high value care
most useful lab tests to diagnose RA
what are RF and anti-cyclic citrullinated peptide antibodies
this medication is first line for treating RA and many other autoimmune diseases
what is methotrexate?
the earliest SKIN manifestation of systemic sclerosis
what is sclerodactyly (diffusely swollen fingers/hands)
the most important genetic risk factor for spondyloarthritis
what is HLA-B27
only 5-6% of people with this gene develop spondyloarthritis AND you can have spondyloarthritis without this gene -- so there ya go
the most common joint manifestation of SLE
what is polyarthralgia of the small peripheral joints
most effective means of diagnosing the underlying cause of acute monoarthritis
what is joint aspiration?
this medication is widely used for SLE -- in which it decreases mortality and the likelihood of developing nephritis
what is hydroxychloroquine?
a pt with skin thickening is unlikely to have systemic sclerosis if this phenomenon is not also present
radiographic findings of pseudo-widening of joints, erosions, sclerosis and ankylosis are evidence of this feature of spondyloarthritis
what is sacroiliitis
greatest malignancy risk assocaited with SLE
what is non-Hodgkin lymphoma
imaging modality that is more sensitive for detecting BONY abnormality or erosions
(u/s cheaper but operator dependent so not as sensitive)
(MRI for soft tissue abnormalities, inflammation, fluid collections)
this medication is used for severe ANCA-associated vasculitis, lupus nephritis or when other agents have failed in milder cases
what is cyclophosphamide?
(lupus nephritis first line = mycophenolate mofetil)
(vasiculitis first line = rituximab)
the main cause of disease related mortality in systemic sclerosis
what is interstitial lung disease
SSC also causes pulmonary arterial HTN
first line medication for ankylosing spondylitis
what are NSAIDS
(PT is most important non-pharmacologic intervention)
this auto-antibody is found in more severe disease, especially kidney disease and if present can be monitored to follow disease activity
what is Anti-double-stranded-DNA
(anti-Smith is specific for SLE and is often associated with more severe disease but less common than Anti-DS-DNA)
this should be initiated in every SLE pt who can tolerate it -- it reduces disease associated damage, prevents flares and improves kidney and overall survival
what is hydroxychloroquine
this medication is highly teratogenic and abortifacient and should be stopped 3 months BEFORE pregnancy
what is methotrexate?
presence of this autoantibody is highly associated with Diffuse cutaneous systemic sclerosis and ILD
what is anti-scl-70
radiographic findings of asymmetric distribution, DIP involvement, osteolysis AND proliferative new bone formation along shaft of metacarpal or metatarsal bones are particularly characteristic for this form of spondyloarthritis
what is psoriatic arthritis
(the hand/foot finding is called pencil-in-cup deformity)
fetuses of women with these auto-antibodies are at risk for neonatal lupus erythematosus (only full answer will be accepted)
what are anti-Ro/SSA and anti-La-SSB
*congenital heart block and rash)
at the time of diagnosis of polymyositis or dermatomyositis the patient should also be screened for this
what is malignancy?
age and gender appropriate screening and looking for (ovarian, lung, pancreas, stomach, colon, lymphoma)
may recommend CT chest/abdomen/pelvis if dermatomyositis the risk is so high
these steps should be taken before starting biologic DMARDs ("two" things if answer is broad, more if you get specific)
1. update vaccinations
2. screen for latent infection (tuberculosis, hep b/c and HIV)
risk factors for scleroderma renal crisis (name 2 out of 3)
what are diffuse systemic sclerosis, use of moderate to high dose glucocorticiods and presence of anti-RNA polymerase III antibodies
these pts present with HTN emergency (HA/encephalopathy/sz/acute renal failure)
tx = ACE (even if Cr increases)
treatment for more severe psoriatic arthritis (class of medication --not specific)
what Tumor necrosis factor alpha inhibitors
this auto-antibody is associated with CNS lupus and lupus hepatitis
what is antiribosomal P