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43 terms

Clin Med

Rheumatology
STUDY
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Degeneration of joint spaces and bony overgrowths, Over 75, involving DIPs PIPs Hips and Knees, crepitus, morning stiffness less than 30 min
Osteoarthritis
X-Ray assymmetric joint space narrowing, osteophytes, subchondral cysts and sclerosis, ESR normal, RF negative, WBC <500
Osteoarthritis
Life-style Modifications, Vitamin supplements, Creams, Acetaminophen, NSAIDS, NSAID and Tramadol, Arthroplasty, Osteotomy
Osteoarthritis
Polyarthritis, systemic autoimmune inflammatory disease, symmetric synovitis, joint erosions, and extra articular manifestations, women, age 30 to 40
Rheumatoid Arthritis
Symmetric pain and swelling of joints, PIPs and MCPs, wrists, elbows, knees, nodules, constitutional symptoms (fatigue, weight loss, fever) Morning stiffness >1hr, ulnar deviation, Extra articular manifestations
Rheumatoid Arthritis
Morning stiffness >1hr, Symmetric joint swelling, Rheumatoid nodules, Serum rheumatoid factor, RFpositive, Anti-CCP positive, ESR & CRP elevated, WBC > 2, 000
Rheumatoid Arthritis
Soft tissue sweilling, periarticular osteopenia, bony erosions
Rheumatoid Arthritis
ASA, NSAIDs, COX-2 inhibitors, DMARDs
Rheumatoid Arthritis
Chronic, widespread pain, sleep disturbances, fatigue, and diffuse tender points, women, 30-50
Fibromyalgia
Tenderness to palpation in 11 of 18 bilateral sites
Trigger Points, Fibromyalgia
Lifestyle modification(exercise, stress relief, sleep aids), TCAs, SSRIs, Dual-reuptake inhibitors
Fibromyalgia
Pollyarthritis and systemic multi-organ disease, women in childbearing years, African Americans>White, exacerbations and remissions
Systemic Lupus Erythematosus (SLE)
Constitutional Symptoms (fatigue, fever, myalgia), Arthritis, Malar rash, Discoid rash, Mucosal ulcerations, Raynaud's phenomena
Systemic Lupus Erythematosus (SLE)
Serositis, Pericarditis, Renal disorder, hematologic disorders
Systemic Lupus Erythematosus (SLE)
Antinuclear Antibodies (ANA) Positive, Anti-double stranded DNA (Anti-dsDNA), anti-Smith (anti-sm), anemia, elevated ESR, false syphilis test
Systemic Lupus Erythematosus (SLE)
NSAIDs, Prednisone, Hydroxychloroquine, Methotrexate, Azathioprine, Mycophenolate, Cyclophosphamide
Systemic Lupus Erythematosus (SLE)
Chronic immune-mediated inflammatory disorder of the salivary, lacrimal, and other exocrine glands
Sjogren's Syndrome
Dryness of eyes and dry mouth, women, possible positive RA, possible non-Hodgkin's lymphoma
Sjogren's Syndrome
Xerophthalmia, Keratoconjunctivitis sicca- sensation of grit or sand in eyes, Xerostomia, enlarged, tender parotid glands
Sjogren's Syndrome
Tx: Patient education good oral hygiene, Artificial tears, NSAIDs and Hydroxychloroquine, punctal occlusion
Sjogern's Syndrome Treatment
Inflammatory back pain, Enthesitis, Dactylitis (sausage digits), Periperhal arthritis, RF and ANA negative, HLA-B27
Spondyloarthropathies
Onset before 35, men, Family history of early-onset low back pain, pain in sacroiliac (SI) joints and the spine
Ankylosing Spondylitis (AS)
Insidious Low back pain for more than 3months, improves with exercise, worsens with rest, morning stiffness of spine
Ankylosing Spondylitis (AS)
Schober's test
toe to floor measurement, Ankylosing Spondylitis
Xray: sacroiliitis, Bony fusion ("bamboo spine")
Ankylosing Spondylitis
Tx: Exercise, Maintain posture, NSAIDs (indomethacin), Sulfasalazine, Methotrexate, Steroids, TNF inhibtors
Ankylosing Spondylitis
Deposition of monosodium urate cyrstals in the joints or soft tissue. Hyperuricemia
Gout
Men, African American, who drink beer and eat red meat
Gout
Myeloproliferative d/o, carcinoma, cytotxic drugs, enzyme dificiences, obesity
overproducers gout
Intrinsic renal disease, tubular disease, alcoholism, dehydration, lactic acidosis
Underexcreters gout
Sudden onset of acute painful arthritis (erythemia, swelling, warmth), nocturnal, monoarticular 1st MTP (podagra)
Acute Gouty Attack
Tophi- chalky deposits of monosodium urate, seen in the joints of the hands/feet, ears, wrists, olecranon bursa, achilles tendon
Chronic Tophaceous Gout
Dx: aspiration and visualiation of crystals under plarizing microscope, Needle or rod shaped crystals, negatively birefringent, soft tissue swelling, punched out erosions
Gout
NSAIDs (indomethacin), or cochicine. no allopurinol
Acute Gout
Xanthane Oxidase Inhibitors (allopurinol) uricosuric drugs and xanthine oxidase inhibitor
Chronic Gout
Rhomboid shaped and birfringent Calcium pyrophosphate dihydrate crystals in larger joints (knee, hip)
pseudogout
NSAIDS, intra-artocular corticosteroids, aspirations, possibly colchicine
pseudogout
Inflammation of the blood vessels; GCA, Henoch-Schonlein Purpura, Polyarteritis nososa, Wegener granulamatois, Goodpasture syndrome.
Vasculitic Syndromes
Granulomatous arteritis of large vessels and medium-sized arteries that can lead to sudden blindness
Giant Cell Arteritis (GCA)
New onset of severe unilateral headache located over the temporal or occiptal regions, jaw claudication, Scalp tenderness, vision disturbances (blindness)
Giant Cell Arteritis (GCA)
Scalp tenderness or loss of pulsation of the temporal artery, Erythematous, thickened, or tender cord of temporal artery
Giant Cell Arteritis (GCA)
ESR>50mm/hr, Anemia, Mild abnormal LFTs, increased alkaline phosphotase, Temporal artery biopsy
Giant Cell Arteritis (GCA)
High-dose corticosteroids , low dose corticosteroids to prevent recurrences
Giant Cell Arteritis (GCA)