Duke PA Miscellaneous Rheumatologic Disease
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| new onset of headaches, or history of headaches with new patter--be suspicious for | Giant Cell Arteritis
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| White, over the age of 50, female to male 2:1, are demographics for | Giant Cell Arteritis
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| Headache – new or different from before, Scalp tenderness, especially over the, temporal artery, Jaw claudication, Systemic illness – weight loss, fevers, malaise | Giant Cell Arteritis
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| Giant Cell Arteritis immediately treated with __ | high dose prednisone
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| labs – very high ESR/CRP, anemia, low albumin | Giant Cell Arteritis
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| if you *suspect* GCA __ | treat it!
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| Sudden, irreversible blindness if left untreated | Giant Cell Arteritis
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| White, over the age of 50, female to male 2:1, are demographics for | Polymyalgia Rheumatica
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| Pain and stiffness of the pelvic and shoulder girdles, Weakness is not a feature, Morning stiffness is severe and protracted, Patients typically complain of difficulty fastening bra and getting up from seated position | Polymyalgia Rheumatica
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| PMR | Polymyalgia Rheumatica
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| GCA | Giant Cell Arteritis
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| treatment of PMR | moderate to low dose prednisone
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| Vasculitis of small vessels and capillaries lead to rupture/bleeding around them, Lower extremities, Redness does not blanch with pressure | Palpable Purpura
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| A SMALL vessel vasculitis | Wegener’s Granulomatosis
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| Signs/symptomsUpper Airway severe sinus disease (suspect in patients with refractory sinus symptoms)epiglottic changesLungsnodules and/or hemorrhageKidneysacute glomerulonephritisprotein, blood, and casts in the urine | Wegener’s Granulomatosis
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| Saddle nose deformity | Wegener’s Granulomatosis
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| treatment of Wegener’s Granulomatosis, | corticosteroids – high dose initially, cyclophosphamide
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| dry eyes (keratoconjunctivitis) and dry mouth (xerostomia) | sicca syndrome
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| An inflammatory disorder of the exocrine glands | Sjögren's Syndrome
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| Symptoms:Sicca Syndrome: Dry eyes (keratoconjunctivitis sicca)Dry mouth (xerostomia) parotid gland enlargementsome patients may also have fatigue/myalgiasrare: internal organ involvement (lungs, kidneys, etc | Sjögren's Syndrome
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| Testing:Eyes: Schirmer’s test: measures tear production on a paperRose-Bengal staining: shows corneal damageMouth:salivary Gland biopsyLabs:antibodies to Ro and L | Sjögren's Syndrome
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| treatment of keratoconjunctivitis | ocular lubricants, artificial tears
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| treatment for xerostomia | liberal fluids; specially-formulated mouthwash, toothpaste and chewing gum (Biotene ®),oral moisturizers
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| treatment for systemic symptoms of Sjögren's Syndrome | steroidsNSAIDsDMAARDs (usually hydroxychloroquine)
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| reddish-cyantotic, lacey pattern of the skin | livido reticularis
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| if you see livido reticularis be suspicious for | Antiphospholipid Syndrome
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| APS | Antiphospholipid Syndrome
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| Recently described syndrome of antibody-mediated hypercoagulabilitySymptoms:recurrent thrombosis – arterial and/or venouspregnancy loss – early or latePatients with this disorder have lupus-like symptoms but fail to meet diagnostic criteria | Antiphospholipid Syndrome
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| Testing:Anti-cardiolipin antibodiesLupus anticoagulantFalse positive RPR (Syphilis test) | Antiphospholipid Syndrome
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| Treatment:If thrombosis: life-long anticoagulation with warfarin plus ASA 81mg qdIf pregnancy loss: heparin and ASA 81mg during future pregnanciesEchocardiography to rule out vegetations | Antiphospholipid Syndrome
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| Chronic pain syndrome of unknown etiologyNot autoimmune or inflammatorySymptoms:“I hurt all over.” “I feel like I was hit by a truck in the morning.” muscle tenderness to palpationfatigue and disturbed sleep, women, ages 20-50 | fibromyalgia
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| Testing: Physical ExamNo joint swelling or inflammationTender points: press until your thumb nail blanches, Laboratory evaluation is within normal limits | fibromyalgia
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| Testing for fibromyalgiatender points: press until your thumb nail blanches | Back of headChest – upper & lowerUpper back – medial & lateralLow backButtockGreater trochanterMedial kneeLateral epicondyle
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| Treatment: Not very effective and very frustratingFollowed by primary care physicianSelf-careExercise, yoga, meditationSleep improvementTreat sleep apnea, restless legsPharmacotherapy: hypnotics, tricyclics, cyclobenzaprine (Flexeril®) | fibromyalgia
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| Anti-depressants: SSRIs, duloxetine (Cymbalta®)Analgesics: tramadol, gabapentin, pregabalin (Lyrica®)SSRIs, duloxetine, cyclobenzaprine also helpful with painNSAIDs, prednisone not helpfulavoid “trap” of chronic narcotics | fibromyalgia
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| Overlap Syndrome of Lupus and Sclerodermamany rheumatologists don’t consider this a unique disease – just the gray between these diseases | Mixed Connective Tissue Disease (MCTD)
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| Symptoms:severe Raynaud’s phenomenonswollen (“puffy”) hands, arthritismay have any/many symptoms of SLE and scleroderm | Mixed Connective Tissue Disease (MCTD)
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