Term
| lymphocytic infiltration of exocrine glands, i.e. salivary and lacrimal |
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Definition
| Sjogren's syndrome, organ specific autoimmune disease |
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Term
| diagnostic criteria including which autoantibodies are involved |
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Definition
Auto antibodies = Ro(SSA) and or La(SSB)
Ocular symptoms:
1: daily dry eyes for more than 3mo
2. rec sensation of sand or gravel in eyes
3. use of tear subst 3 or more times per day
Ocular Signs
1. Schirmer's Test
2. Rose Bengal Score
Oral symptoms
1. drymouth for 3mo or more
2. swollen salivary glands in adulthood
3. freq use of liq to swallow food
Oral Signs
1. Salivary Gland Sialoadenitis dem on histopath
2. Unstim whole salivary Flow
3. Parotid sialograpy showing the presence of duffuse sialectasisa, w/o evidence of obstruction in the major ducts
4. Salivary scintigraphy showing del uptake, red concentration and/or delayed excretion of tracer |
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Term
| What disease is associated with Sjogrens' Syndrome |
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Definition
| RA and Lupus is also associated |
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Term
| Auto Antibodies associated with Sjogren's? |
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Definition
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Term
| Ocular signs and Symptoms for Sjogren's |
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Definition
Ocular symptoms:
1: daily dry eyes for more than 3mo
2. rec sensation of sand or gravel in eyes
3. use of tear subst 3 or more times per day
Ocular Signs
1. Schirmer's Test
2. Rose Bengal Score |
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Term
| Oral Signs and Sympt for Sjogren's |
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Definition
Oral Signs
1. Salivary Gland Sialoadenitis dem on histopath
2. Unstim whole salivary Flow
3. Parotid sialograpy showing the presence of duffuse sialectasisa, w/o evidence of obstruction in the major ducts
4. Salivary scintigraphy showing del uptake, red concentration and/or delayed excretion of tracer |
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Term
| Classification criteria for RA |
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Definition
4 of 7 criteria (1987)
1. Morning stiffness lasting at least 1 hr
2. swelling in 3 or more joints
3. Swelling in Hand Joints
4. Symmetric Joint Swelling
5. Erosions or decalcification on X-ray of Hand
6. Rheumatoid Nodules
7. Abnormal Serum Rheumatoid Factor
*Must be present at least 6 weeks |
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Term
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Definition
| Loss of joint space and erosions |
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Term
| the extrarticular manifestations of RA |
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Definition
Subcutaneous nodules
Sjogren's syndrome
Felty's Syndrome - Splenomegally, pancytopenia, leg ulcers
Pleuropulmonary disease - effusions, interstit lung dis, lung nodules
Episcleritis, scleritis, scleromalacia
Vasculitis |
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Term
| serological (immunological) markers of RA |
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Definition
RF autoantibody
Anti-CCP - anti cyclic, citrullinated peptide antibodies |
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Term
| Characteristics of RA synovial Fluid |
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Definition
| Inflammatory, aseptic, No crystals, clody, yellow, decreased viscosity, 200 - 200,000 Leuk/mm3 |
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Term
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Definition
| Clear, colorless, 200 lk/mm3 |
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Term
| Noninflammatory Syn fluid |
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Definition
| Clear, yellow, viscous, 200-2000 Lk/mm3 |
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Term
| Inflammatory Synovial Fluid |
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Definition
| Cloudy, yellow, decreased viscosity, 2000 - 200,000 lk/mm3 |
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Term
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Definition
| Purulent, markedly, decreased viscosity, >50K, with >95% PMNs |
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Term
| how does the pathogenesis of OA differ from inflammatory arthridities |
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Definition
ASSYM joint involvement unlike RA
affects cervical spine, Ls spine, hips, knees,first carpometacarpal joints, DIPs and PIPs, NOT - MCPs
AM stiff resolves <45 min
Pain exacerbated with activity relieved by rest |
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Term
| clinical presentation of OA esp hand and knee findings |
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Definition
first CMC, DIPs and PIPs, NOT MCPs
Synovial fluid is Non-inflammatory |
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Term
| x-ray diagnostic signs of OA |
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Definition
Joint space narrowing (assym narrowing in a single joint resulting in malalignment)
Subchondral sclerosis
Osteophytes
DIP - Heberden's nodes
PIP - BOuchard's nodes |
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Term
| how do you to make the diagnosis of fibromyalgia but not the exact tender points. |
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Definition
1) History of widespread pain for more than 3 months, on both sides of the body, above and below the waist, and axial skeleton (cervical spine, anterior chest, thoracic pain, or low back)
2) Pain in 11 of 18 tender point sites on digital palpation with approximate force of 4 kg.
