Term
|
Definition
| targets the synovium and works its way into the joint space |
|
|
Term
| What are the type of crystals found in gout? |
|
Definition
| Monosodium urate, needle-like negatively (yellow) birefringent |
|
|
Term
| What type of crystals are found in pseudogout? |
|
Definition
| Calcium pyrophosphate (short, rhomboid positively blue birefringent) |
|
|
Term
| What is Anti-CCP a predictor of? |
|
Definition
| Excellent predictor of RA |
|
|
Term
| definite drugs causing drug/induced lupus |
|
Definition
| hydralazine, minocin, procainamide |
|
|
Term
| what are some anti-TNF inhibitors that can cause drug-induced lupus |
|
Definition
|
|
Term
| in SLE what are NSAIDs used for? |
|
Definition
|
|
Term
| in SLE what is hydroxyclorquine used for? |
|
Definition
| joint pain/skin rask/fatigue & helps decrease flares |
|
|
Term
| in SLE what are steroids used for? |
|
Definition
| significant arthritis or serositis/major organ involvement |
|
|
Term
| in SLE what is MTX used for? |
|
Definition
|
|
Term
| in SLE what is Leflunomide used for? |
|
Definition
| significant arthritis, rash & perhaps major organ involvement |
|
|
Term
| in SLE what is cyclophosphamide used for? |
|
Definition
| serious renal disease/vasculitis |
|
|
Term
| in SLE what is azathioprine used for? |
|
Definition
| serious major organ involvement |
|
|
Term
| what are the triggers for scleroderma? |
|
Definition
| bleomycin, vinyl chloride, contaminated tryptophan, trichorethylene, silicone, epoxy resins |
|
|
Term
| what's the tx for Raynaud's? |
|
Definition
CCB's (most effective in controlling vasospasm)
viagra |
|
|
Term
| how do we tx musculoskeletal issues in PSS? |
|
Definition
| NSAID, plaquenil, steroids |
|
|
Term
| what do we tx malignant HTN in PSS with? |
|
Definition
|
|
Term
|
Definition
CCBs=raynaud's
Ace inhibitors=renal crisis
Bosarten=pulm HTN
NSAIDs/plaquenil=synovitis |
|
|
Term
| what tends to worsen PSS? |
|
Definition
| steroids b/c it can precipitate HTN/renal crisis so use low doses 5-10 mg if possible |
|
|
Term
| what's the tx for the glands in sjogren's? |
|
Definition
hydration, drops, lozenges
salagen/evoxac
tear duct ablation |
|
|
Term
| what's the tx for extra-glandular issues in sjogren's |
|
Definition
plaquenil (prevent breakdown of ach)
steroids
NSAID's |
|
|
Term
| what are some of the issues with using steroids in sjogren's? |
|
Definition
| weight gain, avascular necrosis |
|
|
Term
| what's a new drug that will quell inflammatory eye disease associated w/ sjogren's? |
|
Definition
|
|
Term
| what's the first line tx for PM/DM (Polymyositis/Dermatomyositis)? |
|
Definition
|
|
Term
| if steroids don't work in PM/DM (Polymyositis/Dermatomyositis) what do we move to? |
|
Definition
|
|
Term
| what are the options for tx of PM/DM |
|
Definition
| steroids, MTX, azathioprine, leflunomide, cyclophosphamide, IVIG |
|
|
Term
|
Definition
| steroids & cyclophosphamide followed by MTX |
|
|
Term
|
Definition
high dose IV steroids
IV cyclophosphamide |
|
|
Term
| what are the drugs that will prevent the endothelium from getting inflammed/irritated |
|
Definition
|
|
Term
|
Definition
| hydroxychloroquine, azathiprine, thalidomide, cyclophosphamide, tetracycline, cyclosporine, mycophenolate, clofazimine |
|
|
Term
| 45 y/o pt has been taking hydralazine for a little over a week and is now complaining of muscle aches. You warn him that his medication as well as minocin & procainamide are drugs that have a definite ability to cause this. type of rash due to molecular mimicry. Your suspicion's are confirmed after finding anti-histone antibodies and - anti-DNA. |
|
Definition
|
|
Term
| 40 y/o african america female presents with generalized weakness, a rash over her face sparing the nasolabial folds, mouth sores. On PE you find evidence of a some sort of pericardial inflammation, pancytopenia. After further questioning she complains she has become more sensitive to the sun meaning she is getting burns after only spending a short time in the sun. She has a + ANA as well as a + anti-smith antibodies. |
