Rheum Diseases

ekadar's version from 2016-03-23 07:51

Bone Formation

Question Answer
bones of axial and appendicular skeleton and base of skullendochondral ossification
definiton endochondral ossificationbone first made by chondrocytes
membranous ossificationwoven bone formed directly without cartilage
bones of calivarium and facial bonesmembranous ossification
estrogen in boneestrogen INHIBITS apoptosis in bone-forming osteoblasts and INDUCES apoptosis in bone-resorbing osteoclasts.


Question Answer
Rheumatoid factorRA, Sjogren's
Anti-SSA (Ro)Sjogren's
Anti-SSB (La)Sjogren's
ANASjogren's, SLE (not specific), Polymyositis/Dermatomyositis
Anti-dsDNASLE (poor prognosis, evidence of renal disease DPGN or membranous)
Anti-SmithSLE (specific)
Anti-HistoneDrug induced lupus [SHIPP]
Anti-CardiolipinAnti-phospholipid, SLE (results in +VDRL and false positive for syphilis)
Anti-JoPolymyositis, Dermatomyositis
Anti-SRPPolymyositis, Dermatomyositis
Anti-topoisomerase (Anti-Scl-70)Scleroderma (Diffuse: widespread with rapid progression)
Anti-CentromereCREST Scleroderma (Limited: fingers and face)

Lab Values in Bone Disorders

Question Answer
decreased calcium, decreased phosphate, increased ALP, increased PTHosteomalacia/rickets (too little vitamin D)
increased ALPPaget
Too vitamin Dincreased calcium, increased phosphate, no change ALP, decreased PTH
primary hyperparathyroidismincreased calcium, decreased phosphate, increased ALP, increased PTH
secondary hyperparathyroidism (usually due to chronic renal disease)decreased calcium, increased phosphate, increased ALP, increased PTH


Question Answer
carbonic anhydrase II mutationosteopetrosis
high out put cardiac failurepaget
artery affected at femoral headmedial circumflex
brown tumors of boneoseitits fibrosa cystica
what is elevated in sarcoidosiselevated serum ACE, elevated CD4/CD8 ratio
cause of hypercalcemia in sarcoidosisdue to increased 1-alpha hydroxylase mediated vitamin D activation in macrophages
autoantibodies to postsynpatic nicotinic ACH receptormyasthenia gravis
autoantibodies to presynaptic calcium channelLambert Eaton
lambert eaton associated withsmall cell lung cancer
myasthenia gravis associated withthymoma
worsens with muscle useMG
anticholinesterase reverses symptomsMG


Osteoarthritis vs. Rheumatoid arthritis

Question Answer
Osteophytes of the DIP and PIPOA (eberden's and bouchard's nodes)
Arthritis worse at nightOA
Pannus in the MCP and PIPRA
Swan neckRA (extend PIP, flex DIP)
BoutonniereRA (flex PIP, extend DIP)
Morning stiffness >30 minutesRA
Arthritis improves with useRA
> 50 y.o.OA
< 50 y.o.RA
Treatment for OsteoarthritisAcetomenaphen (scheduled dose)
Hyaluronic acids
Treatment for Rheumatoid arthritisDMARDs (Methotrexate, Sulfasalazine)
TNF-alpha inhibitors (Etanercept, Infliximab)
Increased neutrophils and proteins in synovial fluidRA

So your joints hurt...

