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24 Cards in this Set

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What are 3 typical symptoms of Rheumatoid arthritis?
What joints are more often affected?
1. swollen symetrical, warm, or painful joints
2. deep soreness in joints
3. worse in the morning "Morning Gel"

proximal hand joints
What are 5 other symptoms (constitutional features) of RA?

What about extra-articular findings of RA?
1. fatigue
2. weight loss
3. muscle
4. excessive sweating
5. low grade fever
Extra-
1. Rheumatoid nodules
2. Vasculitis of small vessels
3. neurologic (peripheral neuropathy, carpal tunnel, myelopathy)
4. pulmonary involvement (pulmonary nodules)
What are some differences between RA and OA in following...
a. location observed
b. x-ray findings
RA-
a. proximal
b. nodules on chest x-ray

OA
a. more distal
What are three main contributing factors that are implicated in triggering RA?
1. Viral- Epstein Barr, HTLV-1, Rubella, Herpes
2. Bacterial- Mycobacteria
3. Genetic- dizygotic twins, monozygotic, HLA-DR4 positive
What are some clinical complications of RA that you might notice?
Ulnar deviation and talar deviation
Describe the following deformities seen in RA:
a. boutonniere
b. Swan-neck
a. hyperextension of DIP with flexion of PIP
b. hyperextension of the PIP and flexion of DIP
What are some lab findings in RA (9)?
what should definitely be ordered?
all elevated
1. Anti-CCP antibodies
2. C-reactive protein
3. cryobglobulins and antinuclear antibodies
4.eosinophilia
5. leukocytosis
6.normocytic anemia
7. PMNR
8. rheumatoid factor- not great test
9.Sed rate
Radiographic
How do you officially diagnose RA?
What are the 7 critieria's
6-weeks symptoms
4/7 criteria
1. 1+ hrs morning stiffness
2. three or more joints at same time
3. at least one of areas: wrist, MCP, PIP
4. symetrical
5. Rheumatoid nodules
6. RF factor
7. Radiographic changes
Identify contraindications to the most common treatment options of RA
1. methotrexate
1. methotrexate- breast feeding
What are two complications associated with RA that need to be addressed?
a. Cardiac- pericarditis, pericardial effusion, aortitis
b. ophthalmic- episcleritis, scleromalacia
Differentiate between Gout and Pseudogout
Different crystals!

Gout- monosodium urate crystals, pt may or may not have hyperuricemia

Pseudo- calcium pyrophosphate crystals
Decide on a treatment plan for Gout and Pseudogout
pseudogout-
1. NSAIDs
2. COX-2 inhibitors
3. intraarticular injection of glucocorticoids
4. colchicine

Gout- same but also
1. IV colchicine
2. Allopurinol
3. Probenecid
Interpret the distinctive features of SLE (Systemic Lupus Erythematosus) (11)
4 of 11 over time
1. butterfly rash
2. discoid rash
3. photsensitivity
4. oral ulcers
5. arthritis
6. serositis (pleuritis, pericarditis)
7. renal disorders
8. neurologic disorders
9. hematologic disorders
10. immunologic disorders
11. ANA
Where does gout most often present? and what is first sign called?
called Podagra- 1st MTP (meta-tarsal phalanx)
What gout shows with positively birefringent crystals? negatively?
positive rhomboid shape- pseudo gout
neg needle shaped- gout
What are the three main types of gout?
Which of the three types are men more likely to get than women?
1. monoarticular (men 9: 1 women)
2. polyarticular
3. chronic tophaceous
What is the difference between an inflamed gouty trophy and RA joints during inspection?
Gouty- firm hard palpation

RA- boggy feel
Determine diagnostic criteria for Systemic Sclerosis (Scleroderma) (4)
Systemic Sclerosis (Scleroderma)-
1. H&P
2. HTN- renal involvement
3. Blood LAB- ESR, ANA (anticentromere Ab w/ CREST), anti Scl-70
4. Radiological- CXR, Barium swallow, hand x-rays- show distal tuft reabsorption and calcinosis
Develop an appropriate diagnostic work-up for a patient suspected of having SLE
What do blood findings with high anti-RNP's tend to develop into?
1. H/P
2. Blood work:
a. non-specific ANA
b. specific- anti dsDNA
anti-sm (Smith)
false positives for VDRL (syphillis marker)
- complement findings

elevated anti-RNP's are often seen in relation to future SLE not RA patients
What are clinical signs of Siogrens syndrome?
a. dry eyes- keratoconjunctivitis
b. dry mouth- xerostomia
other drynesses
Connective tissue disease
Determine diagnostic criteria for CREST
CREST-
1. Calcinosis- nodules that are calcium based show up in x-ray
2. Raynaud's phenomenon- hypersensative reaction to cold
3. Esophageal dismotility- food gets stuck
4. scleroderma- sausage digits
5. Telangiectasia- red marks on face and mouth
Determine diagnostic criteria for Siogren's syndrome
H/P
# dry eyes
# dry mouth
# a positive lip biopsy
blood work: Sjogren's antibodies (SS-A,SS-Ro,SS-B,SS-La)
How do you treat scleroderma?
many agents aimed at organs involved, immunomodulating agents and investigational agents
How do you treat Sjogrens
1. symptomatic management
2. artificial tears
3. oral lubrication
4. NSAIDs for systemic symptoms