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Rheumatology for PAs

Adult medicine

What two diseases cause prominent involvement of the DIP joints? OA and psoriatic arthritis
Which rheumatic diseases cause fever? gout, still disease, endocarditis
Which rheumatic diseases cause rash? SLE, psoriatic arthritis, still disease
Which rheumatic diseases cause nodules? RA, gout
Which rheumatic diseases cause neuropathy? polyarteritis nodosa, wegener granulomatosis
Which disease causes polyarticular synovitis with pannus in the PIPs, MCPs, wrists, knees and ankles and MTP joints? RA
Which disease causes palmar erythema and subcutaneous nodules? RA
Which disease features a positive anti-CCP and a positive RF in 70- 80% of cases, as well as an elevated ESR, CRP, and platelet count? RA
Which disease features normal xrays for the first 6 mo of disease? RA
When should DMARDS (disease modifying antirheumatoid drugs) be started for RA patients? ASAP
What disease is caused by trapping of antigen-antibody complexes in capillaries of visceral structures or to autoantibody-mediated destruction of host cells. SLE
What disease can feature joint sx as the earliest manifestation, cotton-wool spots, pericarditis, subcutaneous rheumatoid nodules, neuro complications, among other problems? SLE
Antibodies to double-stranded DNA and to Sm are specific but not sensitive for which dz? SLE
Showers of red blood cells, with or without casts, and proteinuria (varying from mild to nephrotic range) are frequent during renal exacerbation of this disease: SLE
Antinuclear antibody tests are sensitive but not specific for this disease: SLE
Treatment of this disease includes Patient education and emotional support,rest and NSAIDs for minor joint sxs, and corticosteroids for certain complications, as well as the active participation of a rheumatologist. SLE
This disease causes diffuse fibrosis of the skin and internal organs. Scleroderma
This disease causes polyarthralgia, Raynaud phenomenon as an initial manifestation. Scleroderma
Causes CREST syndrome (representing calcinosis cutis, Raynaud phenomenon, esophageal motility disorder, sclerodactyly, and telangiectasia) Scleroderma
Almost always features +ANA, usually features a normal ESR and mild anemia. Scleroderma
Causes GI hypomotility, diverticuli, pulmonary fibrosis and pulmonary vascular dz, pericarditis, heart block, myocardial fibrosis, pulmonary htn and r heart failure. Scleroderma
This disease requires symptomatic and supportive tx, and damage to different organs requires referral to their respective specialists. Scleroderma
Affects mostly women, causes dryness of the eyes and mouth. Sjogren's Syndrome
RF+, ANA+, SSA and SSB+ Sjogren's Syndrome
This disease may need to be referred if symptomatic sxs manifest or the patient is not responsive to artificial tears. Sjogren's Syndrome
Four examples of autoimmune diseases are: Scleroderma, Sjogren's syndrome, RA, SLE.
This disease features appears in patients over 50 and causes fever, malaise, weight loss and pain and stiffness of the shoulder and pelvic girdle. Polymyalgia Rheumatica
This disease is associated with normocytic anemia, elevated ESR, and thrombocytosis: Polymyalgia Rheumatica
You should treat this disease with prednisone for 1 year, PT, and calcium supplement. Polymyalgia Rheumatica
This disease is complicated by GCA: Polymyalgia Rheumatica
This disease affects patients over 50 years old and causes amaurosis fugax, diplopia, blindness, ischemic optic neuropathy: GCA
Causes nodular, enlarged, tender, pulseless temporal artery: GCA
Labs for this disease include elevated ESR, normochromic normocytic anemia, throbocytosis, elevated ALP: GCA
This disease is treated with high dose prednisone and temporal artery bx: GCA
PMR and GCA are known as what type of syndromes? Vascultis syndromes
Known for male predominance, onset usually before age 40, inflammatory arthritis of the spine or the large peripheral joints (or both), enthesopathy, uveitis in a significant minority, the absence of autoantibodies in the serum, and HLA-B2 Seronegative Spondyloarthropathies
May cause chronic back pain, peripheral arthritis, and sausage swelling of a finger or toe: Ankylosing spondylitis
Features neg RF, usually a +HLA-B27 and an elevated ESR, and the earlies radiographic changes are seen in SI joints. Ankylosing spondylitis
To treat this disease, NSAIDs are the first line tx, followed by TNF inhibitors. Ankylosing spondylitis
Causes the costovertebral joints to fuse: Ankylosing spondylitis
You might look for a rash if you suspect this joint problem: Psoriatic Arthritis
This disease resembles RA but usually with fewer joints, the oligoarticular form involves considerable destruction of affected joints. Psoriatic Arthritis
May cause pitting of the nails and onychlysis, sacroiliitis and ankylosis of the spine. Psoriatic Arthritis
