuric rash, arthritis, abdominal pain, hematuria and malignancy in patients over 50.... [Skin biopsy with leukocytoclastic vasculitis with IgA deposits] Treatment... 2 complications.... |
Henoch Schonlein purpura short course of prednisone IgA nephropathy evaluate for underlying malignancy in men over 50 |
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Vasculitis 60% of leukocytoclastic vasculitis is due to... 40% of leukocytoclastic vasculitis is due to... |
SLE, drugs, infection, etc... (identifiable cause) 40% idiopathic |
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Systemic Inflamm Disease recurrent oral ulcers with recurrent genital ulcer, eye lesion, skin lesion, large vessel aneurysm and pathergy without explanation.... [associated with HLA-B51] Treatment..l. |
Behcet Disease infliximab pathergy - small injury to skin causes ulcer or lesion that is difficult to heal |
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Systemic Inflamm Disease chondritis of ears, nose, and resp tract; ocular inflammation and nonerosive seronegative inflamm polyarthritits... Follow up procedure... |
relapsing polychondritis check PFT because it can affect airway |
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Systemic Inflamm Disease daily spiking fever, salmon colored rash, arthritis, HIGH Ferritin level... Need to rule out... Treatment... |
Adult onset Still Disease infection, lymphoma, leukemia NSAIDS, then steroids if NSAIDs fail |
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Systemic Inflamm Disease most common familial autoinflammatory disease... [starts young age with abd pain, red rash on legs] high risk for developing... treatment... |
Familial Mediterranean fever high risk for amyloidosis colchicine |
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Systemic Inflamm Disease brittle bones, blue sclerae, dentinogenesis imperfecta |
osteogenesis imperfecta |
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System Inflamm Disease smooth, velvety skin that is hyperextensible. joint hypermobility, delayed wound healing, easy bruising |
Ehlers-Danlos |
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Systemic Inflamm Disease fragile and thin arteries. aneurysm, AV fistula, bowel and uterine rupture... |
Vascular Ehlers-danlos |
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Systemic Inflamm Disease overgrowth of long bones with eye and aorta problems... FATAL COMPLICATION... |
Marfan aortic root aneurysm |
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Systemic Inflamm Disease noncaseating granulomas that infiltrate tissues of any organ... |
sarcoidosis |
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Systemic Inflamm Disease acute, self-limited disease with hilar LN, erythema nodosum, acute arthritis (ankles) |
Lofgren syndrome - sarcoidosis |
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Systemic Inflamm Disease Diagnosis of sarcoid... Diagnosis of Lofgren... |
tissue biopsy for sarcoid. symmetric hilar LN is needed for diagnosis of Lofgren (limited form of sarcoid) |
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Spondyloarthritis post-infectious, aseptic arthritis that usually occurs with urethritis and conjunctivitis... Diagnosis... Treatment... |
reactive arthritis check for Chlamydia or Gonorrhea resolves in 6mo |
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SLE red rings on skin with anti-Ro/SSA and anti-La/SSB Ab... 50% of these patients.... |
subacute cutaneous lupus erytheramotous DO NOT develop systemic manifestation of lupus |
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OA OA @ atypical joint like metacarpophalangeal... |
hemachromatosis (check iron studies) |
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DMARD risk factor with hydroxychloroquine... |
retinal exam for pigment deposit. can lead to vision loss |
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RA Before any surgery that requires intubation in longstanding RA... |
check cervical spine xray to eval atlantoaxial subluxation and dynamic instability |
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DMARD risk factor for tocilizumab... |
can increase lipids, so check lipid panels |
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Infectious arthritis Diagnosis for mycobacterial osteomyelitis of spine (HIV with hx of Tb)... [Pott disease] |
vertebral biopsy |
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Vasculitis 50yo or older with FUO and fatigue with symptoms of PMR affecting hips and shoulder.... [bilat temporal artery biopsies are negative] Diagnosis... Treatment... |
giant cell arteritis CT angio or MR angio of aortic arch and major branch vessels. prednisone ASAP |
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Raynaud Treatment for acute ischemic digit... Treatment for recurrence of digital ulcer... |
IV epoprestenol for acute vasodilation bosentan for recurrent ulcer |
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Rheum nail pitting and joint pain is seen in… T/F: increase of skin findings correlate with severity of disease process in first part of question... |
psoriatic arthritis (under spondyloarthritis heading) False: no relationship exists between extent of skin and joint disease |
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Vasculitis frequent cutaneous vasculitis complication of lupus.... treatment... |
urticarial vasculitis hydroxychloroquine |
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CPPD Calcium pyrophosphate crystals that deposit directly within cartilage... If asymptomatic... |
chondrocalcinosis No treatment |
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Rheum patient presents with anterior uveitis... |
check chest xray to eval sarcoid |
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infection workup for acute, swollen painful joint (3 labs)… T/F: X-rays are helpful in early diagnosis of early native joint infection... |
arthrocentesis with gram stain, polarized microscopy for crystals, cell count with diff False: X-rays are not helpful |
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Rheum complication of gout or pseudo gout... |
septic arthritis can occur |
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Lyme antibiotic for chronic lyme disease… avoid this drug for pregnant with lyme disease... |
NONE doxycycline |
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OA these conditions can cause OA in atypical joints… condition that causes OA of 2nd and 3rd metacarpophalangeal joints… |
metabolic causes hemachromatosis |
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OA Avoid this treatment with acute joint inflammation… Avoid these 3 treatments for knee OA…. |
steroid joint injection until infection ruled out. arthroscopic lavage, debridement, or closed lavage |
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OA another cause of carpometacarpal OA |
de Quervain tenosynovitis |
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RA T/F: need + RF for diagnosis of RA… |
False, anti-CCP antibody can be + and RF -. |
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RA side effect of TNF-alpha inhibitor if + ANA... |
lupus like syndrome |
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Gout T/F: elevated uric acid level is diagnostic of gout… T/F: normal uric acid level rules out acute gout… joint aspiration with monosodium urate crystals and WBC >50000…. |
F: high uric acid level alone is not diagnostic F: can have acute gout attack with normal uric acid acute gout with concurrent bacterial joint infection |
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Gout avoid NSAIDs for gout treatment in these 2 conditions… when to start allopurinol for acute gout... |
CKD and PUD wait 1-2 wks |
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SLE + ANA with rash that involves nasolabial folds… T/F: ANA titers correlate with disease activity... |
NOT SLE. possible rosacea F: ANA levels do not correlate with activity |
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SLE treatment for life threatening SLE related complication... |
high dose steroids |
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Systemic Sclerosis avoid this drug in management for scleroderma... |
corticosteroids is not involved with management of scleroderma |
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Myopathy continued or new onset worsening of proximal muscle weakness despite normal CK level… always check this lab with myopathy... |
corticosteroid induced myopathy check TSH, CK elevation can occur years after clinical manifestations of hypothyroid |
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Rheum Anti-RNP antibodies are linked to… (ribonucleoprotein) |
mixed connective tissue disorder |
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Regional Pain T/F: olecranon bursitis does not cause restriction or pain with range of motion of elbow… T/F: exercise is helpful for ACUTE low back pain... |
True, no restriction False, not beneficial |
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Regional Pain continuous groin/thigh/buttock pain in SLE or sickle cell who have received steroids… diagnosis... |
osteonecrosis of hip MRI, not plain hip xray |
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Regional Pain + Finkelstein test… constant shoulder pain with normal exam... |
de Quervain tenosynovitis consider pan coast tumor or radiculopathy |
