rheumatology Flashcards
(9 cards)
Causes of Acute and Chronic Monoarthritis
ACUTE
Septic arthritis - staphylococcal, gonococcal, secondary to penetrating injuries
Traumatic
Gout / Pseudogout / Hydroxyapatite arthropathy
Haemarthrosis
Seronegative spondyloarthritis
CHRONIC
Tuberculosis
Seronegative spondyloarthritis
Pigmented villonodular synovitis
Causes of Acute and Chronic Polyarthritis
ACUTE Infection - viral, bacterial Onset of chronic polyarthritis CHRONIC Rheumatoid arthritis Seronegative spondyloarthritis Primary osteoarthritis Gout / Pseudogout / Hydroxyapatite Arthropathy Connective tissue disease (e.g. SLE) Infection - Lyme, spirochete infection
Rheumatoid Arthritis Features
Symmetrical Hands: wrist, MCP, PIP (distal spared) Elbows Knees Small joints of upper cervical spine Feet: tarsal and metatarsophalangeal joints
Bouchard’s nodes
Crepitus in joints denoting inflammatory disease
Rheumatoid nodules
Interstitial lung disease
Eyes: episcleritis
NO anterior uveitis
Psoriatic Arthritis Features
Arthritis - asymmetrical > symmetrical
- usually involves DIP, PIP, MCP, wrist
Dactylitis
Plaques - extensor surface, hair, behind ears
Nail Changes
Hyperkeratosis (thickening of nails)
Onycholysis (detachment of nail from nailbed)
Sacroiliitis, Enthesitis of achilles tendon, plantar fasciitis
X-Ray: pencil-in-cup appearance
Dermatomyositis Features
SKIN FEATURES
Heliotrope Rash - red/purple rash around eyes. Occasionally manifests as plaques over eyelids instead.
Gottron’s papules - scaly erythematous lesions over dorsum of hands, knuckles, and extensor surfaces of small joints
Poikiloderma - red rash over photo-exposed areas, often seen in a shawl-like distribution
SYSTEMIC FEATURES Proximal muscle weakness Respiratory muscle weakness Cardiomyopathy, Arrhythmias Interstitial lung fibrosis
Don’t forget malignancy!
Scleroderma Systemic Features (extra-cutaneous/musculoskeletal)
Cardiac
Cardiomyopathy; congestive heart failure
Conduction defects: heart blocks, arrhythmias
Pericarditis / effusion
Vascular
Raynaud’s
Digitial ischaemia and ulcers
Respiratory
Interstitial lung disease - fibrosis
Pulmonary hypertension
Oesophageal reflux / dysmotility –> aspiration
Gastrointestinal
Reflux / dysmotility
Oesophageal stricture
Bacterial overgrowth, malabsorptive disorders
Decreased peristalsis throughout GI tract - bloating, constipation, diarrhoea, early satiety
Renal
Scleroderma renal crisis - HTN, MAHA, renal failure
Endocrine
Hypothyroidism
Scleroderma Cutaneous and Musculoskeletal Features
Cutaneous Sclerodactyly Calcinosis Telangiectasias Contractures Digital ulcers
Musculoskeletal
Arthralgias / arthritis
Tendon friction rubs
Myositis
What are the clinical features of CREST syndrome?
Calcinosis Raynaud's phenomenon oEsophageal dysmotility Sclerodactyly Telangiectasias
Other associations:
ANA and anti-centromere positive
Found in around 10% of patients with primary biliary cirrhosis
Can cause pulmonary HTN
What are the clinical features of anti-synthetase syndrome and it’s systemic associations?
Mechanic’s hands
Raynaud’s phenomenon
Interstitial lung disease
Inflammatory polyarthritis and myopathy
Dx
Elevated anti-Jo1 and CK
Muscle biopsy
