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PANCE Prep Pearls: 3rd Ed. (2019)
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Rheumatologic Disorders

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PANCE Prep Pearls: 3rd Ed. (2019) | Physician Assistant (PA) School Study Aid

Rheumatologic Disorders
31 Picmonics to Learn | 1 hr 5 mins
Polymyalgia Rheumatica
General Characteristics
Proximal Muscle Pain
Normal Muscle Strength
Morning Stiffness
Age Over 50
Associated With Temporal Arteritis
Diagnosis
Elevated ESR, CRP
Normal CK
Management
Corticosteroids
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4 mins
Polymyositis / Dermatomyositis Disease
Pathophysiology
Idiopathic Inflammatory Myopathy
More Common in Women
Endomysial Inflammation with CD8+ Cells (Polymyositis)
Perimysial Inflammation with CD4+ Cells (Dermatomyositis)
Signs and Symptoms (Both)
Symmetric Proximal Muscle Weakness
Dysphagia
Lung and Cardiac Involvement
Signs and Symptoms (Dermatomyositis)
Malar Rash
Shawl-like Shoulder Rash
Gottron Papules on Knuckles
Heliotrope Rash
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3 mins
Polymyositis / Dermatomyositis Diagnosis and Treatment
Diagnosis
Increased CK (CPK)
Increased Aldolase
Anti-JO-1 Antibody
Anti-SRP Antibody
Antinuclear Antibody
Abnormal EMG
Biopsy
Treatment
Corticosteroids
Methotrexate
Azathioprine
Treatment For Resistant Disease
Intravenous Immunoglobulin (IVIG)
Cyclophosphamide
Rituximab
Calcineurin Inhibitors
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2 mins
Systemic Lupus Erythematosus (SLE) Diagnosis and Clinical Features
IM DAMN SHARP acronym
Immunoglobulins
Malar rash
Discoid rash
Antinuclear antibody
Mucositis
Neurologic disorders
Serositis
Hematologic disorders
Arthritis
Renal disorders
Photosensitivity
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2 mins
Systemic Lupus Erythematosus (SLE) Assessment
Mechanism
Multisystem Inflammatory Disorder
Assessment
Malar Rash
Discoid Rash
Arrhythmias
Arthritis
Hemolytic Anemia
Seizures
Glomerulonephritis
Considerations
Periods of Exacerbation and Remission
Diagnosed by ANA (Anti-nuclear antibody assay)
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Systemic Lupus Erythematosus (SLE) Mechanism, Treatment and Complications
Mechanism and Characteristics
Systemic Autoimmune Disease
9:1 female to male ratio
Treatment
Glucocorticoids
NSAIDS
Hydroxychloroquine
Cyclophosphamide
Complications
Lupus nephritis
Libman-Sacks Endocarditis
Secondary Antiphospholipid Antibody Syndrome
Other
Drug-induced lupus
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2 mins
Systemic Lupus Erythematosus (SLE) Interventions
Avoid Sunlight
Drug Therapy
Glucocorticoids
Methotrexate
NSAIDs
Hydroxychloroquine
Azathioprine
Considerations
Monitor for Renal Failure (ARF)
Manage Pain
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2 mins
Antihistone Antibodies
Drug-induced Lupus
SHIPP Acronym
Sulfonamides
Hydralazine
Isoniazid (INH)
Phenytoin
Procainamide
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Hydroxychloroquine
Mechanism of Action
Immunosuppressant
Indications
Malaria
Rheumatoid Arthritis
Systemic Lupus Erythematosus (SLE)
Porphyria Cutanea Tarda
Side Effects
Cardiotoxicity
Retinopathy
Considerations
Ophthalmological Exams
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3 mins
Antiphospholipid Syndrome
Characteristics
Antiphospholipid Antibodies
Hypercoagulability
Clinical Features
Recurrent Thromboembolisms
Recurrent Miscarriages
Diagnosis
Anticardiolipin Antibodies
Anti-Beta-2-Glycoprotein Antibodies
Lupus Anticoagulant
Management
Anticoagulation
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2 mins
Sjögren’s Syndrome
Mechanism
Autoimmune Exocrine Gland Destruction
Symptoms (Classic Triad)
Xerostomia
Xerophthalmia
Arthritis
Diagnosis
Anti SS-B (La)
Anti SS-A (Ro)
Schirmer's Test
Salivary Gland Biopsy
Treatment
Symptomatic Treatment
Complications
Lymphoma
Other
Sicca Syndrome
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Anticentromere Antibodies
Autoimmune Disorders
CREST Syndrome (Limited Scleroderma)
Diffuse Scleroderma
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Behcet Disease
Characteristics
Mediterranean and East Asian Populations
HLA-B51
Clinical Features
Vasculitis
Pulmonary Artery Aneurysm
Recurrent Painful Ulcers
Erythema Nodosum
Uveitis
Thrombosis
Diagnosis
Positive Pathergy Test
Management
Steroids
Immunosuppressants
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3 mins
Takayasu Arteritis
Pathophysiology
Granulomatous Thickening of Aortic Arch
Pulseless Disease
Asian Females
Signs and Symptoms
Fever
Myalgia
Night Sweats
Arthritis
Ocular Disturbances
Diagnosis
Increased ESR
Different Blood Pressures in Arms
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2 mins
Kawasaki Disease
Cause
Acute Vasculitis
Assessment
Acute Phase
High Fever
Conjunctivitis
Strawberry-Red Tongue and Mucosa
Erythema and Edema of Hands and Feet
Subacute Phase
Desquamative Skin Rash