|
Definition
|
|
Term
| A pt that has a prior hx of SLE would like to know if there kidneys are affected or have a chance of getting affected what would you order? |
|
Definition
|
|
Term
| pt who has has a prior hx of SLE is now presenting w/ a fishlike "rash" on her inner thighs. After further questioning you find that she has had >3 miscarriages in the bast 5 years. On w/u you find she is + anti-cardiolipin. What syndrome do we suspect? |
|
Definition
|
|
Term
| pt presents w/ a c/o of tightening of her hands/fingers that has worsened. She says she is becoming more and more intolerant to cold saying her hands turn the colors of the American flag! She came in today b/c she has noticed some little broken blood vessels & she is having trouble swallowing food. Upon w/u you find she has a + centromere antibodies. What do you suspect? |
|
Definition
|
|
Term
| pt presents w/ diffuse skin thickening & fibrosis. She has wrinkling around her lips. On exam you find that below the wrists there is no issue and u find no telangiectasias or subQ Ca. After doing a w/u she is + for anti SCL 70 antibodies. What do you suspect? |
|
Definition
| progressive systemic sclerosis |
|
|
Term
| pt presents w/ a 4 year hx of cold intolerance. She says when she gets cold her hands turn white & then blue & after a couple minutes finally regain there red color. She's worried she has something wrong with her? What do you think? |
|
Definition
| Raynaud's disease not phenomenon |
|
|
Term
| 65 y/o women presents w/ a c/o of dry eyes/mouth as well as swelling of her cheeks. She has also been experiencing some limited joint pain. After doing a w/u you find she is + for ANA, Ro and La antibodies. After taking a bx of the lacrimal gland tissue you find there is lymphocytic infiltration. You find a + Shirmer's test as well as a + lissamine green staining test. |
|
Definition
|
|
Term
| pt presents w/ a 1 months hx of weakness climbing stairs and lifting her children. She complains she is having difficulty flexing her neck muscles. On a w/u you find she has a + anti Jo 1 and Mi 2 antibodies. As a generalized consensus what do you suspect? |
|
Definition
|
|
Term
| 40 y/o pt presents w/ a 1 months hx of weakness involving her proximal muscles like climbing the stairs and lifting objects. You notice she has a rash and some edema right below her eyes. On PE you find she has some papules on her MCP's, PIP's, and DIP's that completely spare the joints in b/w. What do you suspect? |
|
Definition
|
|
Term
| In working a pt up with a polymyositis what enzymes do you expect to be elevated? |
|
Definition
| CPK, serum aldolase, SGOT |
|
|
Term
| 35 y/o WM presents w/ a recurrent hx of epistaxis and a recent URI. You notice his nose has started to change shape and looks like a saddle. His eyes are red and appear to have uveitis. He is complaining he has begun coughing up blood and had blood in his urine. You find there are some palpable purpura. On w/u find he is + for C-ANCA & decide to put him on high dose steroids as well as cyclophosphamide. |
|
Definition
|
|
Term
| 30 y/o male presents w/ a 5 yr hx of repeated abdominal pain as well as testicular pain and has noticed a 17 kg weight loss. He also c/o of pain/paresthesia radiating to his ankle that you believe to be the sural nerve. You find he has a prior hx of hep B. On PE his lungs are CTA. You notice he has developed some splinter hemorrhages as well as purpura. What do you suspect? |
|
Definition
|
|
Term
| what are the diseases the present with a saddle nose deformity? |
|
Definition
relapsing polychondritis
wegener's
church strauss |
|
|
Term
| what autoantibodies are associated w/ drug induced lupus |
|
