Vasculitic arthropathies (obj 21)

Question 1

55 year old patient complaining of pain and stiffness in shoulders and hips, but NO muscle weakness. This has lasted for several weeks and you can find no other explanation. Diagnosis?

Answer 1

Polymyalgia rheumatica

Question 2

79 year old patient complaining of headache and pain when chewing food. Patient also has diplopia. You get an ESR and it is markedly elevated. Diagnosis? Treatment?

Answer 2

HA, jaw claudication, visual abnormalities = giant cell arteritis

Blindness is a real possibility so want to immediately start high dose prednisone.

Question 3

Name 2 large vessel vasculitic syndromes.

Answer 3

giant cell arteritis

Takayasu arteritis

Question 4

Name a medium vessel vasculitic syndrome.

Answer 4

polyarteritis nodosa

Question 5

Name 2 small vessel vasculitic syndromes.

Answer 5

Behcet syndrome

Wegener granulomatosis

Question 6

Your patient is complaining of fever, malaise, pain in the extremities and a foot drop. You ask him about recent illnesses and he says he had acute hepatitis B three months ago. You examine him and find livedo reticularis as well as ulcerations near the malleoli. Diagnosis? Treatment?

Answer 6

polyarteritis nodosa

corticosteroids - high dose

Question 7

Fingers white, blue, then red

Answer 7

Raynaud phenomenon

Russian flag

Question 8

With what disease is Raynaud phenomenon especially associated?

Answer 8

scleroderma

Question 9

What is an early clue that a person has secondary and not primary Raynaud syndrome?

Answer 9

nailfold capillary abnormalities

Question 10

First-line therapy for Raynaud phenomenon

Answer 10

calcium-channel blockers

Question 11

Phenomenon in which sterile pustules develop at sites where needles have been inserted into the skin

Answer 11

pathergy

Question 12

Your patient is a Turkish gentleman with recurrent painful mouth and genital ulcers. You stick him with some needles and see pathergy.

Diagnosis?

Answer 12

Behcet syndrome

Question 13

Treatments for Behcet syndrome?

Answer 13

colchicine

thalidomide

corticosteroids

Question 14

Disease associated with ANCA

Answer 14

Wegener granulomatosis (granulomatosis with polyangiitis)

Question 15

You see a 40 year old patient for upper respiratory symptoms and you suspect sinusitis or otitis media. 8 months later she comes back to see you and still has upper respiratory symptoms but now she also has systemic symptoms including red eyes and joint pain/swelling.

You suspect ______ and because of this you perform a kidney biopsy, which confirms glomerulonephritis.

What do you suspect? What is your treatment?

Answer 15

granulomatosis with polyangiitis (Wegener)

cyclophosphamide + corticosteroids or

rituximab + corticosteroids