End game

Drug which binds B7-1 and B7-2 on APCs

Abatacept

CI does not cross zero, so effect is

significant

P < 0.001 indicates

strong statistical significance.

MAS Tx refractory to mtx and TNFi

cycloosporine/ CNI

CI is narrow, indicating

precision.

coombs +

warm AHA tx steroids

HLH Tx

high-dose steroids and etoposide

if The 95% CI includes 1, indicating the RR is

not statistically significant at α = 0.05

p-value > 0.05

does not prove the null is true; it indicates insufficient evidence to reject it

bars physicians from referring Medicare/Medicaid patients to entities with which they have a financial relationship for designated health services, unless an exception applies

stark law

The ADA prohibits

discrimination against qualified individuals with disabilities and mandates reasonable accommodations to perform essential job functions

. Food, Drug, and Cosmetic Act (FDCA) — FDA REMS provisions

high-risk drugs. Thalidomide and isotretinoin require prescriber certification, patient registration, and pregnancy prevention documentation.

teardrop cells

myelofibrosis

IgM monoclonal protein associated with a demyelinating neuropathy

Monoclonal gammopathy of clinical significance (MGCS) with anti-myelin IgM — treat with rituximab.

Hypocellular marrow + pancytopenia in autoimmune patients and tx

aplastic anemia, start high-dose corticosteroids and cyclosporine.

decreased GPI-anchored proteins CD55 and CD59

Paroxysmal nocturnal hemoglobinuria (PNH) — consider complement inhibition with eculizumab.

Mixed cryoglobulinemia: treat underlying HCV when possible; if immunologic disease persists, tx

ritux

PAH first line Tx

Endothelial receptor antagonists (bosenten) and PDE5 antagonists (sidenafil)

Paraneoplastic Ab

Anti Hu

LIP Tx

Steroids, then cellcept, imuran, ritux

Positive trendelembergif sagging is on the left side what nerve is it

Right L5

Only ILD associated Ab that doesn’t have to have +ANA

Ro52

septic arthritis always must be

drained

Hepatosplenomegaly and bone pain

Gauchers

Stress fracture (small line on lateral side)

acute kidney injury + severe hypertension + microangiopathic hemolytic anemia (MAHA) ± thrombocytopenia.

scleroderma renal crisis

rheum condition with highest rate of ILD

scleroderma

Radial sagittal band rupture

• extensor tendon subluxes ulnarly.

• Findings: can’t actively extend MCP, but can hold extension once passively placed (no complete rupture).

young lady with provoked DVT and 1 prior miscarriage, labs neg

treat as provoked- warfarin x3 months

non-radiographic axial spondyloarthritis.

X-ray is normal but the MRI shows clear sacroiliitis

recurrent painful lesions with fever

panniculitis- which can be from lupus profundus or weber christian

wilsons disease treatment

d penacillamine or zinc

lace like sarcoid lesions

aneursyms and hep b

PAN

hetertopic ossification- happens after hip surgery esp if they have ank spond, tx ibuprofen

looks like its ankylosed

• Pathologic formation of lamellar bone in soft tissues (muscle, periarticular tissue).

• Common complication after hip arthroplasty, acetabular fracture fixation, or spinal cord/head injury.

best treatment for hip OA

weight loss (as opposed to knee which is both weight loss and PT)

Tx for RA with any history of melanoma or lymphoproliferative malignancy.

Rituxan

late onset neutropenia happens with what medication

rituximab

can be safely added to hydroxychloroquine in patients with cutaneous lupus not controlled by HCQ alone.

Quinacrine

US showing bilateral glenohumeral synovitis, subacromial bursitis, and biceps tenosynovitis.

PMR

drugs which cause SCLE

• thiazide diuretics, beta-blockers, and calcium channel blockers.

• Proton pump inhibitors (PPIs) and H2 receptor antagonists.

• Terbinafine (an antifungal).

• Nonsteroidal anti-inflammatory drugs (NSAIDs).

• Certain cancer treatments, such as checkpoint inhibitors.

• TNFi

drugs which cause SLE

• Hydralazine (antihypertensive)

• Procainamide (antiarrhythmic)

• Isoniazid (antibiotic)

• Minocycline (antibiotic)

• Tumor necrosis factor (TNF) inhibitors (e.g., adalimumab, infliximab)

• Diltiazem (calcium channel blocker)

A palmar plantar rash (a rough, red, or reddish-brown rash on the palms and soles of the feet)

oral ulcers

syphillis “the great mimicer”, dont confuse with reactive

SI capsular bridging has been described in patients with

DISH, which on the pelvic anteroposterior radiograph may give the false appearance of obliteration of the SI joint space

TB testing in someone on pred who had BCG

Pred lowers quant accuracy and BCG lower skin test, do both for more accuracy

Ab with highest predicative value of pregnancy loss

LAC

When to restart TNFi when being treated for latent TB

4 weeks after starting Tx

Flexor tenosynovitis boxing gloves appearance

RS3PE

PIN

Causes finger and thumb extension weakness, possibly radial deviation

• “PIN syndrome paralyzes fingers but barely hurts.

radial tunnel syn

Causes dull, aching pain 3–5 cm distal to lateral epicondyle, pain with resisted supination or long finger extension, no motor deficits initially

• “Radial tunnel is a tunnel 3–5 cm below the epicondyle.”

how does diabetic cheiroarthropathy present

bilateral prayer sing but no cords palpable, and affects more than just a few digits

ACR EULAR SSc criteria

Feature	Score
Skin thickening of fingers extending proximal to MCPs	9 (sufficient alone for classification)
Fingertip lesions (ulcers/pitting)	2
Telangiectasia	2
Abnormal nailfold capillaries	2
Pulmonary arterial hypertension / ILD	2
Raynaud phenomenon	3
SSc-related autoantibodies (anticentromere, anti-topoisomerase I, anti-RNA pol III)	3

note no calcinosis or esophageal issues

child with history of leg pain and bowed legs

ricketts

warm, swollen, erythematous foot with good pulses and little pain

charcot, may flare after trauma

how to diagnose non vascular thoracic outlet syn

clinical, no imaging

MRH

Pulm art aneurysms in bechets, need to do CT

Infiltration of histiocytes with finely-granular eosinophilic cytoplasm, multinucleated giant cells, and fibrosis in nodules

MRH

Lace-like cystic lesions in the phalanges of the hands

sarcoid

painful red eye, common in RA.

