ABIM Rheumatology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

ACR/EULAR 2010 RA criteria

Classification criteria for rheumatoid arthritis requiring at least one joint with clinical synovitis and a total score ≥6/10 from four domains: joint involvement, serology, acute-phase reactants, and symptom duration.

Anti-CCP antibody

Autoantibody against cyclic citrullinated peptides, highly specific for rheumatoid arthritis (specificity ~95%) and associated with erosive disease; included in RA classification criteria.

Methotrexate in RA

Anchor disease-modifying antirheumatic drug for rheumatoid arthritis; a folate antagonist given weekly with folic acid supplementation; monitor CBC, liver enzymes, and renal function.

Gout crystals

Monosodium urate crystals are needle-shaped and negatively birefringent under polarized light microscopy; finding them in synovial fluid confirms gout.

CPPD crystals

Calcium pyrophosphate dihydrate crystals are rhomboid-shaped and positively birefringent; associated with pseudogout and chondrocalcinosis, often in the knee or wrist.

SLE classification criteria

2019 EULAR/ACR criteria: entry criterion ANA ≥1:80, then additive weighted criteria across clinical and immunologic domains; score ≥10 with at least one clinical criterion classifies SLE.

Lupus nephritis

Renal involvement in SLE, classified by ISN/RPS biopsy; proliferative classes III and IV require immunosuppression with mycophenolate or cyclophosphamide plus glucocorticoids.

Antiphospholipid syndrome

Thrombotic or pregnancy morbidity plus persistent antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I) on two occasions ≥12 weeks apart; treated with anticoagulation.

Systemic sclerosis subtypes

Limited cutaneous SSc involves skin distal to elbows/knees and face (anticentromere); diffuse cutaneous SSc involves proximal skin (anti-Scl-70 or anti-RNA polymerase III) with higher risk of lung and renal disease.

Scleroderma renal crisis

Acute kidney injury with hypertension in systemic sclerosis, often with microangiopathic hemolysis; treated with ACE inhibitors; associated with anti-RNA polymerase III and diffuse skin disease.

ANCA-associated vasculitis

Small-vessel vasculitides including GPA, MPA, and EGPA; c-ANCA/anti-PR3 associates with GPA, p-ANCA/anti-MPO with MPA and EGPA; severe disease treated with cyclophosphamide or rituximab plus steroids.

Giant cell arteritis

Large-vessel vasculitis in patients ≥50 with headache, jaw claudication, visual symptoms, and elevated ESR/CRP; treat immediately with high-dose glucocorticoids to prevent blindness; confirm with temporal artery biopsy.

Polymyalgia rheumatica

Inflammatory syndrome in patients ≥50 with bilateral shoulder and hip girdle pain and elevated ESR/CRP; responds rapidly to low-dose prednisone (12.5–25 mg/day).

Axial spondyloarthritis

Chronic inflammatory back pain improving with exercise, sacroiliitis on imaging, HLA-B27 association, and extra-articular features (uveitis, psoriasis, IBD); first-line treatment is NSAIDs.

Osteoarthritis management

Clinical diagnosis with activity-related pain and brief morning stiffness; core treatments are exercise and weight loss; intra-articular glucocorticoids for flares; avoid chronic opioids.

Hydroxychloroquine monitoring

Antimalarial used in SLE and RA; baseline and annual dilated eye examination after 5 years of use (or earlier with risk factors) to screen for retinopathy.

Anti-Ro/SSA in pregnancy

Maternal anti-Ro/SSA (and anti-La/SSB) antibodies cross the placenta and can cause congenital heart block; fetal echocardiographic monitoring is recommended.

Pregnancy-safe DMARDs

Hydroxychloroquine, sulfasalazine, and azathioprine are generally continued in pregnancy; methotrexate, leflunomide, and cyclophosphamide are contraindicated due to teratogenicity.

Latent TB screening

IGRA or tuberculin skin test should be performed before starting TNF inhibitors or other biologics; positive results require treatment for latent tuberculosis before immunosuppression.

Hepatitis B screening

Check HBsAg, anti-HBc, and anti-HBs before initiating biologics or immunosuppressants; reactivation risk requires antiviral prophylaxis in appropriate patients.

Glucocorticoid-induced osteoporosis

Chronic glucocorticoid use reduces bone density; recommend calcium and vitamin D, lifestyle modification, and bisphosphonate therapy based on fracture risk assessment.

Stress-dose steroids

Patients on chronic glucocorticoids may need increased perioperative dosing to prevent adrenal crisis; typical regimen is hydrocortisone 50–100 mg IV at induction with taper.

Live vaccines contraindicated

Live attenuated vaccines (e.g., MMR, varicella, yellow fever) should be avoided in patients on high-dose immunosuppression; inactivated vaccines are safe but may have reduced efficacy.

NSAID cardiovascular risk

NSAIDs, especially nonselective and high-dose, increase risk of myocardial infarction and stroke; use the lowest effective dose and avoid in patients with established cardiovascular disease.

TPMT testing

Thiopurine methyltransferase activity should be checked before starting azathioprine; low activity increases risk of severe myelosuppression, requiring dose reduction or alternative therapy.

Infective endocarditis mimic

Infective endocarditis can present with fever, arthralgias, and positive ANCA, mimicking vasculitis; blood cultures and echocardiography are essential in atypical presentations.

Cardiovascular risk in RA

Rheumatoid arthritis is associated with increased cardiovascular risk; screen and manage traditional risk factors and use NSAIDs cautiously in patients with cardiovascular disease.

Folic acid with methotrexate

Folic acid supplementation (1 mg/day) reduces methotrexate toxicity (mucositis, nausea, cytopenias) without compromising efficacy; given daily except on the methotrexate day.

Anti-TNF inhibitor screening

Before starting TNF inhibitors, screen for latent tuberculosis and hepatitis B, update vaccinations, and assess for demyelinating disease, heart failure, and malignancy risk.

Urate-lowering therapy

Allopurinol or febuxostat titrated to serum urate <6 mg/dL; do not initiate during an acute gout flare unless already indicated; continue during flares if already on therapy.

CREST syndrome

Limited cutaneous systemic sclerosis features: calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias; associated with anticentromere antibodies.

Sacroiliitis imaging

Defined by MRI (bone marrow edema) or radiographic changes (erosions, sclerosis, ankylosis) in sacroiliac joints; key for axial spondyloarthritis classification.