Read the Rheum (Intro)
_________ is the leading cause of disability in the U.S.
Arthritis
Morning stiffness is a common symptom of this inflammatory disease.
RA
Common cutaneous manifestations of SLE.
Malar rash, discoid rash, photosensitivity.
Bilateral sacroiliitis and HLA-B27 antigen are highly associated with this type of spondylitis.
Ankylosing spondylitis.
Bamboo spine (syndesmophytes) are indicative of this disease.
Ankylosing spondyloarthritis.
This type of pain (inflammatory or non-inflammatory) worsens with inactivity.
Inflammatory
The two cardinal features of OA
1) progressive loss of articular cartilage
2) subchondral bone remodeling
This demographic makes up 90% of adult SLE cases.
Females
(Primarily in young women of childbearing age. In addition, SLE occurs more commonly in certain racial and ethnic groups, particularly Black, Asian, and Hispanic populations compared with White populations)
Reactive arthritis may occur following infection of these two organ systems.
Enteric and genitourinary.
Radiating low back pain denotes an inflammatory or non-inflammatory process.
Inflammatory
This solid makes up 10-30% of the joint matrix. It provides tensile strength and stiffness and is anisotropic.
Collagen
Marginal erosions, carpal crowding, and ulnar deviation are common xray findings of this disease.
RA
A serious manifestation of SLE occurring in about 50% of patients. Significant cause of mortality and morbidity.
Lupus nephritis.
This peripheral spondylitis is characterized on film by "pencil-in-cup" deformities.
Psoriatic spondylitis.
Uveitis is associated with these two conditions.
Spondyloarthritis and Sarcoidosis
Plasma proteins synthesized by the liver in response to inflammation. (Bonus: name the two most common).
Acute Phase Reactants
CRP, ESR
Use these pharmacologic agents at the lowest effective dose for the shortest duration possible when treating osteoarthritis.
NSAIDs
The autoantibodies most commonly associated with SLE.
ANA (98%), dsDNA (78%), Extractable Nuclear Antigen Antibodies (anti-Smith, anti-SSA/SSB (Ro/La), anti-RNP)
Reiter's triad is common of this disease.
Reactive arthritis
urethritis, arthritis & conjunctivitis (“can’t pee, can’t see, can’t climb a tree”)
Goals of treatment (3) for osteoarthritis
1) Decrease pain
2) Protect joint
3) Maintain function (decrease & prevent disability)
Overlap syndrome with features of SLE, scleroderma, and polymyositis and associated with high titers of anti-RNP are given this diagnosis.
Mixed Connective Tissue Disorder (MCTD)
Name the pattern of joint involvement for RA.
Symmetrical, proximal, non-weight bearing joints.
MCP, PIP, cervical spine only in advanced seropositive cases
Gold standard treatment for patients with SLE.
Hydroxy-chloroquine
A patient with Crohn's disease develops oligoarticular and asymmetric arthritis of the knee. His most likely diagnosis is:
Peripheral Enteropathic Arthritis
RA is treated early and aggressively with DMARDs. Name the classes of DMARDs and their MOAs.
csDMARDs (conventional synthetic) - anti-inflammatory & antiproliferative; immunomodulators
tsDMARDs (targeted synthetic) - block JAK-STAT intracellular signaling pathway
bDMARDs (biologic) - TNF inhibitors, monoclonal Abs, T-cell inhibitors, Anti CD20 mAb, IL-6 Inhibitor