Term
| What is Sjogren's syndrome? |
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Definition
| autoimmune disorder in which immune cells attack and destroy exocrine glands affecting the glands that form saliva and tears |
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Term
| Who is more commonly affected by Sjogren's syndrome, males or females? |
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Definition
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Term
| What is the average age of diagnosis for Sjogren's syndrome? |
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Definition
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Term
| What is the 2nt most common autoimmune rhematological disease? |
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Definition
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Term
| What does Sjogren's syndrome cause? |
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Definition
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Term
| What test is used to diagnose Sjogren's syndrome? |
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Definition
Schirmer test
measures the amount of tear production over 5 minutes with a filter strip that is held in the lower eye lid and then the moisture is measured with a ruler
producing less than 5 mm is indicative of Sjogren's |
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Term
| What imaging modalities can be used in Sjogren's syndrome to detect calculi and other duct problems? |
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Definition
ultrasound
radiographs with contrast dye (stenson duct) |
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Term
| Who is scleroderma more common in, men or women? |
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Definition
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Term
| What is the most commonly diagnosed age group for scerloderma? |
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Definition
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Term
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Definition
systemic autoimmune disease characterized by fibrosis, vascular alteration, and autoantibodies
kills the arterioles of the epithelial cells and they are replaced by collagen and other fibrotic material |
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Term
| What do 90% of patients with scleroderma present with? |
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Definition
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Term
| What is scleroderma associated with? |
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Definition
CREST
calcinosis
Raynaud's phenomenon
esophageal dysfunction
sclerodactyly
telangiectasia |
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Term
| What internal organs are most commonly affected by scleroderma? |
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Definition
kidneys
heart
lungs
esophagus |
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Term
| Is there a cure for scleroderma? |
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Definition
| no (only treat organ systems it affects) |
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Term
| What complications cause most of the deaths due to scleroderma? |
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Definition
| renal and pulmonary complications |
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Term
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Definition
| abnormal collection of inflammatory cells form as nodules in many organs of the body |
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Term
| What do the granulomas associated with sarcoidosis most often affect? |
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Definition
| lungs and lymph nodes (but can affect any organ) |
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Term
| Sarcoidosis is usually ___________. |
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Definition
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Term
| What condition can cause lung scarring and infection which can lead to respiratory failure and death? |
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Definition
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Term
| What condition has a higher prevalence in non-smokers? |
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Definition
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Term
| What condition is a diagnosis of exclusion? |
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Definition
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Term
| What is the treatment for sarcoidosis if treatment is needed? |
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Definition
corticosteroids
DMARDs
cyclophasphomide |
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Term
| What is first line treatment for sarcoidosis? |
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Definition
corticosteroids
(azathiopine, methotrexat also used) |
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Term
| What annual exams need to be done in a patient with sarcoidosis? |
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Definition
EKG
ocular evaluation
LFTs
serum calcium
24 hour urine calcium
thyroid evaluations |
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Term
| Most patients with sarcoidosis are cured in ___ years. |
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Definition
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Term
| What is Reiter's syndrome? |
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Definition
reactive arthritis in response to an infection elsewhere in the body
seronegative spondyloarthropathy |
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Term
| What are the only autoimmune conditions discussed that are more common in men than women? |
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Definition
Reiter's syndrome
polyarteritis nodosa |
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Term
| What gene is present in 75% of patients with Reiter's syndrome? |
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Definition
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Term
| What is the triad of symptoms associated with Reiter's syndrome? |
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Definition
-inflammatory arthritis (usually polyarticular and asymmetric)
-inflammation of the eye (conjunctivitis, uveitis)
-urethritis/cervicitis |
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Term
| What types of infections are usually the cause of Reiter's syndrome? |
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Definition
| genitourinary or gastrointestinal |
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Term
| What is the most common trigger for Reiter's syndrome? |
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Definition
chlamydia
also gonorrhea, salmonella, shigella, and camphylobacter |
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Term
| If you suspect Reiter's syndrome, what must you get a good history on? |
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Definition
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Term
