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MS Rheumatology
MS Rheumatology lecture 1
41
Anatomy
Graduate
11/18/2011

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Term
Rheumatology lab tests include __ and __, these are present in the acute phase response and helpful for monitoring treatment.
Definition
ESR and CRP
Term
3 things that can produce false positives with ESR:
Definition
- obesity
- age
- female sex
Term
3 things that can produce false positives with CRP:
Definition
- age
- smoking
- diabetes
Term
CRP
normal < 0.2
intermediate 0.2-1.0
inflammatory >1.0
Definition
Term
Patients with a CRP greater than __ mg/dL have a bacterial infection.
Definition
10
Term
Just because a patient has a normal ESR and/or CRP doesn’t mean that the patient does not have an inflammatory disorder (ie. 10% of patients with RA have normal ESR; 20% of patients with Polymyalgia Rheumatica have normal ESR; Patients with active SLE can have normal ESR and CRP)
Definition
Term
Antinuclear antibodies may indicate autoimmune but not always. ANA can also be high in the following conditions:
Definition
- Hepatitis C
- Thyroid disorders
- Patients on multiple meds
- Healthy patients
Term
Sensitivity measures the proportion of actual ___ which are correctly identified.
Definition
positives

example: the percentage of sick people who are correctly identified as having the condition
Term
Specificy measures the proportion of __ which are correctly identified as such.
Definition
- negatives

the percentage of healthy people who are correctly identified as not having a condition
Term
ANA has a high __ in SLE, meaning a negative ANA makes the disease of SLE less likely.
Definition
sensitivity
Term
Since ANA has a low ___ for many inflammatory disorders, it is recommended that you only order ANA if you suspect __.
Definition
specificity
SLE
Term
ANA is a WEAK test for __, __, __, and __ __. But remember only recommended to order ir you suspect SLE.
Definition
- polymyositis
- dermatomyositis
- RA
- Sjogren's syndrome
Term
ANA is not a __ __ of Scleroderma, but is useful in ruling it out.
Definition
- not a positive predictor
Term
ANA is or is not useful in predicting disease activity?
Definition
is NOT
Term
Rheumatoid factor is the __ against the __ portion of __, but in clinical practice it is measured as ___.
Definition
- antibody
- Fc portion of IgG
- IgM
Term
Role of RF is unclear but it may attach to antibodies on B cells and enhance the humeral response
Definition
Term
Sensitivity of RF for RA is ___%, increasing over time, meaning it may be initially negative but later be positive.
Definition
50-85%
Term
with RA, 50% are negative for RF early on and 15% stay negative. Because of this only order RF in right situations includinig:
Definition
- joint effusions
- synovitis
- erosive changes on xray
Term
Anti-cyclic citrullinated peptide (Anti-CCP) is an amino acid that is an __ marker. It has a __ of 90-95%. Its major advantage is its increased ___.
Definition
- RA
- specificity
- specificity
Term
Anti-CCP info:
Definition
An amino acid
RA marker since 1964
It has a specificity of 90-95%; its major advantage is its *increased specificity*
It has a sensitivity of 50-85%
May be useful in the prognosis of RA
Good sensitivity in early prognosis of the disease, but also late in the disease
May be present even before disease manifests itself
Good to help RF diagnosis early in the disease and with the patients who are RF negative
Term
Classes of pharm drugs for rheumatology:
Definition
- Non-steroidal anti-inflammatories
- corticosteroids
- disease modifying anti-rheumatic drugs
- biologics
- analgesics
Term
What is a non-steroidal anti-inflammatory good for pts with h/o stomach ulcers/reflux?
Definition
COX-2 INHIBITOR: CELEBREX
Term
Cant patients on blood thinners take Celebrex?
Definition
yes
Term
NSAIDs have antipyretics and analgesic effects but in high dose have __ effects.
Definition
antiinflammatory
Term
OTC NSAIDS:
Definition
Ibuprofen (Motrin)
Naproxen (Aleve)
Term
Prescription NSAIDs:
Definition
- Naprosyn
- Mobic
- Diclofenac
- Relafen
- Celebrex aka Celecoxib
Term
ibuprofen amount for adults:
Definition
3-4 OTC ibuprofens 3 times a day with food (600-800 mg 3 times/day)
Term
how much OTC naproxen should pt take?
Definition
2 OTC Naproxen 2 times with food
Term
diadvantage of Celebrex:
Definition
expensive and not covered by insurance
Term
what NSAID is great for perioperative pain, especially orthopedics?
Definition
Celebrex
Term
Celebrex is CI in perioperative pain with __.
Definition
CABG
Term
Celebrex good for RA and OA also
Definition
Term
patients who are on long term tmt with NSAIDs need to have their __ and __ checked periodically.
Definition
kidneys and liver
Term
higher dose nsaids are used in the following conditions:
Definition
- familial adematous polyposis
- primary dysmenorrhea
- ankylosing spondylitis
Term
corticosteroid side effects:
Definition
- AVN
- adrenocortical insufficiencies
- tendon rupture
- psychic derangements

lowest possible dose used
Term
mores steroid side effects:
Definition
- weight gain with long term use
- water retention
- osteoporosis
- GI problems
- impaired wound healing
- do NOT use if getting flu shot (wait a few weeks)
- lowers seizure threshold
- do not give to pts with glaucoma
- careful in diabetic pts
Term
If pt is about to get a flu shot, what should you wait a few weeks to start them on?
Definition
steroids
Term
Do NOT give steroids to pts with __.
Definition
glaucoma
Term
acute flare of radiculitis tmt:
Definition
- Medrol dose pack OR
- tapered dose of prednisone
Term
Corticosteroid injections- use a combo of steroid in __ in a 10 cc needle.
Definition
lidocaine
Term
ON FINAL:
Need to know the order of treating arthritis:
nothing, just watch
Oral antiiflammatories and or physical therapy
Steroid shot
Viscosupplementation
If nothing has worked– surgery for replacement of joint.
Definition
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