Rheumatology Flashcards
Extra-articular manifestations of rheumatoid arthritis
- Constitutional Sx (fevers, weight loss, fatigue)
- Bone loss
- Muscle weakness
- Cutaneous - rheumatoid nodule, vasculitis
- Sjogren’s syndrome
- Eye: episcleritis, scleritis, uvetitis
- Pulmonary: pleurisy/ pleural effusion, parenchymal lung disease (ILD,. nodules, bronchiolitis, organising pneumonia)
- Cardiac: pericarditis/pericardial effusion, myocarditis, heart failure, Increase CVS risk
- Renal (rare): GN. membranous nephropathy, vasculitis
- Neuro: carpal tunnel syndrome, compressive myelopathy/radiculopathy
- Anaemia
- Lymphadenopathy
Clinical features RA
Hands
- Z-line deformity; hyperextension IP
- Swan neck deformity; DIP flexed, PIPJ volar
- Boutonniere deformity; opposite of swan neck
C-spine
Wrist
- Radial deviation wrist
- Ulnar deviation of dingers
- Carpal tunnel syndrome
Felty Syndrome
In long-standing seropositive nodular deforming RA
- Neutropenia
- Splenomegaly
- RA
X-Ray Findings in RA
- Joint effusion and periarticular swelling
- Marginal erosions
- Joint space narrowing
- Symmetric involvement
Diagnosis of RA
- Joint involvemet: small > large, >10 joints
- RF+ (sensitive), anti CCP (specific)
- CRP + ESR
- Duration >6 weeks
CRP/ESR + swollen joint count (+ pain) helps assess the severity and activity
Causes of Drug Induced Lupus
Procainamide Hydralazine Minocycline Diltiazem Pencillamine Isoniazid Quinidine IFN-alpha Methyldopa Chlorpromazine
Clinical Features of Lupus
Skin: malar rash, diffuse erythema, photosensitive rash
Non-scarring Alopecia
Oral/nasal ulcers
Inflammatory synovitis - symmetrical, polyarticular, migratory (non-deforming, non-erosive)
Serositis - pleuritis, pericarditis
Cardiac: valvular heart disease (mitral > aortic);
Libman Sacks endocarditis
Renal - 500mg/24hr proteinuria or red blood cell casts
Neurologic - seizure, psychosis, mononeuritis multiplex, myelitis, peripheral /cranial neuropathy, cerebritis
Markers of Lupus Activity
ESR>CRP
Increased anti-dsDNA
Low C3/C4