| What is keratoderma blenorrhagica and what condition is it associated with? |
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Definition
Reiter's syndrome
visco-pustular waxy lesion with a yellow-brown color
less frequent on palms |
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Term
| What must you think about in a patient who presents with balanitis (inflammation of the glans penis)? |
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Definition
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Term
| What type of discharge may be present in a patient with Reiter's syndrome? |
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Definition
| fowl smelling or purulent |
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Term
| How long does Reiter's syndrome last? |
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Definition
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Term
| What is the treatment for Reiter's syndrome? |
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Definition
treat underlying organism
NSAIDs
methotrexate (reduce joint destruction) |
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Term
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Definition
| connective tissue disease related to polymyositis that is characterized by inflammation of the muscles and skin |
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Term
| What do many patients have a history of with dermatomyositis? |
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Definition
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Term
| How does polymyositis present? |
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Definition
bilateral proximal muscle weakness, usually in the upper legs
first c/o fatigue with walking
also occurs in the upper arms |
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Term
| What are patients with dermatomyositis and polymyositis at risk for? |
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Definition
| interstitial lung disease |
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Term
| How is dermatomyositis and polymyositis diagnosed? |
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Definition
increased creatine kinase (not specific)
muscle biopsy |
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Term
| What might x-rays show in a patient with dermatomyositis and polymyositis? |
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Definition
| calcifications in the muscles |
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Term
| What antibodies are present in >65% of diagnosed patients with dermatomyositis and polymyositis if there is also lung disease present? |
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Definition
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Term
| What is the treatment for dermatomyositis and polymyositis? |
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Definition
high dose corticosteroids
strength usually improves in 4-6 weeks
if unresponsive, then immunosuppressants |
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Term
| What is death associated with dermatomyositis and polymyositis usually due to? |
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Definition
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Term
| What is polymyalgia rheumatica? |
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Definition
| inflammatory disorder that present as pain and stiffness in the hips and shoulders |
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Term
| How does polymyalgia rheumatica present? |
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Definition
quickly over a few days
symptoms worse with increased inactivity or first thing in the morning
low grade fever, depression, fatigue, unintentional weight loss, loss of appetitie |
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Term
| What condition is associated with giant cell arteritis? |
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Definition
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Term
| What condition can cause headache, jaw pain, scalp tenderness, and vision impairment? |
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Definition
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Term
| Patients with what condition may find it hard to do simple activities like put on a coat or tend to simple activities of daily living? |
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Definition
polymyalgia rheumatica
hygiene may be poor |
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Term
| What is the treatment for polymyalgia rheumatica? |
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Definition
low dose corticosteroids
pt. usually improves in a few days (if not, think about another diagnosis) |
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Term
| How is polymyalgia rheumatica diagnosed? |
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Definition
normal creatine kinase level
negative RF
negative muscle biopsy
normochromic normocytic anemia (50%)
elevated ESR
mild elevated LFTs
nonspecific mild synovitis |
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Term
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Definition
| group of disorders characterized by inflammatory destruction of blood vessels |
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Term
| What vessels are involved in vasculitis? |
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Definition
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Term
| What conditions are consider vasculitis? |
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Definition
Buerger's disease
Kawasaki disease
polyarteritis nodosa
Behcet's syndrome
Henoch-Schonlen purpura |
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Term
| What is another name for Buerger's disease? |
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Definition
| thromboangiitis obliterans |
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Term
| What vessels are obstructed in Buerger's disease? |
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Definition
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Term
| What demographic is primarily affected by Buerger's disease? |
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Definition
| male smokers between 20 and 40 |
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Term
| What are the signs and symptoms of Buerger's disease? |
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Definition
pain in hands and feet (esp. arches)
claudication in legs
ulcers in the digits
pale, red, bluish hands and feet
symptoms worse with cold/stress |
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Term
| What is the treatment for Buerger's disease? |
|
Definition
control the symptoms
smoking cessation
amputation if gangrene sets in |
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Term
| How can Buerger's disease be prevented? |
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Definition
| don't smoke (especially patients with hx of Raynaud's) |
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Term
| What condition can cause inflammation of blood vessels in children? |
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Definition
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Term
