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