PA540 Rheumatology

Gout Diagnosis (crystal type) and Tx

• Negative birefringent crystals

• Tx

  • Lifestyle, diet, weight loss.

  • Acute: NSAIDS (Indomethacin, Naproxen, Ibuprofen), steroids (intra-articular, PO) Prednisone, Triamcinolone, colchicine

  • Chronic: Allopurinol, Probenecid, Colchicine

Pseudogout Diagnosis (crystal type) and Tx

• Joint aspiration: Positive Birefringent crystals (Rhomboid shaped crystals)

• Xray: chondrocalcinosis- shadows on joint line (meniscus)

• Tx: NSAIDS, glucocorticoids, Intra-articular injections of glucocorticoid

Polyarteritis Nodosa (PAN) Diagnosis

• ANCA negative

Osteoporosis Diagnosis (other than PE) and Tx (pharm)

• DEXA scan

  • -2.5 or less

• Bisphosphonates (Alendronate, Risedronate)

• Osteo-Anabolic meds: stimulate osteoblasts ability to build bone: Teriparatide, Abaloparatide, Romosozumab.

What condition is Polymyalgia Rheumatica (PMR) related to?

Giant Cell Arteritis

Polymyositis Labs

• CK, aldolase, Anti-Jo1

Dermatomyositis PE and Labs

• Gottron papules, heliotrope rash (periorbital), poikiloderma (shawl rash)

• Labs: CK, aldolase, Anti-Mi2

Psoriatic Arthritis Tx

• DMARDs - Methotrexate

Rheumatoid Arthritis Labs

• RF and Anti-CCP

Sjogren’s Syndrome Diagnosis

• Anti-RO/SSA, Anti-La/SSB - not specific

• Schirmer test - paper in eyes for tears

• Biopsy salivary glands

Systemic Lupus Erythematous Labs and Tx

• Labs:

  • ANA (screening) will be positive (very sensitive) but not specific

  • Anti-Double Stranded DNA

  • Anti-Smith Antibodies

  • Antiphospholipid antibodies

• Tx:

  • Hydroxychloroquine

  • NSAIDs/steroids- inflammatory pain

  • Immunosuppressants for severe cases

Systemic Sclerosis (Scleroderma) - Limited

• What does CREST stand for?

• Labs

• CREST

  • Calcinosis cutis- calcium depositis in skin

  • Raynauds phenomenon- spasm in small arteries limiting blood flow

  • Esophogeal dysmotility - preventing food and fluid from moving smoothly

  • Sclerodactyly- tightening of skin on fingers/toes w/ thickening, hard, skiny skin

  • Telangiectasia- small dilated vessels on surface of skin resulting in blue, red spider like appearance

• Labs - Anticentromere antibody

Systemic Sclerosis (Scleroderma) - Diffuse

• What does it affect?

• Labs

• Widespread includes trunk, Organ involvement (heart, lungs, kidneys), Lung fibrosis, kideny renal crisis

• Labs - Anti-topoisomerase I antibody

Temporal Arteritis Tx

• Corticosteroids - Prednisone (IV or PO)

Ankylosing Spondylosis - Extra body areas affected and Labs

• Areas:

  • Hip, rib, back, shoulder pain

  • May include eye uveitis

  • May involve the heart Aortic Artery inflammation and hypertrophy

• Labs: HLA-B27 positive, elevated ESR, ANA negative, RF negative

Ankylosing Spondylitis Tx (Pharm)

• NSAIDs, Corticosteroids

• TNF- Adalimumab, Certolizumab pegol, Etanercept (Enbrel, Cimizia, Humira)

• IL-17 cytokines: Secukinumab, Ixekizumab