| What characterizes the 1st phase of Kawasaki disease? |
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Definition
2 weeks
persistent fever >104 for 5 days |
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Term
| What characterizes the 2nd phase of Kawasaki disease? |
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Definition
| skin on hands and feet may peel in large pieces |
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Term
| What are signs and symptoms of Kawasaki disease? |
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Definition
joint pain, abdominal pain, nausea, vomiting
strawberry tongue
swollen lymph nodes
rash on trunk and genitals
bilateral conjunctivitis without exudate |
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Term
| If treatment if delayed beyond ____ days of the start of the fever associated with Kawasaki disease, heart problems may ensue. |
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Definition
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Term
| What is the treatment for Kawasaki disease? |
|
Definition
IV gamma globulin
ASA to reduce heart problems |
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Term
| What vessels are affected by polyarteritis nodosa? |
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Definition
small and medium sized vessels
spares the aorta and its bronches and the small vessels including the capillaries and arterioles |
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Term
| Where do the microaneurysms associated with polyarteritis nodosa occur? |
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Definition
| bifurcations or branch points of vessels |
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Term
| What organs are affected by polyarteritis nodosa? |
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Definition
skin
heart
kidneys
nervous system
musculoskeltal system
GU
eyes
brain
GI |
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Term
| What condition is associated with necrotizing inflammatory lesions in the blood vessels? |
|
Definition
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Term
| What are the complications of polyarteritis nodosa? |
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Definition
organ infarction
gangrene of a limb
aneurysm rupture causing intra-organ bleeding |
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Term
| How many of the 10 criteria must be present to diagnose polyarteritis nodosa? |
|
Definition
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Term
| How is polyarteritis nodosa treated? |
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Definition
corticosteroids
severe disease--cyclophosphamides
surgery for bowel complications
need multi-specialty involvement with multi-organ involvement |
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Term
| What vessels are affected by Behcets syndrome? |
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Definition
| small (capillaries, arterioles, venules) |
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Term
| What is the triple symptom complex associated with Behcets syndrome? |
|
Definition
recurrent oral apthous ulcers
genital ulcers
uveitis |
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Term
| What is the most common vasculitis in children and teens? |
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Definition
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Term
| What causes Henoch-Schonlein purpura? |
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Definition
| deposition of IgA in the skin and kidneys |
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Term
| What is the classic triad associated with Henoch-Schonlein purpura |
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Definition
purpura (palpable hemorrhages in the skin)
joint pain
abdominal pain |
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Term
| What is the prognosis/treatment for Henoch-Schonlein purpura? |
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Definition
usually self-limiting
most of the time just treat symptoms
1/3 may develop kidney problems which can lead to ESRF |
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Term
| How is the diagnosis of Henoch-Schonlein purpura made? |
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Definition
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Term
| What is there a risk of in children under 10 who have Henoch-Schonlein purpura? |
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Definition
1/3 chance of recurrence within 4 months of the first attack
recurrence is more common in older children and adults |
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Term
| Who is end stage renal failure more common in with patients who have Henoch-Schonlein purpura? |
|
Definition
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Term
| What is chronic myofascial pain syndrome? |
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Definition
| painful condition affecting the muscle and fascia |
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Term
| What is a common presentation of chronic myofascial pain syndrome? |
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Definition
trigger points
twitching of the muscle
referred pain
sleep disturbance
muscle weakness
tingling
stiffness |
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Term
| What sign might a patient with chronic myofascial pain syndrome exhibit? |
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Definition
| "jump sign" upon trigger point palpation |
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Term
| What is the treatment for chronic myofascial pain syndrome? |
|
Definition
NSAIDs
PT
massage
trigger point injections (-caine, Botox, dry needle)
correcting posture, leg length, workplace ergonomics, depression/anxiety |
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|
Term
| What does fibromyalgia stem from? |
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Definition
| dysfunction of neurotransmitters and hormones that transfer information from tissue to tissue |
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Term
| What condition produces general aching? |
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Definition
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Term
| How does fibromyalgia differ from chronic myofascial pain? |
|
Definition
fibromyalgia--tender points
myofascial pain--trigger points with radiating pain |
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Term
| How is a diagnosis of fibromyalgia made? |
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Definition
| 3 months of widespread pain and tenderness at 11 of the 18 tender points |
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Term
| What are components of treatment for fibromyalgia? |
|
Definition
gentle exercise and stretching
support groups
patient education
balanced diet
acupuncture
no high impact aerobics/weight lifting
medications |
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Term
| What medications can be used for the treatment of fibromyalgia? |
|
Definition
Lyrica
Cymbalta
Savella
anti-inflammatories |
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