Clin Med

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Rheumatology

Degeneration of joint spaces and bony overgrowths, Over 75, involving DIPs PIPs Hips and Knees, crepitus, morning stiffness less than 30 min

Osteoarthritis

X-Ray assymmetric joint space narrowing, osteophytes, subchondral cysts and sclerosis, ESR normal, RF negative, WBC <500

Osteoarthritis

Life-style Modifications, Vitamin supplements, Creams, Acetaminophen, NSAIDS, NSAID and Tramadol, Arthroplasty, Osteotomy

Osteoarthritis

Polyarthritis, systemic autoimmune inflammatory disease, symmetric synovitis, joint erosions, and extra articular manifestations, women, age 30 to 40

Rheumatoid Arthritis

Symmetric pain and swelling of joints, PIPs and MCPs, wrists, elbows, knees, nodules, constitutional symptoms (fatigue, weight loss, fever) Morning stiffness >1hr, ulnar deviation, Extra articular manifestations

Rheumatoid Arthritis

Morning stiffness >1hr, Symmetric joint swelling, Rheumatoid nodules, Serum rheumatoid factor, RFpositive, Anti-CCP positive, ESR & CRP elevated, WBC > 2, 000

Rheumatoid Arthritis

Soft tissue sweilling, periarticular osteopenia, bony erosions

Rheumatoid Arthritis

ASA, NSAIDs, COX-2 inhibitors, DMARDs

Rheumatoid Arthritis

Chronic, widespread pain, sleep disturbances, fatigue, and diffuse tender points, women, 30-50

Fibromyalgia

Tenderness to palpation in 11 of 18 bilateral sites

Trigger Points, Fibromyalgia

Lifestyle modification(exercise, stress relief, sleep aids), TCAs, SSRIs, Dual-reuptake inhibitors

Fibromyalgia

Pollyarthritis and systemic multi-organ disease, women in childbearing years, African Americans>White, exacerbations and remissions

Systemic Lupus Erythematosus (SLE)

Constitutional Symptoms (fatigue, fever, myalgia), Arthritis, Malar rash, Discoid rash, Mucosal ulcerations, Raynaud's phenomena

Systemic Lupus Erythematosus (SLE)

Serositis, Pericarditis, Renal disorder, hematologic disorders

Systemic Lupus Erythematosus (SLE)

Antinuclear Antibodies (ANA) Positive, Anti-double stranded DNA (Anti-dsDNA), anti-Smith (anti-sm), anemia, elevated ESR, false syphilis test

Systemic Lupus Erythematosus (SLE)

NSAIDs, Prednisone, Hydroxychloroquine, Methotrexate, Azathioprine, Mycophenolate, Cyclophosphamide

Systemic Lupus Erythematosus (SLE)

Chronic immune-mediated inflammatory disorder of the salivary, lacrimal, and other exocrine glands

Sjogren's Syndrome

Dryness of eyes and dry mouth, women, possible positive RA, possible non-Hodgkin's lymphoma

Sjogren's Syndrome

Xerophthalmia, Keratoconjunctivitis sicca- sensation of grit or sand in eyes, Xerostomia, enlarged, tender parotid glands

Sjogren's Syndrome

Tx: Patient education good oral hygiene, Artificial tears, NSAIDs and Hydroxychloroquine, punctal occlusion

Sjogern's Syndrome Treatment

Inflammatory back pain, Enthesitis, Dactylitis (sausage digits), Periperhal arthritis, RF and ANA negative, HLA-B27

Spondyloarthropathies

Onset before 35, men, Family history of early-onset low back pain, pain in sacroiliac (SI) joints and the spine

Ankylosing Spondylitis (AS)

Insidious Low back pain for more than 3months, improves with exercise, worsens with rest, morning stiffness of spine

Ankylosing Spondylitis (AS)

Schober's test

toe to floor measurement, Ankylosing Spondylitis

Xray: sacroiliitis, Bony fusion ("bamboo spine")

Ankylosing Spondylitis

Tx: Exercise, Maintain posture, NSAIDs (indomethacin), Sulfasalazine, Methotrexate, Steroids, TNF inhibtors

Ankylosing Spondylitis

Deposition of monosodium urate cyrstals in the joints or soft tissue. Hyperuricemia

Gout

Men, African American, who drink beer and eat red meat

Gout

Myeloproliferative d/o, carcinoma, cytotxic drugs, enzyme dificiences, obesity

overproducers gout

Intrinsic renal disease, tubular disease, alcoholism, dehydration, lactic acidosis

Underexcreters gout

Sudden onset of acute painful arthritis (erythemia, swelling, warmth), nocturnal, monoarticular 1st MTP (podagra)

Acute Gouty Attack

Tophi- chalky deposits of monosodium urate, seen in the joints of the hands/feet, ears, wrists, olecranon bursa, achilles tendon

Chronic Tophaceous Gout

Dx: aspiration and visualiation of crystals under plarizing microscope, Needle or rod shaped crystals, negatively birefringent, soft tissue swelling, punched out erosions

Gout

NSAIDs (indomethacin), or cochicine. no allopurinol

Acute Gout

Xanthane Oxidase Inhibitors (allopurinol) uricosuric drugs and xanthine oxidase inhibitor

Chronic Gout

Rhomboid shaped and birfringent Calcium pyrophosphate dihydrate crystals in larger joints (knee, hip)

pseudogout

NSAIDS, intra-artocular corticosteroids, aspirations, possibly colchicine

pseudogout

Inflammation of the blood vessels; GCA, Henoch-Schonlein Purpura, Polyarteritis nososa, Wegener granulamatois, Goodpasture syndrome.

Vasculitic Syndromes

Granulomatous arteritis of large vessels and medium-sized arteries that can lead to sudden blindness

Giant Cell Arteritis (GCA)

New onset of severe unilateral headache located over the temporal or occiptal regions, jaw claudication, Scalp tenderness, vision disturbances (blindness)

Giant Cell Arteritis (GCA)

Scalp tenderness or loss of pulsation of the temporal artery, Erythematous, thickened, or tender cord of temporal artery

Giant Cell Arteritis (GCA)

ESR>50mm/hr, Anemia, Mild abnormal LFTs, increased alkaline phosphotase, Temporal artery biopsy

Giant Cell Arteritis (GCA)

High-dose corticosteroids , low dose corticosteroids to prevent recurrences

Giant Cell Arteritis (GCA)

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