Block 3 POM Exam -- Rheumatology (Important facts)

Start Studying!

Terms

undefined, object

copy deck

Morning stiffness is associated w/ what types of arthritis?: INFLAMMATORY

Note: this is known as gelling
Note: the pain generally improves w/ activity
What characteristics are NOT usually seen in RA (3)?: Involvement of DIP joints
Involvement of lumbar spine
Monoarticular involvement
What is a valgus deformity of the knee?: When the knee is bent in more medially

Think "knock-kneed"
What is a varus deformity of the knee?: When the knee is bent out more laterally

Think "bow-legged"
What main conditions are on the differential for acute MONOarticular arthritis (4)?: Trauma
Infection
Gout
Pseudogout
What group of women are usually affected by gout?: POST-menopausal (almost exclusively)
What is the best test to diagnose gout?: Polarized microscopy of synovial fluid
What are the crystals involved in gout composed of?: Monosodium urate
What drugs impair uric acid excretion (3)?: Diuretics
Salicylates
Cyclosporine
Breakdown of causes of gout (w/regards to uric acid handling): 90% due to under-excretion
10% due to overproduction
Most commonly involved joint in gout: 1st MTP

NOTE: gout is NOT the only disorder that can affect this joint
What types of food are a risk factor for gout?: Purine-rich food
What drugs are used to treat gout (3)?: NSAIDs (indomethacin)
Corticosteroids
Colchicines
What drugs can be used to prevent gout (2)?: Probenecid
Allopurinol

NOTE: urate lowering drugs can actually precipitate an attack of gout
Drugs that qualify as DMARDs (5): Methotrexate
Sulfasalazine
Leflunomide
Gold
TNF-alpha inhibitors
What are the X-ray findings early on in gout? What about late in the disease?: Typically normal

Later, can find asymmetric, erosive arthritis w/ "punched out" erosions
What are the crystals in pseudogout composed of?: Calcium Pyrophosphate Dihydrate
What joints are most commonly involved in pseudogout (2)?: Knees
Wrists
What is different between one's predisposition for gout and pseudogout?: Dietary factors and meds are NOT precipitating factors in pseudogout
What is the hallmark radiographic finding in pseudogout?: Chondrocalcinosis
(calcifcation of articular cartilage)
What sex is pseudogout more common in? What about gout?: Females

Males
What is the treatment for pseudogout?: NSAIDs/corticosteroids for acute attacks

Daily colchicine can help prevent recurrence
What joints does OA usually NOT involve?: MCPs
What are bony swellings on the DIPs called? What disease are they related to?: Heberden's nodes

OA
What are bony swelling on the PIPs called? What disease are they related to?: Bouchard's nodes

OA
Which knee deformity is commonly seen in OA?: VARUS deformity
Which knee deformity is commonly seen in RA?: VALGUS deformity
In what circumstance are intra-articular steroids contraindicated?: Possible septic arthritis

Steroids may suppress the immune response
What is Sjogren syndrome?: Autoimmune disorder

Immune cells destroy glands that produce tears and saliva
What is a Schirmer's test? What condition is it used to test for?: Test whether eyes produce enough tears to stay moist

Used in Sjogren's syndrome
What aged patients is polymyalgia rheumatica typically seen in?: Almost exclusively in elderly
What type of condition is fibromyalgia? (inflammatory vs non): NON-inflammatory

NOTE: despite this, DOES have some inflammatory symptoms
(ie morning stiffness)

SO, corticosteroids are NOT indicated
90% of pts w/ ankylosing spondylitis are positive for what?: HLA-B27

NOTE: 8% of the population is HLA-B27 positive
What part(s) of the skeleton does ankylosing spondylitis affect most often?: Axial skeleton
(including the sacroiliac joints)
What ages pts. does ankylosing spondylitis usually affect?: YOUNG pts.
(unusual after 50 y.o.)
How long may it take for X-ray findings to show up in ankylosing spondylitis?: Up to 10 years
What drugs may have a role in slowing the progression of ankylosing spondylitis?: TNF inhibitors

NOTE: methotrexate and sulfasalazine have little effect on spinal disease
What is the best therapy for polymyositis?: Most pts. respond to systemic steroids alone
Which is more common in adults? Polymyositis or dermatomyositis What about in children?: Polymoyositis

In children, dermatomyositis is more common
What are Gottron's papules? What condition are they assoc. w/?: Raised, scaly, ertyhematous lesions over MCPs and PIPs

Dermatomyositis
What is a heliotrope rash? What condition is it assoc. w/?: Violaceous rash over the eyelids

Dermatomyositis
What condition is often assoc. w/ a V-neck pattern rash? (sun-exposed areas_: Dermatomyositis
What are common lab findgings in polymyositis?: Elevated CPK and aldolase
What is the treatment for polymyositis/dermatomyositis?: High dose corticosteroids

Methotrexate/azathioprine added if myositis relapses
What conditions did we cover that can have a positive ANA (5)?: RA
Polymyositis/dermatomyositis
SLE
Sjogren's
Pauciarticular JRA
Polyarticular JRA
A subset of polyarteritis nodosa has been assoc. w/ what disease?: Hepatitis B
What parts of the body does polyarteritis nodosa commonly affect (5)?: Kidneys
Nerves
GI
Skin
Musculoskeletal
What parts of the body does polyarteritis typically spare (2)?: Lung
Cerebral vessels
What is the treatment for polyarteritis nodosa?: High dose corticosteroids
Immunomodulatory agent (ie cyclophosphamide)
What is keratoderma blennorrhagica? What disease is it assoc. w/?: Papulosquamous lesions on the soles and the palms

