Rheumatology

Antibodies

Antibody Disease ANA SLE Anti Smith (Sm) SLE Anti dsDNA SLE + Renal involvement Anti Histone Drug-induced SLE Lupus Anticoagulant Antiphospholipid Syndrome + ↑aPTT Anti Cardiolipin Antiphospholipid Syndrome + Spontaneous abortion Anti SS-A (Ro) Sjogren’s Neonatal SLE Anti SS-B (La) Sjogren’s Anti CCP RA RF RA Anti Scl-70 (Topoisomerase...

Complex Regional Pain Syndrome

Etiology After trauma 3 Phases Acute/Traumatic phase Dystrophic phase Atrophic phase Presentation Diffuse pain Out of proportion to injury Non-anatomic distribution Can occur anytime after injury Loss of function → of affected limb Sympathetic dysfunction Skin changes Soft tissue changes Blood flow changes Change in Skin temperature Hair growth...

Acute Rheumatic Fever

Due to strep pyogenes (Group A) pharyngitis and cross reaction with M protein (Hypersensitivity type 2) JONES Criteria Joints → Migratory polyarthritis ♥︎ → Carditis Nodules (subcutaneous) Erythema marginatum Sydenham’s Chorea

Behçet Syndrome

Etiology Asian Middle Eastern Presentation Painful ulcers Oral Genital Ocular lesion Uveitis Blindness Erythema nodosum-like skin lesion Arthritis CNS lesions (mimics MS) Pathergy → Sterile skin pustules from minor trauma or needle stick Diagnosis Clinical No characteristic lab Treatment Corticosteroids To wean off Azathioprine Cyclophosphamide Colchicine Thalidomide

Joint Pain

Osteomyelitis

Etiology Children → Hematogenous Adults → Contiguous (nearby) Due to diabetes, vascular insufficiency Organisms Most common → Staph aureus Sickle cell → Salmonella Hip replacement → Staph epidermidis Foot puncture → Pseudomonas IVDU → Staph aureus, Pseudomonas Presentation Diabetic patient with ulcer Warmth, redness, swelling Draining sinus Afebrile Diagnosis Best initial → X-ray If Normal → Best...

Septic Arthritis

Etiology Damaged joint DJD RA Prosthetic joint → Highest risk <3m → Perioperative → S. aureur, Pseudomonas 3-12m → Perioperative → S. epidermidis >12m → Not related to surgery → New S. aureus infection Blood spread Endocarditis IVDU Organism Staph (40%) Strep (30%) Gram ⊖ rod (20%) Staph epidermidis →...

Osteoporosis

Etiology ↓ Bone density Osteomalacia is mineralization defect due to severe ↓ Vit D Risk Factors Age Smoking Caffeine Alcohol Family history ↓ Estrogen in women Hypogonadism in men Hyperthyroidism Chronic inflammatory disease Corticosteroid Presentation Old woman Asymptomatic Spontaneous finding with routine DEXA scan in F>65y Vertebral fracture → ↓...

Seronegative Spondyloarthropathies

Ankylosing Spondylitis Etiology HLA-B27 association Can be associated with IBD → Enteropathic Spondylitis → Different from reactive arthritis Presentation Men <40y Low back pain/stiffness Worsen by rest Relieved by activity Radiate to buttocks Lumbar curvature flattening ⨁ Schober test → ↓ Spine flexion ↓ Chest expansion Enthesopathy → Achilles tendon...

Sjögren Syndrome

Etiology Lymphoplasmacytic infiltration of exocrine glands Ab against lacrimal/salivary glands 90% women Causes Idiopathic RA SLE Primary biliary cirrhosis Polymyositis Hashimoto Presentation Dry eye Keratocunjunctivitis sicca Sand in eye Burning, itching Dry mouth Need to drink water constantly Difficult swallow Dental caries → Loss of teeth Parotid swelling Dry vagina →...

Polymyositis / Dermatomyositis

Diseases Inclusion Body Myositis → T-cell mediated Polymyositis → T-cell mediated Dermatomyositis → Complex deposition Etiology Proximal muscle weakness Idiopahic Cancer (25%) Ovary Lung GI Lymphoma Presentation Muscle Getting up from chair Walking up stairs Pain/tenderness (25%) Dysphagia → Difficulty initiate swallowing Myocarditis Heart block ↑CK-MB but Cardio is normal! NO facial/ocular...

Systemic Sclerosis (Scleroderma)

Etiology Collagen deposition Presentation 80% → Limited → CREST Syndrome Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangectasia Can also have primary pulmonary HTN NO damage to the lungs 20% → Diffuse → CREST + organ involvement Raynaud White → Blue → Red Precipitated by cold and stress Skin Fibrosis Telangectasia Pigmentation abnormality GI GERD Large-opening diverticula...