Randos
Arthritis
Treatments
Straight up lupus
Randos
100
What are the most common presenting symptoms of ankylosing spondylitis?
Back pain and progressive stiffness. Primarily affects sacroiliac joints and the spine.
100
Describe the characteristics of pain from osteoarthritis
Pain that worsens as the day goes on, relieved by rest, less than 30 min of morning stiffness, no constitutional or systemic symptoms, "gel phenomenon" (stiffness after rest or inactivity). Often made worse by damp weather.
100
What is first line treatment for Temporal arteritis?
Prednisone Consider diagnosis of temporal arteritis in any patient older than 50 with new onset or new type headache, elevated ESR, abrupt loss of vision, PMR (polymyalgia rheumatica), and prolonged fever.
100
What are the most common presenting symptoms of lupus?
Arthralgias and arthritis. (Symmetric involvement of hands, wrists, or knees)
100
What are some risk factors for upper GI bleeds (for patients you want to start on NSAID therapy)?
Age over 65, history of PUD or upper GI bleeding, concurrent use of oral steroids and anticoagulants, maybe smoking and alcohol.
200
Which joint is most commonly infected with septic arthritis?
The knee. S. Aureus and N. gonorrhoeae are the two most common causes.
200
Name two infectious agents that can cause arthritis.
Parvovirus B19, HIV, N. gonorrhoeae, Borrelia burgdorferi, strep
200
What is first line treatment for RA?
NSAIDs...followed closely by DMARDS- the first line being Methotrexate. Hydrochloroquine may also be used, but typically along with Methotrexate or another DMARD when initial treatment fails. Etanercept and Infliximab are other important treatment options in patients who have failed methotrexate or combo therapy.
200
What are some complications for pregnant women with SLE?
Increased incidence of spontaneous abortion, intrauterine death, and prematurity. Can try to prevent this with use of heparin and low dose aspirin therapy.
200
What is the difference between the crystals in gout and pseudogout?
Urate crystals are needle-shaped and negatively birefringent, and calcium pyrophosphate dihydrate crystals are rhomboidal and weakly positively birefringent.
300
What are the serologic findings in Sjogren's Syndrome?
Elevated RF, elevated ANA, anti SS A (RO), and anti SS B (LA) antibodies.
300
This antigen is associated with Rheumatoid Arthritis.
What is HLA- DR4. As a side note for boards and otherwise, HLA-B27 is associated with ankylosing spondylitis.
300
What is the best treatment for gout?
NSAIDs, then colchicine, then corticosteroids if neither of the previous two work. Allopurinol for prophylaxis. Limit alcohol intake.
300
What is the treatment for cutaneous lupus?
Sunscreen and sun avoidance, topical or intralesional corticosteroids, topical cryotherapy with liquid nitrogen, and antimalarials.
300
What other diseases have a positive RF?
COPD, viral hepatitis, sarcoidosis Also, malignancy, primary biliary cirrhosis The higher the titer, the more likely it is RA.
400
How long after a strep infection can rheumatic fever be seen?
2-4 weeks. Manifestations of rheumatic fever- carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules, arthragia, fever, elevated ESR/CRP, prolonged PR interval.
400
Which infections typically precede a reactive arthritis (Reiter's Syndrome)?
GI, GU, and maybe pulmonary infections. Shigella, Salmonella, Campylobacter, Klebsiella, Clostridium, and Yersinia can all cause reactive arthritis.
400
Name four things that improve the symptoms of fibromyalgia.
1.Pregabalin (Lyrica) 2. Aerobic exercise 3. Cognitive behavioral therapy 4. Antidepressants (TCAs are best) 5. Combined Acetaminophen and Tramadol 6. Maybe cyclobenzaprine (Flexeril) SIDE NOTE: NSAIDS are not helpful in treating pain assoc. with fibro.
400
Name 4/11 criteria for diagnosis SLE
1. Malar rash 2. Discoid rash 3. Photosensitivity 4. Oral ulcers 5. Arthritis 6. Serositis 7. Renal disorder 8. Neurologic disorder 9. Hematologic disorder 10. Immunologic disorder 11. Antinuclear antibody
400
What precautions do patients have to take while on methotrexate?
They cannot drink alcohol, and must have LFT's drawn every 4-6 weeks.
500
Name some criteria for diagnosing Kawasaki's syndrome.
Fever lasting longer than 5 days plus 4/5 of the following- polymorphous rash, bilateral conjunctival infection, mucous membrane changes, cervical lymphadenopathy, changes in the extremities.
500
Name 5 criteria for diagnosing RA
1. Morning stiffness lasting longer than one hour 2. At least 3 joint areas affected 3. At least one affected joint in hand 4. Arthritis is symmetric 5. Presence of rheumatoid nodules 6. Serum rheumatoid factor 7. Radiologic changes on hand and wrist x rays.
500
What are some treatment options for systemic sclerosis?
UVA therapy is most effective for the skin. High-dose topical corticosteroids and methotrexate help. Calcium channel blockers MAY help with calcinosis, but more studies are needed. Avoid cold and tobacco for Raynaud's, and try biofeedback and other stress reduction techniques. CCBs , topical nitro, and prazosin also for Raynaud's. Avoid excess bathing and moisturizers. NSAIDs, low-dose corticosteroids, narcotics for systemic symptoms. Acid-reducers may help prevent esophageal strictures.
500
Name some drugs that cause drug-induced lupus
1. Anti-TB drugs ( Isoniazid, streptomycin) 2. Antibiotics ( penicillin, tetracycline, sulfa, griseofulvin) 3. Anticonvulsants ( phenytoin, ethosuximide, carbamazepine) 4. Phenothiazines (perphenazine, promethazine, thioridazine) 5. Antihypertensives- hydralazine, methyldopa, reserpine 6. OCPs 7. Lithium 8. propylthiouracil 9. Procainaminde Symptoms with drug induced lupus are usually mild and don't involve CNS or kidneys.
500
What labs should be ordered to confirm lyme disease?
ELISA, followed by Western Blot.
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