Scleritis

red eye but no loss of vision.

Episcleritis

most likely autoimmune disease associated with retinitis

bechets

where does enbrel bind

TNF alpha and Beta

Do you need skin Bx for psoriasis

Not if typical presentation

Alk p in hyperthyroidism

Increased

U1 RNP is associated with

MCTD

where does non enbrel TNFi bind

TNF alpha

FIP1L1/PDGFRa associated with

primary hypereosinophillic syndrome

indicates worse prognosis in eGPA

cardiac involvment

sacral Fx with bone marrow edema, avoid exercise

HCV cryo

Polyclonal B-cell activation leading to IgM anti-IgG Fc

age around 20 with high CPK and proximal muscle weakness, all refractory to immunosuppression

muscular dystrophy, check dysferlin

: exercise-induced episodes (rhabdomyolysis, myoglobinuria), often normal exam between flares

CPT II

patient with joint pain and likely lung cancer, +Tx

Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by digital clubbing, periostitis of long bones, and joint pain and swelling

can be primary or secondary (like this)

biopsy shows hypercellularity and vascular thickening

skin changes mimic acromegally

Tx celecoxib, then bisphosphonates

anterior uveitis

limited in active and passive especially external but not as much internal rotation and is most often age 40-60.

highly associated with diabetes

adhesive capsulitis

shoulder OA

can also be limited in active and passive ROM, often older and limited in all planes of motion

SLAC- can be caused by OA, RA, trauma

Kienboeck’s disease

lunate bone in the wrist loses its blood supply, leading to bone death (avascular necrosis)

Right knee AVN

Accumulation of homogentisic acid in connective tissue

of skeletal fluorosis with interosseous membrane calcifications- has been described as endemic in areas with high concentrations of fluoride in the drinking water, excessive tea consumption (100-150 tea bags daily) and consumption of toothpaste

seronegative inflammatory arthritis + myositis + Raynaud’s + ILD symptoms + Gottron’s papules/mechanic’s hands, biopsy shows perifascicular necrosis (not atrophy), less inflammation, often called an “intermediate” or “overlap” pattern

Anti-synthetase syndrome (classically anti–Jo-1 positive)

cholesterol which is indicative of chronic inflammation, rule out infection

drugs which cause seratonin syn

• SSRI + MAOI (most dangerous)

• SSRI/SNRI + linezolid

• SSRI + tramadol or meperidine

• SSRI + triptan

Antidepressants

• SSRIs: fluoxetine, sertraline, paroxetine, citalopram, escitalopram

• SNRIs: venlafaxine, duloxetine, desvenlafaxine

• TCAs: clomipramine, imipramine, amitriptyline (some more serotonergic than others)

• MAOIs: phenelzine, tranylcypromine, isocarboxazid, selegiline

2. Other Psychiatric Drugs

• Atypical antidepressants: trazodone, vilazodone, vortioxetine

• Buspirone (5-HT1A agonist)

• Lithium (rare, but potentiates serotonin)

3. Analgesics

• Tramadol

• Meperidine (pethidine)

• Methadone

• Fentanyl

• Tapentadol

• Dextromethorphan (cough syrup, especially in abuse/OD)

4. Migraine Drugs

• Triptans: sumatriptan, rizatriptan, zolmitriptan (5-HT1B/1D agonists)

5. Antiemetics

• Ondansetron, metoclopramide, granisetron (weaker, but possible in combos)

6. Antibiotics / Other

• Linezolid (acts like an MAOI!)

• Chlorpheniramine (OTC antihistamine with serotonergic activity)

• St. John’s Wort (herbal supplement, induces serotonin release)

• MDMA (ecstasy), LSD, cocaine, amphetamines → recreational causes

macroglossia seen in

amyloidosis

amyloidosis prolonged PTT due to

binding of factor X, Tx chemo or spleenectomy

undetectable complement component is due to

complete deficiency

Belimumab MOA

inhibits a B cell survival factor

Pseudoachondroplasia

to Mutation in the COMP gene –which can also cause multiple epiphyseal dysplasia.

Scleromyxedema

primary cutaneous mucinosis characterized by a generalized, papular and sclerodermoid, cutaneous

eruption that usually occurs in association with monoclonal gammopathy. Skin bx: acid mucopolysaccharide deposition in upper reticular dermis

senstivity

a / (a + c)

Specificity

d / (b + d)

PPV

Sensitivity / (1 − Specificity)

“SpPin” → High Sp → Positive rules in → LR+ ↑

NPV

(1 − Sensitivity) / Specificity

SnNout” → High Sn → Negative rules out → LR− ↓

HBsAg

Current infection (acute or chronic)

HBsAb

Immunity (from vaccination or past infection)

Calcification of C1-C2 ligament- crowned dens, improves with NSAIDs

Apreimlast MOA

inihibits PDE4 which would normally break down cAMP thereby decreasing IL 17 and 23 and TNFa and increasing IL 10

TTP labs

elevated LDH and plt <50