BOTH MUST BE PRESENT
Presence of second clinical disorder does not exclude diagnosis of fibromyalgia. |
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Term
| co-morbidities of fibromyalgia |
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Definition
depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, and rheumatoid arthritis
J Clin Rheumatol. 2006 Jun;12(3):124-8.
The incidence of fibromyalgia and its associated comorbidities: a population-based retrospective cohort study based on International Classification of Diseases, 9th Revision codes.
Weir PT, Harlan GA, Nkoy FL, Jones SS, Hegmann KT, Gren LH, Lyon JL. |
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Term
| patients will complain of pain in specific joints but the joints are normal; what is the source of the pain? |
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Definition
| it is the soft tissue tender points in the vicinity of the joints that are the source of the pain |
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Term
| Identify features/findings which might distinguish dermatomyositis from polymyositis |
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Definition
PD has endomysial infiltr w/ predom CD8 Tcells, progression to fatty and fibrous replacement
DM demonstr a perivascular infl cell infiltr. Predom CD4+ infil w/ MAC C5-9. Atrohy is more prom perifascularly |
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Term
| Recognize association for inflammatory myositis with malignancy |
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Definition
| Myositis can occur as a paraneoplastic syndrome. Solid tumors and lymphomas , but the highest with ovarian and GU-related malignancies |
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Term
| Identify features/findings which might distinguish inclusion body myositis from the other inflammatory myopathies |
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Definition
Older patients in ICM >50 and predom male. Slow prog over years rather than months.
In add to prox weakn, also distal early weakness and asymm weakness.
Both muscle and nerve involvement.
Poor response to immunosuppre in ICM
Additionally intracellular red-rimmed vacuoles containing amyloid
Mononuclear cell infiltratie is typically sparse |
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Term
| at least 5 non-muscle related clinical features which can be seen as part of an inflammatory myopathy |
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Definition
Interstitial Fibrosis - major mort and morb
GI disease - Pharyng dysphasia upper esoph
Arthritis - Infla RA distrib, non-def. non-erosive
Cardiac disease - arrythmia and CHF due to infl
Calcinosis - calcification with inflammation
Vascular Manif - Reynaud's, Nailfold dilated capillary loops |
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Term
| anti-synthetase syndrome features |
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Definition
Myositis
Fever
Arthritis
Mechanic's Hands
Interstitial Lung disease |
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Term
| 3 types of crystals that cause disease |
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Definition
Monosudium Urate Monohydrate
Calcium pyrophosphate dihydrate
Calcium phosphate |
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Term
| differentiate uric acid crystals from calcium pyrophosphate crystals |
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Definition
uric acid are negatively biref w/Yellow Parallel to polarizer
Calcium weakly positively biref. |
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Term
| clinical presentation of crystal induced arthritis and how this differs from other inflammatory arthridities e.g. RA |
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Definition
| monoarticular with acute onset, and short subsides 3-10 days |
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Term
| characteristics of septic synovial fluid |
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Definition
purulent, markedly decreased viscosity, >50K LK/mm3
>95% PMNs |
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Term
| Infective organism in Rh Arthritis |
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Definition
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Term
| Infective organism in Alcoholism or Cirrhoiss |
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Definition
| Gram neg bacilli and Strep pneumo |
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Term
| Infective Organism in Drug abusers |
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Definition
| pseudomonas aeruginosa and Serratia mar |
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Term
| Infective organism in Myeloproliferative disorders |
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Definition
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Term
| Infective Org in Diabtes mellitus |
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Definition
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Term
| How does the clinical presentation differ between gonococcal and non-gonococcal arthritis? |