Features elevated ESR, RF-, high uric acid levels, pencil in cup deformity, bony ankylosis, and assymetric sacroillitis. 50% HLA positive. Psoriatic Arthritis
80% of cases have psoriasis preceding onset Psoriatic Arthritis
NSAIDs are usually sufficient for mild cases, followed by methotrexate. Psoriatic Arthritis
Antecedent GI and GU infections, manifests as a sterile asymmetric oligoarthritis Reactive arthritis (aka Reiter syndrome)
May cause urethritis, conjuctivitis, uveitis, and mouth ulcers, and is most common in young men Reactive arthritis (aka Reiter syndrome)
high percentage of cases are HLA B27+, negative synovial fluid cx, and may follow GI infection Reactive arthritis (aka Reiter syndrome)
Treat this disease with NSAIDs, and treat the associated STD early. Reactive arthritis (aka Reiter syndrome)
Joint effusions are usually large, with white blood counts commonly > 50,000/mcL Infectious arthritis
Migratory polyarthralgias vs single joint, tenosynovitis, necrotic pustules on palms and soles, most common in young women. Gonococcal septic arthritis
S. aureus most common cause, gram stain and cx +, xrays not helpful for 2 weeks Non-gonococcal septic arthritis
Typical H&P includes hx of joint damage or injection drug use, bacteremia, prosthetic joints, acute pain swelling and heat Non-gonococcal septic arthritis
5-10% die of sepsis, if polyarticular then risk goes up Non-gonococcal septic arthritis
Gout and psuedogout are ruled out with synovial fluid exam for crystals, and an ortho consult is necessary for drainage and lavage. Non-gonococcal septic arthritis
Prodromal migratory polyarthralgias Tenosynovitis most common sign Most common in young women common in male homosexuals purulent monarthritis Septic Arthritis (gonococcal)
synovial fluid Gram stain is positive in one-fourth of cases and culture in less than half radiographs normal Septic Arthritis (gonococcal)
Urethral, throat, and rectal cultures should be done in all patients,dramatic response to antibiotics, should be admitted to the hospital to confirm the diagnosis, to exclude endocarditis, and to start treatment, complete recovery is the rule Septic Arthritis (gonococcal)
Flu like sx and rash, then Bell's palsy and meningitis, then arthritis Lyme dz
Labs include ELISA testing, IFA for antibody, western blot, and lumbar puncture if patient has Bell's palsy Lyme dz
Urticaria, polyarthralgia, and lab findings of parvovirus, Hep B, Hep C Viral arthritis
If DDx includes RA and viral arthitis from Hep C, what lab can rule out Hep C? Anti-CCP
Can result from hematogenous dissemination of bacteria, invasion from a continous focus of infection, or skin breakdown from vascular insufficiency Osteomyelitis (acute pyogenic)
Most common site for hematogenous dissemination of bacteria thoracic and lumbar vertebral bodies
In osteomyelitis, how do you differentiate hematogenous dissemination vs contigous focus? fever vs no fever
osteomyelitis without bone occurs when? when there is neuropathy from vascular insuffciency
complicated by extension to adjacent bone or joints, recurrence, and neoplasia in persistently infected tissues osteomyelitis
Need to identify the offending organism to start tx, may need a bone bx osteomyelitis
features a +PPD, +Bx, +synovial bx, osteomyelitis (TB)
Treat with 6-9 mo of ABX osteomyelitis (TB)
Treat with bone & tissue debridement and prolonged abs osteomyelitis
Non specific test used to detect illness associated /c acute and chronic infection, inflammation, advanced neoplasm, and tissue necrosis or infarction ESR
A protein present in acute phase that is measured to indicate inflammatory illness CRP
Normal serum levels indicate probable diagnosis of pseudogout. Elevated levels point to gout. Monitoring for slowly lowering levels is important because rapid decrease of this metabolite can precipitate a gouty attack. Uric acid
It is an autoantibody. It can be present in RA, SLE, Sjogren, & Scleroderma (both diffuse & limited) as well as other dz RF and ANA
Is not genetically encoded and it is produced in the body in the course of RA. Compared to rheumatoid factor, the currently available ELISA tests for this have superior specificity and comparable sensitivity for the diagnosis of rheumatoid arthritis. anti-CCP(Anti–Cyclic Citrullinated Polypeptide Antibodies)
can show presence of intra articular nodes, calcifications, dissolving & ankylosing boney joints, shape/pattern of bony pathology plain x-rays
It is an autoantibody that can be present in RA & SLE anti-native DNA
This is an autoantibody that can be present in SLE anti-Sm
They are autoantibodies that can be present in RA, SLE, & Sjogren syndrome anti-SS-A and anti SS-B
strongly associated with seronegative spondyloarthropathies HLA-B27
Women 20-50yo; Chronic aching pain & stiffness, global with focus in neck, shoulders, low back, and hips. A dx of exclusion. R/o RA, SLE with CRP. R/o hypothyroidism fibromyalgia
Created by: cwyatt13