CM - Rheum Skin

Chronic, autoimmune, systemic, inflammatory disorder of unknown cause characterized by slow progression of keratoconjunctivitis sicca and xerostomia. What is the diagnosis?

• Sjogren Syndrome

• Scleroderma

• Raynaud's

• Polymyositis

• Dermatomyositis

What is NOT a lab that should be done to evaluate for Sjogren's Syndrome?

• Rheumatoid factor

• ANA: SS-A (R0), SS-B (La)

• Thyroid function tests

• Schirmer test

• SCL-70/ Anti-RNA polymerase III antibodies

Answer explanation

- CBC

- Rheumatoid factor

- ANA: SS-A (Ro), SS-B (La)

- Thyroid function tests

- Schirmer test

- Lip biopsy

- Parotid gland biopsy

55 yo female pt presents with slow progression of burning, itching, photophobia, and foreign body sensation in the eyes. Pt also reports dysphagia, feeling of "cotton mouth," dental caries, loss of taste/smell. On PE you note parotid enlargement. What is NOT a possible treatment?

• Topical ocular 0.05% cyclosporine

• Hard candy/sugar free gum

• Phosphodiesterase inhibitors

• Pilocarpine/ Cevimeline

• Xylimelts

Answer explanation

Sjogren Syndrome

- Artificial tears

- Topical ocular 0.05% cyclosporine

- Increase water intake

- Hard candy/sugar-free gum

- Pilocarpine/Cevimeline (increase flow of saliva)

- Fluoride/oral hygiene

- Xylimelts

What is NOT something that can impact prognosis of Sjogren's Syndrome patients?

• Pulmonary disease

• Lymphocytic vasculitis

• Painful peripheral neuropathy

• Lymphoma

A syndrome of paroxysmal digital ischemia, most commonly caused by an exaggerated response of digital arterioles to cold or emotional stress. Intermittent arteriolar vasospasms. What is the diagnosis?

• Sjogren Syndrome

• Scleroderma

• Raynaud's

• Polymyositis

• Dermatomyositis

25 yo female pt with no PMH presents with changes to all fingers symmetrically on each hand, but excluding the thumbs. Pt denies pain, ulcers, and hx of peripheral vascular disease. Labs show negative ANA. What diagnsis do you suspect?

• Primary Raynaud's

• CREST syndrome

• Polymyositis

• Secondary Raynaud's

• Dermatomyositis

Answer explanation

Pt with PMH of autoimmune disease presents with changes to fingers asymmetrically. Symptoms exclude the thumbs. Pt admits to pain and ulcers. What diagnsis do you suspect?

• Primary Raynaud's

• CREST syndrome

• Polymyositis

• Secondary Raynaud's

• Dermatomyositis

Answer explanation

Pt presents with rubor, throbbing/pain, paraesthesia, and slight swelling in the fingers down to the distal palm. Initially it only impacted 1 or 2 fingertips affected. The symptoms improve with warmth. What is NOT included in the treatment?

• Topical nitrates

• Phosphodiesterase inhibitors

• CCB

• Pilocarpine

• Lotion

Answer explanation

Raynaud's

- Warmth

- Lotion

- Stop smoking

- Avoid decongestants, diet pills, amphetamines

- CCB

- Topical nitrates

- Phosphodiesterase inhibitors

- SSRIs

- Endothelin-receptor inhibitors

Pt presents with rubor, throbbing/pain, paraesthesia, and slight swelling in the fingers down to the distal palm. Initially it only impacted 1 or 2 fingertips affected. The symptoms improve with warmth. What is NOT included in the treatment?

• Avoid decongestants, diet pills, amphetamines

• SSRIs

• Endothelin-receptor inhibitors

• Cevimeline

• Stop smoking

Answer explanation

Raynaud's

- Warmth

- Lotion

- Stop smoking

- Avoid decongestants, diet pills, amphetamines

- CCB

- Topical nitrates

- Phosphodiesterase inhibitors

- SSRIs

- Endothelin-receptor inhibitors

A chronic multisystem disease characterized by autoantibody production, collagen deposition, and vascular dysfunction. Fibrosis of skin and internal organs. Name meaning "hard skin." What is the diagnosis?

• Sjogren Syndrome

• Scleroderma

• Raynaud's

• Polymyositis

• Dermatomyositis