Rheumatology and Uveitis Management

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Questions and Answers

What is the primary goal in treating patients with Arteritic Anterior Ischemic Optic Neuropathy (AAION)?

Enhancing visual acuity in the affected eye

Lowering eye pressure

Relieving symptoms of headache

Preventing loss of vision in the other eye (correct)

Which treatment method is recommended as the initial approach for AAION?

Topical beta-blockers

Laser photocoagulation

Oral or IV steroids (correct)

Anti-VEGF injections

What diagnostic test is crucial to perform within two weeks of AAION treatment initiation?

Temporal artery biopsy (TAB) (correct)

Magnetic Resonance Imaging (MRI)

Fluorescein angiography

Complete Blood Count (CBC)

Which laboratory values should be monitored closely in AAION patients receiving steroid treatment?

Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) Signup and view all the answers

Which demographic is predominantly affected by Systemic Lupus Erythematosus (SLE)?

Young, non-white women of child-bearing age Signup and view all the answers

Which medication class is known to potentially induce drug-induced lupus?

Anticonvulsants Signup and view all the answers

Fluctuating vision loss is characteristic of which type of underlying condition?

Diabetic retinopathy Signup and view all the answers

Painful vision loss on a bilateral basis is typically indicative of which condition?

Papilledema Signup and view all the answers

What is the best management option for a patient diagnosed with anterior uveitis and joint pain?

Prescribe Pred Forte 1% 1 gtt q1hr OD only and instill 1 drop of atropine in-office, with follow-up the next day Signup and view all the answers

Which of the following is a recognized side effect of DMARDs?

Kidney toxicity Signup and view all the answers

What is the most likely diagnosis for a 27-year-old female with a 20-year history of knee pain referred to as 'arthritis'?

Pauciarticular Juvenile Rheumatoid Arthritis Signup and view all the answers

What test should be performed on a 52-year-old female who has been taking Plaquenil for 6 years?

Visual field test Signup and view all the answers

In a case of anterior uveitis, what is the role of atropine when administered in-office?

It dilates the pupil to reduce pain Signup and view all the answers

What condition is associated with morning joint pain in the hands besides rheumatoid arthritis?

Psoriatic arthritis Signup and view all the answers

What is a common characteristic symptom of Still's Disease seen in patients?

High fever with rash Signup and view all the answers

Which medication is commonly prescribed to manage inflammation in cases of severe anterior uveitis?

Prednisone Signup and view all the answers

Which of the following is a diagnostic criterion for Systemic Lupus Erythematosus (SLE)?

Malar (butterfly) rash Signup and view all the answers

What percentage of patients with Systemic Lupus Erythematosus (SLE) experience arthritis?

90% Signup and view all the answers

Which lab test is most likely to yield a positive result in patients diagnosed with Systemic Lupus Erythematosus (SLE)?

Antinuclear antibody (ANA) Signup and view all the answers

Inflammation of which of the following structures indicates serositis in a patient with Systemic Lupus Erythematosus (SLE)?

Heart and pleura Signup and view all the answers

Which of the following is NOT commonly associated as a complication of Systemic Lupus Erythematosus (SLE)?

Diabetes mellitus Signup and view all the answers

Which symptom is NOT characteristic of arthritis in patients with Systemic Lupus Erythematosus (SLE)?

Presence of joint deformities Signup and view all the answers

Which of the following conditions is classified as an immunologic disorder in the context of Systemic Lupus Erythematosus (SLE)?

Serositis Signup and view all the answers

What form of skin rash is a significant cutaneous manifestation observed in Systemic Lupus Erythematosus (SLE)?

Malar rash Signup and view all the answers

Which of the following symptoms is least likely to be associated with spondyloarthropathies?

Dull pain in the elbows Signup and view all the answers

Which of these conditions is most typically characterized by asymmetric joint pain?

Spondyloarthropathies Signup and view all the answers

What is the most commonly described feature of dactylitis in spondyloarthropathies?

Sausage-like appearance of fingers and toes Signup and view all the answers

Which initial treatment is preferred for managing symptoms in spondyloarthropathies?

NSAID monotherapy Signup and view all the answers

In cases where NSAIDs fail to alleviate symptoms in axial spondyloarthritis, what class of medication is often used next?

Biologic agents like TNF-alpha inhibitors Signup and view all the answers

Which ocular condition is most often related to spondyloarthropathies?

Acute anterior uveitis Signup and view all the answers

Which type of spondyloarthropathy is conjunctivitis most frequently observed in?

Reactive arthritis Signup and view all the answers

What is a noted characteristic of spondyloarthropathies concerning joint involvement?

