Xmsk Week 3

Front 1

What signs are required for arthritis?

Back 1

- Joint tenderness
- Swelling
- Stress pain

Front 2

What is the difference between Monoarthritis, Oligoarthritis and Polyarthritis?

Back 2

Monoarthritis: 1 Joint
Oligoarthritis: < 5 joints
Polyarthritis: >= 5 joints

Front 3

What percent of Rheumatoid Arthritis is seropositive?

Back 3

Seropositive: 85%
Sernonegative: 15%

Front 4

What are the factors that makes "seropositive"?

Back 4

- Rheumatoid factor
- Cyclic Citrullinated Peptide
- ANA

Front 5

What are the different Crystal Arthropathies and their crystals?

Back 5

- Gout (Monosodium urate)
- CCPD (Calcium Pyroophosphate Dihydrate)
- HAA (Calcium Hydroxyapatite)

Front 6

What are the bacterias that can be associated with arthritis?

Back 6

Common: Staph aureus, Staph epi
Other: Strep, Gonnococcal arthritis

Front 7

What are the articular features of Rheumatoid arthritis?

Back 7

- Diffused erosion (Juxta-articular margins & subchondral bone)
- Juxta-articular ostepenia
- Joint space loss
- Pannus
- Subluxed/ankylosed joints

Front 8

What is Pannus?

Back 8

Hypertrophied synovium

Front 9

Where does erosions often occur in Rheumatoid arthritis?

Back 9

Double reflection of synovium

Front 10

Varus and Valgus which do you see in OA and which do you see in RA?

Back 10

OA: Varus
RA: Valgus (Knocked-Knee)

Front 11

What are the extra articular features of Rheumatoid arthritis? (9)

Back 11

- Nodule
- Sjogren's syndrome
- Scleritis/episcleritis/keratitis
- Lung (pleuritis, nodules, interstitial fibrosis)
- Heart (Pericarditis)
- Peripheral neuropathy
- Vasculitis/leg ulcers
- Amyloidosis
- Felty's syndrome

Front 12

What are the symptoms of Sjogren's syndrome?

Back 12

- Keratoconjunctivitis Siccs
- Xerostomia
- Parotid Gland Enlargement

Front 13

What is the ethiology of Lupus?

Back 13

- Genetics
- Estrogen (OCP induces)
- Complement cascade (C1q)
- Sunburn and cell apoptosis

Front 14

What do you get with Felty's syndrome?

Back 14

- RA
- Splenomegaly
- Leukopenia

Front 15

Diagnosis of Lupus

Back 15

"SOAPBRAINMD"
- Serositis (Pleuritis or Pericarditis)
- Oral ulcers
- Arthritis
- Photosensitivity Rash
- Blood disorders (Lymphocytopenia or Coombs +vs HA)
- Renal (Nephrosis or Nephritis)
- ANA
- Immune test (DNA Ab, Sm, APLS)
- Neurologic (Seizure or Psychosis)
- Malar rash
- Discoid Rash

Front 16

What are the 2 types of scleroderma?

Back 16

- Limited cutaneous
- Diffuse systemic

Front 17

What is seen in limited cutaneous scleroderma?

Back 17

"CREST"
Calcinosis
Raynaud's
Esophageal Dilation
Sclerodactyly
Telaniectasia

Front 18

What can scleroderma lead to?

Back 18

- Severe Raynaud's Syndrome
- Renal failure & Hypertensive crisis
- Interstitial lung disease

Front 19

What blood test you can do for scleroderma?

Back 19

Limited: Anti-centromere Antibody
Diffuse: Topisomerase

Front 20

What is mixed connective tissue disease?

Back 20

Disease with mixed features of lupus, RA, scleroderma, polymyositis

Front 21

What are the different forms of Psoriatic arthritis?

Back 21

1. Asymmetric oligoarthritis
2. RA like poly arthritis (DIP involvement, asymmetric, sausage digits)
3. DIP variant
4. Arthritis mutilans
5. Psoriatic spondylits

Front 22

What does seronegative spondylarthropathies have in common?

Back 22

- Enthesis is involved
- HLA B-27 mutation

Front 23

Night pain is associated with what disease?

Back 23

Ankylosing spondylitis

Front 24

What are the features of ankylosing spondlylitis?

Back 24

- Syndesmophytes
- Sarcilitis
- Enthesopathy
- Bamboo spine

Front 25

What are the seronegative spondyloarthropathies?

Back 25

- Ankylosing spondylitis
- Reiter's Syndrome
- Psoriatic Spondylitis
- Spondylitis of inflammatory bowel disease

Front 26

What is Reiter's triad in Reactive arthritis?

Back 26

1. Arthritis
2. Conjunctivitis
3. Urethritis - Chlamydia

Front 27

What is Berefringence?

Back 27

Negative: Yellow parallel; Blue perpendicular = Gout
Positive: Yellow perpendicular; Blue parallel = CPPD

Front 28

What do you stain for Calcium Hydoxyapitite Crystals?

Back 28

Alizarin Red Stain.

Front 29

How do you treat Gout?

Back 29

Acute: NSAID, Cochicine, Prednisone
Chronic: Allopurinol or Urolic (> 3 attacks & not during acute attack)

Front 30

What is the MOA for allopurinol?

Back 30

Xanthine oxidase inhibitor

Front 31

What is the pathogensis of Systemic Lupus Erythematosis?

Back 31

Inflammatory autoimmune disorder characterized by the production of autoantibodies directed against cell nuclei

Front 32

What are the symptoms of Discoid lupus?

Back 32

"FEAST"
- Follicular plugging
- Erythema
- Atrophy
- Scarring
- Telangiectasia

Front 33

What are the Neurologic symptoms of lupus due to?