Definition
|
|
Term
| which autoantibodies are present in the myositis (PM, DM)? |
|
Definition
| anti-Jo-1, anti-Mi-2, anti-SRP |
|
|
Term
| which autoantibodies are present in lupus nephritis |
|
Definition
|
|
Term
| which autoantibodies are present in CREST? |
|
Definition
|
|
Term
| which autoantibodies are present in PSS (systemic)? |
|
Definition
|
|
Term
| which diseases are + for Ro and La autoantibodies (SSA & SSB) |
|
Definition
sjogren's
neonatal lupus
subacute cutaneous lupus |
|
|
Term
| what are the autoantibodies that are present in vasculitis (general) |
|
Definition
|
|
Term
| which disease correlates directly with C-ANCA |
|
Definition
|
|
Term
| which diseases have DECREASED ace levels? |
|
Definition
|
|
Term
| which diseases have an increased ACE level? |
|
Definition
| sarcoidosis, leprosy, interstitial lung disease (as far as this lecture we only covered sarcoidosis) |
|
|
Term
| which autoantibodies correlate with fetal wastage, arterial/venous thrombosis, thromboyctopenia? |
|
Definition
|
|
Term
| which antibodies are 98% pos for systemic lupus |
|
Definition
|
|
Term
| which enzymes (3) will be elevated in a myositis? |
|
Definition
|
|
Term
| which autoantibodies are specific for RA? |
|
Definition
|
|
Term
| what is present in purpura, glomerulonephritis, lung dz, arthritis |
|
Definition
|
|
Term
| which autoantibody crosses the placenta easier? |
|
Definition
|
|
Term
| what does the C-anca target? |
|
Definition
|
|
Term
| what do the P-anca's target? |
|
Definition
|
|
Term
| which autoantibodies are present in sjogren's? |
|
Definition
|
|
Term
| what are some of the triggering events for SLE? |
|
Definition
| infxn, stress, hormonal (estrogen/progesterone worsen it), sunlight, drugs |
|
|
Term
| this type of lupus is localized to skin mostly & tends to scar (above the waist) |
|
Definition
|
|
Term
| how do we dx discoid lupus? Are they ANA - or +? |
|
Definition
|
|
Term
| what signifies a true lupus induced butterfly rash? |
|
Definition
| spares the nasolabial folds |
|
|
Term
| this type of lupus produced annular, circular, papulosquamous lesions that are very photosensitive & involve sun exposed areas; constitutional sx's may also be present |
|
Definition
|
|
Term
| what are the antibodies associated w/ subacute cutaneous lupus erythematosus? |
|
Definition
| Ro (SSA) and La (SSB)-->ribonucleoproteins |
|
|
Term
| what's the first line tx for both discoid and subacute cutaneous? |
|
Definition
|
|
Term
| how does neonatal lupus occur? |
|
Definition
| vertical transmission of Ro and LA from mother to fetus |
|
|
Term
| this is a transient lupus that lasts up to 8 months due to vertical transmission of Ro and La antibodies across the placenta |
|
Definition
|
|
Term
| what are the most severe effects of neonatal lupus? |
|
Definition
| cardiac (congenital heart block w/ bradycardia) or myocarditis |
|
|
Term
| what are some possible causes of drug induced lupus |
|
Definition
| quinidine, phenytoin, sulfonomides, D-penicilliamine, isoniazid |
|
|
Term
| this is a self-limited lupus that is mainly a serositis due to molecular mimicry inflamming the internal organs when taking certain drugs |
|
Definition
|
|
Term
| who may have a milder case of SLE? |
|
Definition
|
|
Term
| what are the 2 ages of onset for SLE? |
|
Definition
|
|
Term
| what are some of the medications that can trigger SLE? |
|
Definition
| sulfa antibiotics, hormones, BCP's |
|
|
Term
| What diseases pathogenesis is described as exessive T helper cells w/ low T suppressor cell activity which results in B cell proliferation & autoantibody production? |
|
Definition
|
|
Term
| what are some of the clinical features of SLE? |
|
Definition
systemic (fatigue, fevers)
butterfly rash
synovitis
oral ulcerations
pleural/pericardial inflammation
renal disease
neurologic
hematologic (hemolytic anemia, leukppenia, thrombocytopenia) |
