Rheumatology

Question	Answer
What is OP?	Bones weak enough to fracture during normal conditions.
Osteoportic	weaker than normal but not osteoporotic
What is the first sign of OP in most patients?	Fracture
what are the t scores for osteopenia?***	-1.0--2.5 SD
Most common serious illness?***	OP
T-score for severe OP?	<-2.5 with fragilty fracture
T -score for normal OP?	>-1.0
what is the T score for OP?	<-2.5
OP occurs when?	after menopause female before male male takes longer
Diagnosis of OP is confirmed by?	DEXA
what is the pathophysiology of OP?	bone resorption exceeds bone formation net bone loss > osteopenia > OP
when looking at an OP bone we focus on which layer of the bone?	the trabecular bone marrow
where can OP fractures occur?	Vertebrae (most common) Femoral neck (most severe and deadly) Pubic ramus (less severe) Wrist Ribs
What will Kyphosis cause?	chest compression PNA restricted lung expansion dyspnea chest pain
What are the non-modfiable risk factors for OP?***	having a relative with a fracture
What are the modifiable risk factors?***	low Ca intake low body weight low vitamin D exercise
what are the medications that causes OP?****	Steroids (cortisone/prednisone) anti-sex hormones (lupron) thyroid replacement anti-seziure medications
what are specifically indicated test?	hypercalcemia>Pth elevated esr>inflammatory disease anemia>serum iron stool
what are some preventive measures of OP?	weight bearing exercise vitamin D calcium 1,200 mgs (in which everyone needs)
What medications should be given to an osteoporotic patient?	Bisphosphonates (inhibit resorptive phase) fosmax (alendronate) actonel (risedondrate) boniva (ibandondrate) prolia tertrapeptide (is the only bone forming agent) reclast (zolendrate)(strongest one) should be given when patient has not eaten so that it does get up take with the food
What is PMR?*** and some symptoms/where is located?	an inflammatory disease of the muscles and small arteries occurring exclusively in >60 yoa* morning stiffness in proximal girdles (shoulders & hips)* sudden onset high ESR*
what is GCA aka TA?	inflammation of the temporal artery
what is an ESR?	erythrocyte sed rate non- specific measurement of inflammation. sticky rbcs (rouleaux) which have less surface area which means less friction which causes them to fall
what is an elevated ESR?***	its is NON-SPECIFIC an inflammatory disease infection chronic disease (copd, RA, Crf)
WHat are the clinical featured of PMR?****	pelvic girdle achine morning stiffness sudden onset knee effusions carpal tunnel syndrome rapid response to low dose steroids
what is the lab featured for PMR and GCA?***	Elevated ESR
what is the rx of PMR?***	low dose prednisone! 10-20mgs rapid response**
what are the clinical features of GCA/TA?***	Vision loss when rx with a high dose of prednisone (60mg) symptoms are relived headache jaw claudication
what is the diagnosis of GCA/TCA?	temporal artery biopsy
what is the rx of GCA?***	60mg of prednisone immediately after suspicion aspirin (to reduce blood clotting) call opthamologist for biopsy assess and treat for OP prophylactic bisphosphonates follow BP, weight, glucose, hgb A1c, DEXA dont change dose until biopsy is reported maintain dose after a month is positive then taper down
What system is most commonly involved in Spondylitis?	Gi Tract most commonly involved
What is ankylosing spondylosis?	A chronic systemic inflammatory disease involving the SI joint, spine and hips. which can progress to vertebral fusion, fracture and spinal deformity
What is the gene associated with Ankylosing spondylosis?	HLAB-27 allele gentically predermines if you will develp the disease
What is the most common manifestation of AS?	Back pain, localized or extended to the neck. Pain, stiffness and loss of mobility rendering the patient disable
Key points of inflammatory disorders	Mild inflammatory disease such as (OA & Fibromyalgia) are more common than inflammatory types of arthritis
What is the first place you would want to xray with AS?	SI Joint
What are some spondyloarthropathies?	AS Psoriatic Arthritis (PSA) Reactive Arthritis IBD associated with arthritis such as (crohn's disease ( UC))
The classification of SPA disorders	AS belongs to a group of disorders in (SPAs) that does not include RA. Classic feature of SPA are SI joint and prevalence of the gene HLA-B27
What is the diagnosis of AS?	A clinical evaluation is the best way to diagnose this disease. There are currently no lab test to define this disease may be predictive but are not reliable diagnostic tools. Most important finding is the HLA-B27 gene.

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	Created by Sèyi Olayinka about 9 years ago