Back 33

1. Inflammation
2. Thrombotic from hypercoagulatory states

Front 34

What are the cardiovascular and respiratory symptoms of lupus?

Back 34

Cardiovascular:
- Atherosclerosis
- Endocarditis
- Pericarditis
- Myocarditis
Respiratory
- Pulmonary Hypertension
- Interstitial lung disease
- Pneumoitis
- Pulmonary Hemorrhage
- Shrinking Lunge Syndrome
- Pural Effusion

Front 35

What is the most dangerous form of Lupus Nephritis?

Back 35

Class IV: Diffuse proliferative glomerulonephritis

Front 36

What drugs cause drug induced lupus?

Back 36

"CHIMP"
Chlorpromazine
Hydralazine
Isoniazid
Minocycline
Procainamie, Propylthiouracil

Front 37

What is Neonatal Lupus

Back 37

Mother with positive SSA and SSB can pass lupus to fetus.

Front 38

What is the main concern with neonatal lupus and what is its treatment?

Back 38

Congenital Heart Block
Treat with Dexamethasone

Front 39

What is the treatment for lupus?

Back 39

Conservative:
- Sun avoidance
Drugs:
- Prednisone
- Hydroxychloroquine
- Azathiorpine
- Cyclosproine
- Cyclophosphamide
- Rituximab

Front 40

High ESR indicates

Back 40

- Polymyalgis Rheumatica
- Giant cell Arteritis (Temporal Arteritis)

Front 41

What HLA confers risk for RA?

Back 41

HLA-DR B1

Front 42

In citrullination, what amino acid gets modified into citrulline?

Back 42

Arginine

Front 43

In RA what does T cell activation lead to?

Back 43

1. Activation and proliferation of synovial lining and endothelial cells
2. Recruitment and activation of additional proinflammatory cells from the bone marrow and circulation
3. Secretion of cytokines and proteases by macrophages and firboblast-like synovial cell
4. Autoantibody production

Front 44

What are the 4 autoantigens that have potential as pathogenic factors in RA?

Back 44

1. Type II Collagen
2. Cartilage Ag Glycoprotein 39
3. IgG
4. Citrullinated protein and peptides

Front 45

What are the 2 important cytokines involved with the pathogensis of RA?

Back 45

- TNF alpha
- IL-17

Front 46

What does TNF cause? (5)

Back 46

1. Increase immune cells (T & B cells)
2. Interfere with supressive effect of regulatory T cells
3. Generates expression of collagenase & metalloproteinases and prostagladins by synovial cells
4. Synthesis of IL-1b
5. Decrease RANKL/OPG ratio

Front 47

What does IL-17 cause?

Back 47

1. Increase PGE2
2. Enhance osteoclast activation

Front 48

What are the factors promoting Bone destruction? (4)

Back 48

1. TNF
2. RANKL
3. Cathepsin K (Found in osteoclasts)
4. Wnt Pathway (Regulates OPG)

Front 49

Which proteins inhibit Wnt pathway?

Back 49

Dickkopf (DKK) family

Front 50

What How does Prostagladins play a role in RA?

Back 50

PGE2 stimulates perarticular bone resorption in RA

Front 51

How do you classify RA patients using severity?

Back 51

Mild: >3, -ve RA/CCP, no erosion or cartilage loss
Moderate: 6-20, +ve RA/CCP, inc ESR/CRP, osteopenia, no erosion
Severe: > 20, +ve RA/CCP, inc ESR/CRP, Hypoalbuminea, dec functional capacity

Front 52

What are the drugs used for RA?

Back 52

Analgesics: Acetaminophen, opioids
NSAIDs & COX-2
Glucocorticoids
DMARDS

Front 53

What are the early side effects of Glucocorticoids? (5)

Back 53

- Mood disturbance
- Hyperglycemia
- Blurred vision
- Hypokalemia
- Osteonecrosis

Front 54

What are the late side effects of Glucocorticoids? (6)

Back 54

- Osteoprosis
- Cushingoid feature
- Hypertension
- Increased cardiovascular risks
- Osteonecrosis
- Cataracts

Front 55

What are the small molecule DMARDS for RA? (4)

Back 55

- Methotrexate
- Hydroxychloroquine
- Sulfasalazine
- Leflunomide

Front 56

What is the MOA for Hydroxychloroquine?

Back 56

Inhibits T cell lysosome degranulation.

Front 57

What is the MOA for methotrexate?

Back 57

Inhibits dihydrofolate reductase

Front 58

What is the MOA for Abatacept

Back 58

Modulates Co-stimulation via CD80/86:CD28 pathway

Front 59

What is the MOA for Rituximab?

Back 59

Anti-CD20. Selectively depletes CD20+ B Cells.

Front 60

What is the MOA for Tocilizaumab?

Back 60

Anti-IL6

Front 61

What is the treatment guideline for RA?

Back 61

Mild: Hydroxychloroquine
Moderate-Severe: MTX or Combination or MTX/biologics
Severe w/ extra-articular: Glucocorticoids + MTX or Cyclosporin or Biologics

Front 62

What is the triple therapy for RA?

Back 62

Methotrexate + Sulfasalazine (5-AZA) + Hydroxychloroquine

Front 63

How many traditional DMARD do you have to try before switching to biologics?

Back 63

3

Front 64

What are the consequence of scleroderma? (3)

Back 64

- Severe Raynauds
- Renal failure (Hypertensive crises)
- Interstitial lung disease

Front 65

What are the different classes of biologic DMARDs? (5)

Back 65

- TNFa (Infliximab)
- IL-1 (Anakinra)
- IL-6 (Tocilizumab)
- CD28 (Abatacept)
- CD20 (Rituximab)