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Definition
Gonn young healthy, vs. old and sick for non-Gonn
Gonn is migratory with tenosynovitis and pustular dermatitis
Gram is alm never pos and cultures are <40% positive
Critical to culture blood in Gonnococcal
24hr resp to 3rd G Ceph in Gonn |
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Term
| presentation, and diagnosis of giant cell arteritis (temporal arteritis) |
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Definition
1. Age >50 YO at onset
2. New Headache
3. Temporal Artery Abn (Tender or decr pulse)
4. Elevated Westergren ESR> 50mm/Hr
5. Abn Art Biops w/ PMN Inf, Granul Infl, Usually w/ multinucl Giant cells.
May also see Jaw Claudication and Visual loss. |
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Term
| potential serious outcome of giant cell arteritis |
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Definition
| Vision loss - ischemic optic neuropathy |
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Term
| how to diagnose polymyalgia rheumatica and the relationship with giant cell arteritis |
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Definition
Temporal Artery Biopsy showing a mononuclear inf
Intimal hyperplasia occluding lumen
40-60% of pat with GCA have PMR sympts
PMR is often first manif of GCA 10-15% of PMR pat have GCA
Treatment of GCA req larger doses of steroids than PMR |
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Term
| treatment of giant cell arteritis |
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Definition
In patients strongly suspected of having GCA (especially those with recent or impending vascular complications such as visual loss), therapy SHOULD be started immediately.Temporal artery biopsy should be obtained promptly, but treatment should not be withheld while awaiting the performance or the results of the biopsy if the clinical suspicion is high.
Treatment is corticosteroids |
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Term
| clinical presentation of Vasculitis—Wegener’s Granulomatosis: |
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Definition
| upper respiratory, lower respiratory, renal |
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Term
| Upper Resp Pres of Weg Gr |
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Definition
Upper resp:
Ear - hearing loss due to eust tube dysfxn
sensorinerula hearing loss or vertigo due to vestibule dysfxn.
Nose:pain, stuffiness, rhinities, epistaxis, bloody nasal crust due to cartilage infl leading to septal erosions, septal perforation or collapse
Sunis - nasal cong and obstruction, purul nasal discharge, facial pain and press, headache |
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Term
| Lower Resp Pres of Weg Gran |
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Definition
Lower Resp Tract: Pulmonary nodules, multiple and bilateral, often cavistate, must biopsy to differen.
infiltrates bilateral can be fleeting or fixed, often misdiagn as pneumo. Infil may be alveolar hemorrhage pres as severe hemoptysis w/ drop in serum hemoglobin |
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Term
| Renal Manifest of Weg Gran |
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Definition
75% of patients
Proteinuria, hematuria, rbc casts or renal insuff with normal urinaty sediment
pauci immune glomnephritisi - focal or segmental GN w/o imm complex depos
Necrotizing crescentic GN is assoc with rapidly progr renal failure <10% of patients
Hypertension is Rare |
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Term
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Definition
ANCAs are diagnostically useful but do not follow disease activity or predict a disease flare
immfluorescence cannot identify all patients - need ELISA for specific antibodies |
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Term
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Definition
Anti-myeloperoxidase
Relatively non-specific - found in glomerulonephritis, non-weg vasculities, and Goodpasture's disease |
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Term
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Definition
Anti-proteinase 3
Sensitivity for Weg 66% Act dis 91%
Spec for Weg 98%, act dis 99%
Thus if it's positive you have the disease. It it's negative, you might still have the disease. |
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Term
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Definition
Kidneys 70%
GI 50%
Periph Nerves 50%
Brain 10% |
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Term
| how to diagnose PAN e.g. useful radiologic procedures, biopsies |
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Definition
Manifest as asymmetric sensory and motor neuropathy due to ischemia of peripheral nerves.
Infarction of named nerves called mononeuritis multiplex usually:
i)Foot drop inability or difficulty moving the foot upward (dorsiflexion) due to infarction of peroneal or sciatic nerves or
ii) Wrist drop inability to extend wrist --infarction of portion of radial nerve
American College of Rheumatology Classification Criteria
At least 3 or 10 criteria:
Weight loss > 4kg
Livedo reticularis
Testicular pain or tenderness
Myalgias, weakness, or leg tenderness
Mononeuropathy
Diastolic blood pressure >90mm Hg
Elevated BUN 40mg/dl or creatinine > 1.5mg/dl
Hepatitis B infection
Arteriographic abnormality
Biopsy of medium-sized artery containing polymorphonuclear neutrophils.
82% sensitivity 87% specificity |
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Term
| Know how differentiate PAN from Wegener’s granulomatosis e.g specific organ involvement |
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Definition
| NO lung involvement in PAN |
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Term
| What is the difference between localized scleroderma and systemic sclerosis? |
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Definition
| Localized can occur anywhere on the body whereas systemic is symmetrical and bilateral, and usually starts in hands and face. |
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Term
| identify differences in skin and organ involvement between limited-cutaneous and diffuse-cutaneous systemic sclerosis |
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Definition
Limited is limited to hands and face and never progresses proximally unlike diffuse.Calcinosis and Telangectaisias are more commonly seen in Limited. 70% of diffuse get ILD, 30% in limited.