Reiter's syndrome
What is the treatment for Reiter's?: NSAIDs for pain
Tetracycline and sulfasalazine for refractory cases
What age group does pauciarticular JRA typically affect?: Children < 6 y.o.
What is iridocyclitis? What disease is it a complication of?: Inlfammation of the iris and ciliary body

Pauciarticular JRA
What joint is commonly involved in pauciarticular JRA?: The knee
What lab test abnormality is common in pauciarticular JRA?: 60% of pts are ANA positive
In polyarticular JRA, what is the joint distribution like?: Symmetric arthritis, similar to adult RA

NOTE: this arthritis tends to be chronic
Which JRA usually has a negative ANA and RF?: Systemic-onset JRA
(aka Still's disease)
What are the distinguishing charactertistics of systemic-onset JRA (4)?: Daily spiking fevers
Evanescent rash
Lymphadenopathy
Hepatosplenomegaly
What does pauciarticular mean, in terms of number of joints?: < 4
Which of the JRAs actually is more common in males than in females?: Juvenile spondylitis
When does juvenile spondylitis usually present? (what age group): "Late onset" for the JRAs
Occurs in 9 - 16 year olds
What is the 1st line therapy for JRA?: NSAIDs

If these fail, DMARDs and corticosteroids may be used
What joints are commonly involved in SLE related arthritis?: Small joints of the hand
99% of SLE pts. are ANA positive What are the limitations of this test in identifying pts.?: Sensitive, but NOT specific
What are the limitations of Anti-dsDNA and anti-Sm Abs in IDing SLE cases?: Specific, but NOT sensitive
Beyond NSAIDs and steroids, what other treatments are there for SLE?: Hydroxychlorquine
Cyclophosphamide
Azathioprine
Methotrexate
Mycophenalate mofetil
The classic case of non-gonococcal arthritis involves how many joints?: ONE
It's a mono-articular arthritis
What pathogen is usually assoc. w/ non-gonococcal arthritis?: Staph aureus
In gonococcal arthritis, what should be cultured?: Cervix
Throat
Urethra
Rectum

NOTE: joint is low yield in these cases
What joints are often involved in arthritis due to Pseudomonas (2)?: Sternoclavicular
Sacroiliac
Erythema migrans is assoc. w/ what condition that can cause arthritis?: Lyme disease
What is Libman-Sacks endocarditis? What disease is it assoc. w/?: Non-bacterial, thrombotic endocarditis

SLE
How many joints does Lyme arthritis typically involve? What types of joints?: Mono- or pauciarticular

Involves LARGE joints

NOTE: the arthritis is often late in the disease and is intermittent
Elevations of these may be indicative of recent strep infection (2)?: ASO
DNase B
Conditions assoc. w/ dactylitis (2)?: Reiter's syndrome
Psoriatric arthritis
What are syndesmophytes? What condition are they assoc. w/?: Like osteophytes, but vertical, in between vertebrae

Psoriatric arthritis
Why must you be careful w/ using corticosteroids to treat psoriatic arthritis?: Steoid taper can worsen the cutaneous psoriasis
What Abs to all MCTD pts. have?: High titer anti-RNP Abs
In Sjogren's syndrome, what type of infiltrate is seen in glands?: Lymphocytic
What drugs is used in Sjogren's syndrome that may also help in SLE?: Hydroxychloroquine
What type of staining is used to view the eyes of Sjogren's pts.?: Rose bengal stain
What arteries does PAN primarily affect?: Small and medium arteries
Is microscopic polyangitis granulomatous?: NO
What lab test is positive in a majority of microscopic polyangiitis cases?: Positive ANCA (70%)
What lab test is often positive in Wegener's granulomatosis?: Positive c-ANCA (50 - 90%)
Wegener's and microscopic polyangiitis both often involve the kidney What is unusual about the involvement in these?: Often NOT assoc. w/ hypertension
What artery is commonly involved in Giant cell arteritis?: Superficial temporal artery

NOTE: other branches of the carotids as well
What common symptoms presents in 90% of cases of Giant cell arteritis?: Moderate - severe headache
What lab test is markedly elevated in giant cell arteritis?: ESR
20 - 40% of giant cell arteritis pts. experience what symptom?: Visual loss
Giant cell arteritis is linked w/ what other condition?: Polymyalgia rheumatica
What is the treatment for polymyalgia rheumatica?: Small doses of corticosteroids
Vast majority of PMR patients are over what age?: 65, it is a disease of the elderly
Behcet's disease is most common in people of what descent (2)?: Eastern mediterranean
Japanese
What JRA is characterized by an evanescent rash?: Still's disease (aka systemic-onset JRA)
In what condition might the serum ferritin be markedly elevated?: Adult Still's Disease
What is often the 1st complaint in relapsing polychondritis?: Ear pain and swelling
In scleroderma, what is the skin thickening a result of?: Dermal collagen accumulation
What are the signs of limited scleroderma? CREST: Calcinosis cutis
Raynaud's phenomena
Esophageal dysmotility
Sclerodactyly
Telangiectasias
What Ab do many CREST syndrome pts. have?: Anti-centromere Ab
What Ab do many diffuse scleroderma pts. have?: Anti-Scl70
Prognositically, how do limited and diffuse scleroderma compare?: Limited -- good

Diffuse -- poor
What is unique about the use of corticosteroids in diffuse scleroderma?: NOT helpful

May actually contribute to the development of renal crisis
What other disease develops early in diffuse scleroderma pts.?: Interstitial lung disease

Start Studying!

Deck Info

Number of cards 104