what are the clinical features of RA
slow onset chronic polyarticular - hands/feet small joints low grade fever myalgia malaise fatigue systemic - heart and lungs
what are the lab features of RA
anemia present
WBC normal or increase
RF/RA factor
Anti CCP
what percent of people with RA have anemia
40% of men
60% of women
in 3% of RA cases, what other problems occur
leukopenia
splenomegaly
RA
= Feltys Syndrome
how sensitive is RA/RF factor for rheumatoid arthritis
85%
how sensitive is anti CCP for rheumatoid arthritis
95%
what are the seronegative spondyloarthropathies also called
rheumatoid variants
what are the clinical features of AS
spine and SI joints
extremities - 30%
males common
what are the lab features of AS
ESR increase 90%
HLA-B27 - not diagnostic
what are the clinical features of psoriatic arthritis
DIP joints
spine 20%
what percent of psoriatics develop arthritis
10%
what are the clinical features of reiters syndrome
arthritis urethritis - non GC conjuctivitis iritis mucocutaneous oral ulcers
what are the clinical features of arthritis associated with IBD
20% of IBD develop migratory, lower extremity, peripheral joint disease
sacroilitis 15%
iritis is common
spondylitis 5%
iritis is common in what 2 arthritidies
reiters syndrome
and
enteropathic/IBD
enteropathic/IBD arthritis commonly affects what joints
knee and ankle
acute rheumatic fever is caused by what
group a beta hemolytic strep
hypersensitivity reaction after infection of GABHS
what are the aggregations of histiocytes called in acute rheumatic fever
aschoff bodies
what are the clinical features of acute rheumatic fever
fever
migratory arthritis
cardiac damage
renal damage
what is the ASO titer used for
what are the values that may indicate or that are diagnostic of the disease
GABHS
> 200 = indicative of recent strep infection
> 500 = diagnostic for disease
what are the lab values of acute rheumatic fever
ASO titer
>200 - indicates strep
>500 - diagnostic
ESR elevated
what is a extremely painful and immobilizing form of arthritis
gout
what are the clinical features of gout
painful
monoarticular
affects big toe
what part of the body does gout rarely affect
spine
what causes gout
uric acid accumulation from purine synthesis
increased intake of purines - doesnt cause gout - may worsen tho
decreased excretion of uric acid
increased production of uric acid
decreased secretion of uric acid can be caused by what
renal insufficiency thiazide diuretics ketoacidosis alcoholism hypothyroidism
increased production of uric acid can be caused by what
hypermetabolic syndromes myeloproliferative syndrome leukemia polycythemia vera malignancy chemo or radiation hemolytic anemia diabetes sarcoidosis
what are a defined group of diseases exhibiting necrosis of collageneous tissue and inflammatory arterial disease
collagen vascular disease
what are the clinical features of collagen vascular diseases
myalgia
fatigue
headache
stiffness
what are examples of diseases in the group of collagen vascular diseases
progressive systemic sclerosis (PSS) mixed connective tissues disease (MCTD) sjorgens syndrome temporal arteritis SLE
what does ANA indicate
any autoimmune disorders
SLE, MTCD, PSS, RA, scleroderma, sjorgens
ANA is 95% sensitive for what autoimmune condition
SLE
anti DNA is found in what conditions
SLE 60-80% (anti DNA ds)
rare in all other autoimmune disorders
what are the two subtypes of anti DNA
double strand ds
single strand ss
which subtype of anti DNA is found in SLE
double strand anti DNA
ds
anti ENA is found in what conditions
SLE and MCTD
not found in any other autoimmune conditions
what does anti ENA stand for
anti extractable nuclear antigen
anti scleroderma 70 is DIAGNOSTIC for what condition
PSS