Question Answer
SICCASjogren's: Mucosal dryness (eyes, mouth, nose, vagina, bronchioles)
XeropthalmiaSjogren's: Decreased tear production associated with corneal damage
XerostomiaSjogren's: Decreased saliva production associated with dental caries and dysphagia
Sjogren's big picture symptomsCan't see, Can't spit, Can't climb shit
Lab findings with Sjogren'sSS-A (anti-RO), SSB (Anti-La), Rheumatoid factor
Joint pain and stiffness without weaknessPolymyalgia rheumatica
Joint pain accompanied by systemic symptoms (fever malaise and weight loss)Polymyalgia rheumatica
Associated with Temporal arteritis (giant cell)Polymyalgia rheumatica
Lab findings in Polymyalgia rheumaticaHigh ESR, High CRP, Normal CK (not a muscle disease)
Treatment of Polymyalgia rheumaticaLow dose corticosteroids
Joint pain with proximal muscle weaknessPolymyositis/Dermatomyositis (usually shoulders)
Mediators of PolymyositisCD8+ cells cause endomysial inflammation
Malar rashSLE or Dermatomyositis
Gottron papulesDermatomyositis: red papules on knuckles and knees
Shawl and face rashDermatomyositis
HeliotropeDermatomyositis: erythematous rash on the upper eyelids
Mediators of DermatomyositisCD4+ T cells
Lab findings with Polymyositis/DermatomyositisHigh CK, +ANA, +Anti-Jo, +anti-SRP
Longterm treatment of Polymyositis/DermatomyositisImmunosuppressant therapy (methotrexate)
Muscle tenderness with generalized cognitive/mood impairmentFibromyalgia
Who gets Fibromyalgia?Women 20-50 y.o.
Treatment for FibromyalgiaPregabalin
SNRI (Milnacipran)
TCA (Amitriptyline)
Joint pain in a sexually active young adultSeptic arthritis (N. Gonorrhea), Reactive arthritis (Chlamydia)
Migratory, asymmetric arthritisSeptic arthritis
How do you diagnose septic arthritis?Arthrocentesis: examine joint aspirate
HLA-B27Seronegative spondyloarthropathies: Psoriatic arthritis, Ankylosing spondylitis, IBS, Reiter syndrome [PAIR]
HLA-B27MHC class 1
Asymmetric joint pain and stiffness with psoriasisPsoriatic arthritis
Pencil in cupPsoriatic arthritis
DactylitisPsoriatic arthritis: sausage fingers
What triggers Psoriatic arthritis?Steroids, alcohol
Inflammation of the spine and sacroiliac jointsAnkylosing spondylitis
Bamboo spineAnkylosing spondylitis: fusion of the vertebrae
UveitisAnkylosing spondylitis or Reactive arthritis
hypoventilationcan happen in ankylosing sponylitis. Chest expansion should be monitored
aortic regurgankylosing spondylitis
Post Gi infectionsreactive arthritis
Reiter syndromeCan't see, Can't pee, Can't climb a tree
Treatment for seronegative spondyloarthropathies?NSAIDs, DMARDs, TNF-alpha inhibitors
Joint pain, Fever and rashSLE
What are the symptoms of SLE?RASH OR PAIN
Rash: Malar or discoid
Hematologic disorder
Oral/nasopharyngeal Ulcers
Renal disease, Raynaud phenomenon
ANA antibodies
Neurologic disorders: Seizures, Psychosis
Renal findings with SLENephritic: DPGN, Nephrotic: Membranous
Cardiac findings with SLELibman-Sacks Endocarditis (LSE): Nonbacterial, wart-like vegetations on both sides of valve
Cause of death in SLELupus nephritis, Coronary atherosclerosis, Infection
Lab findings with SLELow C3+C4, +ANA, Anti-dsDNA, Anti-Smith, Antihistone
Which drugs cause SLE?Sulfonamide, Hydralazine, Isoniazid, Procainamide, Phenytoin
hypercoaguable state w increased PTTantiphospholipid syndrome
Treatment of SLEHydroxychloroquine


Question Answer
Scleroderma triadAutoimmunity
Noninflammatory vasculopathy
Collagen deposition
What symptoms do you see with Diffuse sclerodermaTaut skin
Renal crisis
Fibrosis of the blood vessels
Autoantibody associated with Diffuse sclerodermaAnti-Topoisomerase, Anti-Scl-70
What symptoms do you see with Limited sclerodermaCalcinosis
Raynaud phenomenon
Esophageal dysmotility
Telangiectasia, Taut skin on fingers and face
Autoantibody associated with Limited sclerodermaAnti-Centromere antibodies
Most common cause of death in SclerodermaPulmonary complications (fibrosis)
Which type is worse?Diffuse: Rapid progression with early visceral involvement

Gout and Pseudogout

Question Answer
Yellow crystals under parallel lightGout: Negatively birefringent
Blue crystals under parallel lightPseudogout: Positively birefringent
blue under perpendicular lightgout
Needle shaped crystalsGout: Monosodium urate crystals
Rhomboid shaped crystalsPseudogout: Calcium Pyrophosphate crystals
Asymmetric joint distributionGout
Painful MTP jointGout: Podagra
Tophus (ear, olecranon, Achilles tendon)Gout
Causes of goutUnderexcretion of uric acid (MC, thiazide diuretics)
Overproduction of uric acid (Lesch-Nyhan, PRPP)
What can trigger gout attackslarge meals, alcohol
Why does alcohol trigger gout attacks?Alcohol metabolites use the same excretion sites as uric acid in the kidney
Treatment of acute goutNSAIDs (Indomethacin), colchicine, glucocorticoids
Treatment of chronic goutxanthine oxidase inhibitors: Allopurinol, Febuxostat, Probenicid

Histology of rheumatological diseases

Question Answer
lamellar bone structure resembling a mosaic patternPaget
osteoid matrix accumulation around trabeculaevitamin d deficiency (osteomalacia/rickets)
persistence of primary spongiosa in medullary cavity with no mature trabeculaeosteopetrosis
trabecular thinning with fewer interconnectionsosteoporosis
subperiosteal resorption with cystic degenerationprimary hyperparathyroidism