Moans & Groans
What is the mainstay of long-term therapy for rheumatoid arthritis?
Methotrexate
What is the gold standard diagnostic when assessing for Gout and what are the findings?
Synovial Fluid Analysis:
needle-shaped and negatively birefringent etc...
Which 2 primary areas of the body does rheumatoid arthritis tend to spare?
L-spine & DIPs
In which condition is chiropractic maneuvers potentially fatal?
RA
What is your 1st line option when treating chronic gout?
Allopurinol
+/- Colchicine
What is the classic triad of Granulomatosis with Polyangiitis?
URI sx + Lower Resp sx + renal involvement
Which 3 markers are highly specific for identifying SLE?
ANA
Anti-dsDNA
Anti-Sm
What are the findings seen under light microscopy for Pseudogout?
Rhomboid-shaped, positively birefringent CPPD crystals.
Pseudogout & gout vary in many ways but one distinguishing factor is the location of symptoms. In which area of the body is Pseudogout most likely to originate? (2 answers accepted)
Pseudogout: knee & wrist
What is the hallmark feature of Behcet disease?
painful recurrent oral aphthous ulcers
A 68-year-old female presents with a 2-week history of severe, unilateral headache, scalp tenderness, and jaw claudication. Physical examination reveals a tender, pulseless temporal artery. Labs show an elevated ESR & CRP. What is a potential outcome for delaying treatment?
permanent blindness
Which marker is highly specific but not sensitive when assessing for Rheumatoid Arthritis?
Anti-CCP
What is a rare but serious complication of Henoch Schonlein Purpura that might indicate an abdominal ultrasound?
Intussusception
Tom is a 3-year-old boy who presents with a 5-day history of high fever, bilateral nonexudative conjunctivitis, erythema and swelling of the hands and feet, and a polymorphous rash. Cervical lymphadenopathy is also noted with elevated ESR. What is the next best step in management?
IVIG + high dose aspirin
A 55-year-old male presents with a 24-hour history of severe pain, redness, and swelling in his right great toe. He reports that the pain began suddenly during the night and has progressively worsened. He denies any recent trauma or injury. What is the next best step in management?
Colchine + NSAIDs
Steroids if NSAIDs don't work or contraindicated
An 18-year-old female presents with a 3-month history of fatigue, intermittent fevers, and weight loss. She reports bilateral upper extremity claudication. On physical examination, her blood pressure is 160/90 mm Hg in the right arm and 120/70 mm Hg in the left arm. The right radial and brachial pulses are absent, while the left pulses are diminished. Labs show elevated ESR. What is the 1st line treatment?
Prednisone +/- glucocorticoid sparing meds
Surgery if stenosed per MD
A new PA suspects that her patient has rheumatoid arthritis & wants to start the patient on an immunosuppressant. What must the new PA do before starting her patient on an immunosuppressant?
Complete TB & Hepatitis panel
(don't want reactivation)
A 45-year-old woman presents with a 6-month history of dry eyes and dry mouth. She reports a gritty sensation in her eyes and difficulty swallowing dry foods. She also notes fatigue and joint pain, particularly in her wrists and knees. On examination, her parotid glands are mildly enlarged and tender. Labs are positive for anti-Ro/SSA and anti-La/SSB antibodies. Considering her symptoms, what is the best initial treatment?
Dry eyes & dry mouth need to be treated: choose a few
Artificial tears/ointment/cyclosporine + Pilocarpine/ frequent sips of water/sugarless candy
NSAIDs/steroids
An 8-year-old boy presents with a 4-day history of fever reaching 104°F, accompanied by enlarged cervical lymph nodes and splenomegaly. Lab findings include a positive antinuclear antibody test and class 2 synovial fluid analysis. What is appropriate education to deliver to the parent regarding his follow-up care? (many answers accepted)
Eye care: be aware of possible complications
Dental care: might be difficult to floss or brush teeth
!Refer to rheum!
Colin is a 69-year-old woman who presents with sudden-onset pain and stiffness in her shoulders, thighs, and hips. She exhibits full strength and no swelling. Given the close association of her condition with another severe illness, what additional diagnostic test is recommended?
Temporal a. bx
A 45-year-old male presents with a 2-month history of unexplained weight loss, fever, and muscle aches. Physical examination reveals livedo reticularis and a blood pressure of 160/100 mm Hg. Laboratory tests show elevated creatinine levels and a positive hepatitis B surface antigen. Which is the most likely diagnosis?
Polyarteritis nodosa
A 25 yo male presents with eye pain, dysuria, & achy joints after visiting Miami 2 weeks ago with a group of friends. Today, he tests positive for Chlamydia, gonorrhea, and Syphilis. What antigen is closely associated with this condition?
HLA-B27
A 50-year-old woman presents with a 1-month history of progressive skin tightening and thickening, starting from her fingers and extending to her forearms and face. She reports her first Raynaud's flare 3 weeks ago. On exam, there is notable skin induration on her hands and face, and telangiectasias on her lips and fingertips. She tests positive for Anti-SCL-70. What is the leading cause of mortality for this condition?
Diffuse Scleroderma
A 42-year-old woman with a history of Raynaud's presents with progressive dysphagia and challenges in performing daily activities such as running after her children, climbing stairs, and reaching high cabinets. Physical examination reveals muscle weakness. What is the 1st line treatment and monitoring parameters?
Polymyositis
Prednisolone 1mg/kg/day x4-8 weeks
Monitor CK levels & muscle strength
A 62-year-old male presents with a 2-year history of progressive muscle weakness, initially noted in the right hand, leading to difficulty with tasks such as turning keys and buttoning shirts. Over time, he has experienced frequent falls due to weakness in the quadriceps muscles, particularly on the left side and choking on his dry foods. He denies any sensory disturbances or pain. Physical exam shows atrophy and weakness of the forearm flexors and quadriceps muscles.
What is the 1st line treatment?
Azathioprine + Prednisone x few months