Pulmonary HTN is a late manifest of limited. Renal seen in 20% of diffuse cases. |
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Term
| Identify at least 3 organ manifestations of systemic sclerosis which represent vascular involvement |
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Definition
Pulmon HTN - narrowing of arteries leads to P HTN and right side HF.
Renal Disease - arteriols and arcuate and interlobular arteries of the kidneys. Decreased cortical blood flow with increase in BP.
Cardiac inv. has microvascular and fibr involvement |
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Term
| Know the association of interstitial lung disease, pulmonary hypertension, and renal crisis with systemic sclerosis |
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Definition
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Term
| classification criteria, i.e. how to diagnose SLE, name classification criteria, there are 11 |
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Definition
Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Neurologic Disorder
Hematologic Disorder
Immunologic Disorder
Renal Disorder
Antinuclear antibody |
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Term
| autoantibodies associated with SLE and which can be used to track disease activity |
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Definition
ANA positive in 95% of pateients with SLE, but not specific
Anti-DS DNA - very specific but not sens
Anti-Smith - Very Specific but not sens
Anti-SSA - fetal heart cross reactivity
Complements - used to help diagnose and follow recurrence and/or progression, C3,4,and CH50 low during an SLE flare |
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Term
| Know the mechanism by which immune complexes initiate and contribute to tissue damage |
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Definition
| Pathogenesis is the deposition of immune complexes composed of DNA bound to anti-DNA antibody in the basement membrane of multiple organs : kidney, lungs, skin, brain |
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Term
| Know which diseases are included in the spondyloarthropathy group |
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Definition
Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Arthritis
Enteropathic arthritis |
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Term
| Know the historical questions that allow one to make the diagnosis of inflammatory back pain w/o even examining the patient |
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Definition
Back pain in inflammatory is worsened with rest and improves with activity,
it is the opposite for mechanical back pain |
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Term
| Know the physical examination findings of inflammatory back pain |
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Definition
| Patients complain of low back pain with radiation into the buttocks. Insidious onset, with marked AM stiffness, worsened with rest and improves with activity |
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Term
| Clinical presentation of Reactive Arthritis(Reiter's Syndrome) |
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Definition
Triad of arthritis, uveitis, and urethritis. 1-4 weeks after diarrheal illness or a bout of urethritis due to Chlamydia. Also assoc with HIV inf.
Manifest by sacroilitis and spondylitis with syndesmophyte formation but usually milder than ankylosing spondylitis.
Kerratoderma blennorhagicum paulosquamous scaly erruptions on the soles and palms.
Circinate balanitis, painless eruption of the penis. |
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Term
| What is the genetic predisposing factor to spondyloarthropathies |
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Definition
| HLA-B27, along with environmental factors. Rat with B27 in germ free environ does not get the disease. |
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Term
| Know the mucocutaneous, dermatologic, cardiac ophthalmological, & genital urinary findings associated with these diseases |
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Definition
Eye - acute anterior uveitis, can cause irreg of pupil
Pulmonary - decr total lung cap due to kyphosis and decr chest expan. 1.3% get idopathic pulm fibr
Cardiac - Pathcy destr of aorta, repl by granulation and fibrous tissue ext to aortic valve, causing regurg and thickening of valve cusps. Fibr of intraventricular septum with cond abnorm and heart block
Reactive Arth has Mucocut manifestations - Kerratoderma blenorhaicum papsquam scaly erruption on palms and soles. Circinate balanitis painless eruption on penis. |
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Term
| Know the x-ray characteristics of a spinal osteophyte compared to a syndesmophyte |
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Definition
| Inflammation occurs along the entire spine at entheses where the fibers of the nucleus palpsis insert into the body of the vertebrae. Thin ossification extends vertically from one vertebrae to another, as syndesmophytes. Osteophytes are thicker and extedn horizontally. |
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Term
| Know the difference between enthesitis and synovitis |
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Definition
| Ethesis is inflammation at the jointion point between a tendon or ligament and a bone. Synovitis is inflammation of a synovial membrane in a joint. |
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Term
| Know the defining features of psoriatic arthritis |
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Definition
Definining feature on x-ray is arthritis mutilans - lysis of bone showing cup/pencil morphology.
Occurs with established cutaneous psoriasis.
Affects men and women equally, no known etiology.
20% axial psoriatic arthritis, and 80% peripheral assymetric oligoarthritis - Sausage digits, DIP invl with nail pitting, Arthritis Mutilans, HIV assoicated |
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