They exhibit bilateral involvement of ankles and knees Signup and view all the answers

Which of the following conditions is directly linked to the presence of HLA-B27?

Ankylosing spondylitis Signup and view all the answers

What is the primary site of inflammation in ankylosing spondylitis?

Sacroiliac joints Signup and view all the answers

Which condition is classified as a peripheral spondyloarthropathy?

Reactive arthritis Signup and view all the answers

What clinical presentation is indicative of reactive arthritis?

Joint pain with urethritis and conjunctivitis Signup and view all the answers

Which pathogen is most commonly linked to the development of reactive arthritis?

Chlamydia trachomatis Signup and view all the answers

Psoriatic arthritis most commonly affects which type of joints?

Distal joints Signup and view all the answers

What nail changes are characteristic of psoriatic arthritis?

Nail pitting and leukonychia Signup and view all the answers

What is the most common symptom of axial spondyloarthropathies?

Chronic back pain Signup and view all the answers

Study Notes

Anterior Uveitis

A 39-year-old woman with anterior uveitis should be managed with Pred Forte 1% 1 gtt q1hr OD, 1 drop of atropine in-office OD, and a referral to a rheumatologist for consultation.
The patient should return to the clinic the next day for follow-up.

DMARD Side Effects

Kidney Toxicity is a possible side effect of disease-modifying antirheumatic drugs (DMARDs).

Juvenile Rheumatoid Arthritis

A 27-year-old woman with a history of left knee pain for 20 years, likely has Pauciarticular Juvenile Rheumatoid Arthritis.

Plaquenil Side Effects

A 52-year-old Caucasian female who has been taking Plaquenil for 6 years should be monitored for sudden, painless vision loss. This is a potential side effect of the medication.

Arteritic Anterior Ischemic Optic Neuropathy (AAION)

Preserving remaining vision and preventing involvement of the fellow eye are the primary goals of treatment for AAION.
Oral or IV steroids are the initial treatment for AAION.
Temporal artery biopsy (TAB) is a key diagnostic test that should be performed within two weeks of starting treatment.
The Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) should be monitored closely in patients with AAION undergoing steroid therapy.

Systemic Lupus Erythematosus (SLE)

Young, non-white women of child-bearing age are most commonly affected by SLE.
Hydralazine, Phenytoin, Isoniazid are medications that can trigger drug-induced lupus.
Malar (butterfly) rash is a diagnostic criterion for SLE.
Arthritis occurs in 50% of patients with SLE, but joint deformities are not always present.
Antinuclear antibody (ANA) is the lab test most likely to be positive in patients with SLE.
Serositis, including inflammation of the heart and pleura, is a diagnostic criterion for SLE.
Pneumonitis, interstitial lung disease, Raynaud’s phenomenon, and mesenteric vasculitis are potential complications of SLE.

Ocular Manifestations of SLE

The most common ocular manifestation of SLE is unknown, as the provided text mentions HLA-B27, HLA-A1, BRCA1, CFTR, and JAK2. These are all genetic markers and not related to ocular manifestations.

Ankylosing Spondylitis

Spine (sacroiliitis) is the area of the body most commonly affected by Ankylosing Spondylitis.

Peripheral Spondyloarthropathy

Reactive arthritis is classified as a peripheral spondyloarthropathy.

Reactive Arthritis

“Can’t see, can’t pee, can climb a tree”, (conjunctivitis, urethritis, arthritis) is the classic clinical presentation of Reactive Arthritis.
Chlamydia trachomatis is the pathogen most commonly associated with reactive arthritis.

Psoriatic Arthritis

Distal joints are the most commonly affected joints in Psoriatic Arthritis.
Onycholysis and Beau’s lines, nail pitting and leukonychia are nail changes associated with Psoriatic Arthritis.

Axial Spondyloarthropathies (SpA)

Chronic, inflammatory lower back pain is the most common symptom of axial SpA.
Asymmetric joint pain affecting less than five joints is a common feature of SpA affecting the lower extremities.
Sausage fingers and toes is a classic description of dactylitis in SpA.
NSAID monotherapy is the initial treatment of choice for SpA.
Biologic agents such as TNF-alpha inhibitors or IL-17 inhibitors are commonly used next if NSAID treatment fails.
Posterior uveitis is the ocular manifestation most commonly associated with SpA.
Conjunctivitis is most commonly seen in Reactive Arthritis, not Ankylosing Spondylitis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, or Gout.
Limiting pain and maintaining joint function are the primary goals of treatment for SpA.

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Description

This quiz covers key concepts in managing anterior uveitis, DMARD side effects, and juvenile rheumatoid arthritis. It includes treatment protocols and monitoring for potential side effects of commonly used medications. Test your knowledge on rheumatologic conditions and emergency management.