|
|
Term
| which antibodes are + in SLE? |
|
Definition
ANA
anti-ds DNS
smith
ACL abs |
|
|
Term
| what does MD SOAP BRAIN stand for in SLE? |
|
Definition
M - malar rash,
D - discoid rash,
S - serositis,
O - oral ulcers,
A - arthritis,
P - photosensitivity,
B - blood (anemia, thrombocytopenia/leukopenia), R - renal,
A - +ANA,
I - immunologic antibodies,
N - neurologic features |
|
|
Term
| which antibodies affect which organs? |
|
Definition
kidney: anti ds DNA
heart: ro/la
anti-histone: skin |
|
|
Term
| in the fractionated ANA which antibodies appear speckled? |
|
Definition
anti-Sm & RNP
anti ro and la
anti-jo-1 and Mi-2
anti-scl-70 |
|
|
Term
| which antibodies correlate w/ PSS (CREST)? |
|
Definition
|
|
Term
| which antibodies correlate w/ both SLE & PSS? |
|
Definition
|
|
Term
| what's the order of tx for SLE? |
|
Definition
| steroids, MXT, leflunomide |
|
|
Term
| what do APL antibodies attack? |
|
Definition
| negatively charged phospholipid/plasma proteins |
|
|
Term
|
Definition
| hypercoaguable state resulting in fetal wastage, arterial/venous thrombosis, thrombocytopenia, livedo reticularis |
|
|
Term
| pt presents w/ a hx of 4 previous miscarriages, fishlike purpleish hue rash b/w forearms & thighs as well as a hx of thrombocytopenia what do you suspect? |
|
Definition
|
|
Term
| how do you make a dx of APL syndrome? |
|
Definition
| any of the 3 labs (LAC, ACL, beta glyp !) |
|
|
Term
| what's the recommended tx for APL w/o thrombosis? |
|
Definition
|
|
Term
| what's the recommended tx for APL w/thrombosis? |
|
Definition
| coumadin w/ high INR b/w 3-4 |
|
|
Term
| what's the recommended tx for APL w/thrombosis? |
|
Definition
| coumadin w/ high INR b/w 3-4 |
|
|
Term
| when should you never anticoagulate? |
|
Definition
|
|
Term
| what do you do when the APL becomes negative? |
|
Definition
|
|
Term
| what is the limited cutaneous sclerosis? |
|
Definition
|
|
Term
| a chronic widespread small vessel vasculopathy & fibrosis that usually involves the skin, lungs, & GI tract as well as the renal system |
|
Definition
|
|
Term
| what are the 3 variants of scleroderma? |
|
Definition
progressive systemic sclerosis (PSS)
CREST (localized)
morphea (localized) |
|
|
Term
| what are the environmental causes of scleroderma? |
|
Definition
| bleomycin, vinyl chloride, contaminated tryptophan, trichloreythelene, silicone, epoxy resins |
|
|
Term
| What does CREST stand for |
|
Definition
C-calcinosis
R-raynaud's phenomenon
E-esophageal dysmotility
S-sclerodactyl
T-telangiectasias |
|
|
Term
| how far does sclerodactyl in CREST go? |
|
Definition
| to wrists (doens't go past) |
|
|
Term
| what syndromre is strongly associated with SLE? |
|
Definition
|
|
Term
| what are the cutaneous changes in CREST? |
|
Definition
| early diffuse finger swelling, hands below wrist, telangectasias, subQ Ca |
|
|
Term
| what are some of the triggers for morphea? |
|
Definition
RT in cancer pts
infxn (EBV)
trauma |
|
|
Term
| what's the difference between morphea and scleroderma? |
|
Definition
| lacks features such as sclerodactyl, raynaud's phenomenon, internal organ development |
|
|
Term
| What does en coup de sabre occur in? |
|
Definition
|
|
Term
| thickened skin extending from the hairline onto the forehead in morphea & doesn't involve the brain |
|
Definition
|
|
Term
| if there is diffuse/deep morphea how do we tx it? |
|
Definition
| systemic IV steroids, penicillamine, phototherapy |
|
|
Term
| Pt presents w/ diffuse skin sclerosis, major organ involvment and + Anti SCL 70 antibody involving skin above wrists and there are no telangectasias, subQ Ca |
|
Definition
| progressive systemic sclerosis |
|
|
Term
| what's the initial sx in 90% of pt's w/ scleroderma |
|
Definition
|
|
Term
| What does BAD CT correlate with and what does it stand for? |
|
Definition
Raynaud's
B: blood disorder (polycythemia)
