ESTER Reumatologia flashcards

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

ANA sensitivity

Antinuclear antibody testing is highly sensitive for systemic lupus erythematosus but poorly specific; low titers occur in healthy individuals, so results must be interpreted with clinical features and specific autoantibodies.

Synovial fluid crystals

Monosodium urate crystals are needle-shaped and negatively birefringent, indicating gout; calcium pyrophosphate crystals are rhomboid and positively birefringent, indicating pseudogout. Polarized microscopy confirms the diagnosis.

ESR vs CRP

Erythrocyte sedimentation rate rises slowly and lags behind inflammation, and is affected by anemia and age. C-reactive protein responds rapidly, making it better for tracking acute disease activity.

DAS28 remission target

The Disease Activity Score in 28 joints combines tender and swollen joint counts, an acute-phase reactant, and patient global assessment. A score below 2.6 defines remission in rheumatoid arthritis.

Septic synovial fluid

Synovial fluid white cell count above 50,000 per microliter with neutrophil predominance suggests septic arthritis. Gram stain and culture plus urgent aspiration and antibiotics are required to preserve the joint.

Hydroxychloroquine retinal screening

Hydroxychloroquine can cause retinopathy. Baseline ophthalmologic examination is recommended, with annual screening after five years of use or earlier in patients with risk factors such as renal impairment.

RA classification criteria

The 2010 ACR/EULAR criteria score involved joints, serology (rheumatoid factor and anti-CCP), acute-phase reactants, and symptom duration. A total of six or more points classifies definite rheumatoid arthritis.

Anti-CCP specificity

Anti-cyclic citrullinated peptide antibodies are less sensitive than rheumatoid factor but far more specific for rheumatoid arthritis, and their presence predicts erosive disease and extra-articular manifestations.

Gout urate target

Urate-lowering therapy aims for serum urate below 360 micromol/L (6 mg/dL), or below 300 micromol/L in severe disease, to dissolve tophi and prevent flares.

Colchicine for acute gout

Low-dose colchicine given early in a flare reduces pain and inflammation; it is contraindicated in severe renal impairment and interacts with CYP3A4 inhibitors such as clarithromycin.

Dactylitis

Dactylitis is uniform swelling of an entire digit, producing a sausage-like appearance. It is characteristic of psoriatic arthritis and other spondyloarthropathies and indicates more severe disease.

Ankylosing spondylitis features

Inflammatory back pain improves with exercise, worsens with rest, and causes morning stiffness. Sacroiliitis on imaging, HLA-B27 positivity, and enthesitis support the diagnosis of axial spondyloarthritis.

Rheumatoid nodules

Subcutaneous rheumatoid nodules occur over extensor surfaces and pressure points in seropositive rheumatoid arthritis. Their presence associates with more severe disease and extra-articular involvement.

Lupus nephritis biopsy

Kidney biopsy is indicated in systemic lupus erythematosus with proteinuria above 0.5 g/day or active urinary sediment. Proliferative classes III and IV require immunosuppression with mycophenolate or cyclophosphamide.

Scleroderma renal crisis

Scleroderma renal crisis presents with sudden hypertension, rising creatinine, and microangiopathic hemolysis in diffuse cutaneous systemic sclerosis. Treatment is with angiotensin-converting enzyme inhibitors.

Limited vs diffuse scleroderma

Limited cutaneous systemic sclerosis affects the face and distal limbs with anticentromere antibodies and late pulmonary hypertension. Diffuse disease has proximal skin involvement, anti-topoisomerase antibodies, and early lung fibrosis.

Giant cell arteritis treatment

Giant cell arteritis requires immediate high-dose glucocorticoids to prevent vision loss, even before biopsy confirmation. Temporal artery ultrasound or biopsy supports the diagnosis.

Antiphospholipid syndrome

Antiphospholipid syndrome is defined by thrombosis or pregnancy morbidity plus persistent anticardiolipin, anti-beta2-glycoprotein I, or lupus anticoagulant on two occasions at least twelve weeks apart.

ANCA associations

Anti-proteinase 3 antibodies (c-ANCA) associate with granulomatosis with polyangiitis. Anti-myeloperoxidase antibodies (p-ANCA) associate with microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis.

Sjögren sicca features

Sjögren syndrome causes dry eyes and mouth with anti-Ro/La antibodies. Persistent parotid enlargement or lymphadenopathy warrants evaluation for lymphoma, which occurs at increased frequency.

Osteoporosis T-score

Dual-energy X-ray absorptiometry T-score of -2.5 or lower at the hip or lumbar spine defines osteoporosis. Scores between -1.0 and -2.5 indicate osteopenia, and Z-scores are used in younger patients.

FRAX tool

FRAX estimates ten-year probability of major osteoporotic and hip fracture using clinical risk factors with or without bone mineral density. Treatment thresholds commonly include hip probability of 3% or more.

Bisphosphonate administration

Oral bisphosphonates must be taken on an empty stomach with water, followed by remaining upright for thirty minutes, to maximize absorption and reduce esophageal irritation.

Denosumab discontinuation risk

Stopping denosumab abruptly causes rapid bone loss and rebound vertebral fractures. Patients should transition to a bisphosphonate or continue therapy indefinitely unless contraindicated.

Osteomalacia laboratory clues

Osteomalacia from vitamin D deficiency shows low calcium and phosphate with elevated alkaline phosphatase, bone pain, proximal myopathy, and Looser zones or pseudofractures on radiographs.

Primary hyperparathyroidism

Primary hyperparathyroidism causes hypercalcemia with elevated or inappropriately normal parathyroid hormone, leading to bone loss and nephrolithiasis. Parathyroidectomy is curative when criteria are met.

Fibromyalgia diagnosis

Fibromyalgia is a clinical diagnosis of widespread pain lasting at least three months with fatigue, sleep disturbance, and cognitive symptoms, without inflammatory markers or erosive joint disease.

Carpal tunnel syndrome

Median nerve compression at the wrist causes nocturnal paresthesia in the thumb, index, and middle fingers, with positive Tinel and Phalen signs. Nerve conduction studies confirm the diagnosis.

Lateral epicondylitis

Lateral epicondylitis causes pain at the common extensor origin, worsened by resisted wrist extension. It is usually self-limited and managed with activity modification and eccentric strengthening.

Plantar fasciitis

Plantar fasciitis produces first-step heel pain with tenderness at the medial calcaneal tubercle. Stretching, orthoses, and activity modification are first-line; imaging is reserved for atypical presentations.

JIA uveitis screening

Children with juvenile idiopathic arthritis risk asymptomatic chronic anterior uveitis, especially with oligoarticular onset, young age, and positive ANA. Regular slit-lamp screening enables early treatment.

Kawasaki disease treatment

Kawasaki disease is treated with intravenous immunoglobulin and aspirin to reduce coronary artery aneurysm risk. Fever persisting after IVIG may require a second dose or corticosteroids.

IgA vasculitis nephritis

Henoch-Schönlein (IgA) vasculitis causes palpable purpura, abdominal pain, arthritis, and nephritis. Urine should be monitored for hematuria and proteinuria for months after presentation.

Growing pains features

Growing pains are bilateral evening leg pains in children aged three to twelve, with no morning stiffness or limping and normal examination and inflammatory markers.

Familial Mediterranean fever

Familial Mediterranean fever causes recurrent short febrile episodes with serositis and arthritis, inherited in an autosomal recessive pattern. Colchicine prevents attacks and amyloidosis.