Interventions
Aspirin
Intravenous Immunoglobulin (IVIG)
Antipyretics
Considerations
Coronary Aneurysm
Children < 5 Years old
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2 mins
Polyarteritis Nodosa
Pathophysiology
Immune Complex-Mediated Transmural Vasculitis
Hepatitis B Association
Fibrinoid Necrosis
Signs and Symptoms
Black Stool (Melena)
Neurologic Dysfunction
Myalgia
Fever
Hypertension
Diagnosis
Vessels / Lesions in Different Stages
Renal Microaneurysms (On Arteriogram)
Spares Pulmonary Arteries (No Pulmonary Involvement)
Treatment
Corticosteroids
Cyclophosphamide
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2 mins
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)
Pathophysiology
Granulomatous Vasculitis
Signs and Symptoms
Sinusitis
Skin Lesions
Peripheral Neuropathy
Asthma
GI Disease
Heart Disease
Kidney Failure
Diagnosis
Eosinophilia
p-ANCA
Treatment
Corticosteroids
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4 mins
Granulomatosis with Polyangiitis (GPA) Characteristics
Pathophysiology
Small Vessel Vasculitis
Necrotizing
Lungs and Upper Airway
Crescentic Glomerulonephritis
DIAGNOSTICS
c-ANCA
X-ray
Multiple Nodules in Lungs
Treatment
Cyclophosphamide
Corticosteroids
Rituximab
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3 mins
Granulomatosis with Polyangiitis (GPA) Symptoms
Upper Respiratory Tract
Saddle Nose
Perforation of Nasal Septum
Chronic Sinusitis
Otitis Media
Mastoiditis
Lower Respiratory Tract
Cough
Dyspnea
Hemoptysis
Kidney
Rapidly Progressive Glomerulonephritis
Hematuria
RBC Casts
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2 mins
Microscopic Polyangiitis
Pathophysiology
Necrotizing Small Vessel Vasculitis
Signs and Symptoms
Lungs, Kidneys, and Skin Commonly Affected
Palpable Purpura
Rapidly Progressive Cresentic Glomerulonephritis
Diagnosis
Lesions are Same Age
Non-granulomatous
Minimal Nasopharyngeal Involvement
P-ANCA
Treatment
Corticosteroids
Cyclophosphamide
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2 mins
Henoch-Schonlein Purpura
Most Common Childhood Vasculitis
Follows Pharyngeal or Respiratory Infection
Palpable Purpura on Legs and Buttocks
Arthralgia
Intestinal Hemorrhage
Black Stool (Melena)
Associated with IgA Nephropathy
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2 mins
Anti-glomerular Basement Membrane Antibodies
Glomerulonephritis
Goodpasture's Disease
Linear immunofluorescence
Hemoptysis
Hematuria
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1 min
HLA-B27 Associations
Associations
PAIR Acronym
Psoriatic Arthritis
Ankylosing Spondylitis
Inflammatory Bowel Disease
Reactive Arthritis
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1 min
Ankylosing Spondylitis
Chronic Inflammatory Arthritis
"Bamboo Spine"
HLA-B27
Uveitis
Aortic Regurgitation
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Gout Disease
Acute Inflammatory Monoarthritis
Epidemiology
Primarily in Males
Pathophysiology
Precipitation of Monosodium Urate Crystals
Underexcretion of Uric Acid
Overproduction of Uric Acid
Negatively Birefringent, Needle-Shaped
Symptoms
Swollen, Red, Painful Joint
Asymmetric Joint Distribution
Podagra
Tophus
After Large Meal or Alcohol
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Gout Treatment
Acute (Acute-angle)
NSAIDs
Glucocorticoids
Colchicine
Impairs Leukocyte Chemotaxis
Chronic Gout (Crone Goat)
Inhibit Xanthine Oxidase
Allopurinol
Febuxostat
Inhibit Reabsorption of Uric Acid
Probenecid
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1 min
Pseudogout
Pathophysiology
> 50 Years Old
Arthritis of Large Joints (Classically the Knee)
Calcium Pyrophosphate Crystals
Diagnosis
Positively Birefringent
Chondrocalcinosis (On X-ray)
Treatment
NSAIDs
Colchicine
Steroids
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1 min
Systemic Juvenile Idiopathic Arthritis Characteristics and Presentation
Characteristics
Idiopathic
Still's Disease
Autoimmune Joint Destruction
Onset < 16 Years Old
Presentation
Arthritis
Quotidian Fever
Evanescent Exanthem
Lymphadenopathy
Hepatosplenomegaly
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2 mins
Systemic Juvenile Idiopathic Arthritis Diagnosis and Management
Laboratory Findings
Increased Ferritin
Management
Glucocorticoids
Tocilizumab
Anakinra
Complications
Joint Deformities
Limb-Length Discrepancy
Uveitis
Macrophage Activation Syndrome
Considerations
Variable Prognosis
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2 mins
Osteoporosis Assessment
Highest Risk
Postmenopausal Women
Long Term Corticosteroids
Assessment
Kyphosis
Dowager's Hump
Loss of Height
Back Pain
Pathologic Fractures
Spinal Compression Fracture
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1 min
Osteoporosis Interventions
Increased Calcium Intake
Vitamin D Supplements
Bisphosphonates
Raloxifene
Denosumab
Calcitonin
Teriparatide
Bone Densitometry (DEXA) Scan
Weight Bearing Exercises
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2 mins

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