A: arterial (blockage)
D: drugs (BB's)
C: CT disorders (SLE, SCL)
T: Traumatic (vibration injury) |
|
|
Term
| with which type of scleroderma is raynaud's always present? |
|
Definition
|
|
Term
| pt presents with this type of scleroderma that involves polyarthralgias, friction rubs |
|
Definition
|
|
Term
| What's the major cause of death is PSS |
|
Definition
|
|
Term
| what's more likely to happen in pt's with PSS who have friction rubs? |
|
Definition
|
|
Term
| what is malignant HTN and rising creatinine in PSS signify |
|
Definition
|
|
Term
| what's the tx for the HTN associated with PSS? |
|
Definition
|
|
Term
| although renal problems are a major issue associated with death in PSS what's usually the cause of death? |
|
Definition
| cardiac issues such as CHF and arrhythmias |
|
|
Term
| What's the different b/w pulmonary findings in PSS vs. CREST |
|
Definition
| PSS consists of pulmonary fibrosis as well as restrictive disease that is usually bibasilar where CREST has an incidence of pulm HTN late in the disease that is monitored by DLCO that may be responsive to CCB's or bosarten |
|
|
Term
| what can we tx the pulm HTN associated with CREST with? |
|
Definition
|
|
Term
| what's the difference between GI sx's in PSS vs CREST? |
|
Definition
| PSS and CREST both involve esophagitis and distal motor dysfunction but in CREST lower GI involvement is rare where in PSS sm/lg bowel hypomotility is common. Primary biliary cirrhosis may occur in CREST |
|
|
Term
| in which type of scleroderma does pseudodiverticulum occur? |
|
Definition
|
|
Term
| What are characteristics of OA of the hands on PE? |
|
Definition
| Heberden's (DIP) and Bouchard's (PIP) nodules |
|
|
Term
| 50 y/o Pt presents with pain in her knees, especially when she has stopped moving (after rest). What condition do you suspect? |
|
Definition
|
|
Term
| Pt presents with painful, swollen big toe (metatarsal joint) that is erythematous. The joint is warm and is intolerable to any touch. The pt is 45 y/o and has never experienced anything like this previously.What condition do you suspect? How would you treat it? |
|
Definition
|
|
Term
| What is the name of the sex-linked disorder of HGPRT enzyme deficiency causing accumulation of uric acid in all tissues? |
|
Definition
|
|
Term
| How is uric acid build up's cause determined? |
|
Definition
| 24 hr urine (looking for uric acid) |
|
|
Term
| What is the majority of hyperuricemia associated with? |
|
Definition
| 90% associated with undersecretion of uric acid |
|
|
Term
| Which diseases is gout associated with? |
|
Definition
|
|
Term
| Pt c/o of morning stiffness lasting > 1hr, especially in both their wrists. She also has nodules on her elbows. What condition do you suspect? What is the gold standard tx for this condition? |
|
Definition
| RA; Methotrexate(Rheumatrex/Trexall):gold standard/FIRST LINE |
|
|
Term
| What is the classic triad of symptoms of Sjogren's syndrome? |
|
Definition
| Xerostomia, Keratoconjunctivitis sicca, & Arthritis |
|
|
Term
| What is the diagnostic procedure for sjogren's syndrome? |
|
Definition
| Abnormal salivary gland or lip biopsy showing lymphocytic infiltration |
|
|
Term
| What are the auto anti-bodies associated with Sjogren's |
|
Definition
| Positive RF or ANA or SSA/SSB |
|
|
Term
| What is a heliotrope rash and what condition is it associated with? |
|
Definition
| (purplish, scaly rash over eyelids) associated with Polymyositis |
|
|
Term
| How is the definitive diagnosis of polymyositis made? |
|
Definition
Muscle biopsy (DEFINITIVE)
Perivascular infiltrate of inflammatory cells (lymphs)
Rule out on muscle biopsy: inclusion body myositis (vacuoles)
Mitochondrial (ragged red fibers) |
|
|
Term
| What is the best means of diagnosis of osteoporosis? |
|
Definition
| Bone Mineral Density (BMD) & Vertebral Fracture Assessment (VFA) – gold standard |
|
|
