(2) Lupus, Systemic Sclerosis & Gout Flashcards
What areas of the body are affected by Lupus?
- multiple organ systems
- primarily skin, joints, kidneys
(affects ligaments > bone)
What demographic is Lupus more common in?
women of childbearing age
What are the general clinical manifestations of Lupus?
- gradual onset
- chronic fever & malaise
- skin rash (malar rash)
- arthralgia (late stage; BL symmetric)
Lupus is characterized as a ____-____ disorder
collagen-vascular
What radiographic characteristics of Lupus are caused by vasculitis?
- soft tissue calcifications
- osteonecrosis
What deformities may be caused by Lupus?
(reversible subluxations)
- swan neck
- boutonniere
- hitch-hiker thumb
- ulnar drift
What imaging test is required before any treatment to the neck in a patient with any autoimmune condition?
c/s radiographs with flexion/extension
The butterfly rash of systemic lupus erythematosus is also known as ____
malar rash
How does soft tissue calcification in Lupus appear radiographically?
diffuse (tiny white dots everywhere)
What are the 3 radiographic findings for osteonecrosis in order of occurrence?
- sclerosis
- flattening
- fragmentation
What are the relevant lab findings for Lupus?
- ^ESR/CRP
- ANA
- Anemia (ACD)
- Anti-DSDNA
What are the radiographic findings of Lupus?
- osteopenia
- reversible subluxations in hands (deformity w/o arthropathy)
- soft tissue calcification
- osteonecrosis
- atlanto-axial instability (^ADI)
What is a possible complication of corticosteroids used for Lupus?
avascular necrosis (AVN)
(Lupus already predisposes to AVN on its own)
What are other names for systemic sclerosis?
- progressive systemic sclerosis
- scleroderma (old name; implies skin only)
Systemic sclerosis is a ____-____ disorder
collagen-vascular
(excess collagen + vasculitis)
How does vasculitis present in patients with systemic sclerosis?
Raynaud phenomenon (finger/toe tips, ears, nose)
What is CREST syndrome?
Aspects of progressive systemic sclerosis:
- Calcinosis
- Raynaud phenomenon
- Esophageal motility issues
- Skin/subcutaneous calcification
- Telangiectasia (bruising)
What are the clinical features of progressive systemic sclerosis?
- peripheral pain & swelling
- Raynaud phenomenon
- thickening of skin (sclerosis; Vitiligo)
- mouse-like facies
- dilation of esophagus (GERD)
- decreased bowel function
- pleural/pericardial effusion
- may have deformity w/o arthropathy
What are the radiographic characteristics of systemic sclerosis?
- Acro-osteolysis (ungual tuft resorption)
- soft tissue retraction, tapered fingers
- calcinosis cutis (working surface)
Gout is characterized by ____ deposition throughout the body
sodium monourate crystal
(uric acid crystals)
What population is primarily affected by gout?
M>F (20:1)
40-50s
What is often the initial joint affected by gout?
big toe (1st MTP)
Gout in the big toe is called ____
Podagra
What would be on your differential diagnosis list for a patient with 1 big, red, swollen joint within a day?
- septic arthritis
- gout
- cellulitis
- osteomyelitis
What are the 4 stages of gout?
- asymptomatic hyperuricemia
- acute gouty arthritis
- polyarticular gouty arthritis
- chronic tophaceous gout
What is another name for chronic tophaceous gout?
lumpy bumpy joint disease
What causes the “lumpy bumpy” appearance of chronic gout?
tophi
What are the radiographic characteristics of gout?
- overhanging margin sign
- dense soft tissue tophi
- corticated bone erosions
- secondary degeneration
- soft tissue swelling
What causes “overhanging margin” sign in gout?
bone regrowth of marginal bone during remissions
What causes corticated erosions in gout?
longer remission periods of gout allow for thin cortical bone to begin forming around erosions
What is the average radiographic latent period for gout?
7 years
What would you include on your list of differential diagnoses for extensive soft tissue swelling around the elbow?
- Olecranon bursitis (“water on the elbow”)
- septic bursitis
- gout (in olecranon bursa)
What can worsen erythema in a patient with Lupus?
sunlight (UV exposure)
What is the diagnostic latency period for Lupus?
7 yrs
(labs used for early Dx)
Can you adjust a patient who has Lupus?
No, adjusting is contraindicated, especially in c/s
What sign may be seen in a patient with Lupus if there are small temperature changes in the environment?
Raynaud phenomenon
(acute necrotizing vasculitis causes hyperreactivity of BVs)
What deformities may be caused by Lupus?
(reversible subluxations, as opposed to RA which is more rigid)
- swan neck
- boutonniere
- hitch-hiker thumb
- ulnar drift
What are the possible clinical manifestations of systemic sclerosis involving the GI tract?
- Xerostomia (dry mouth)
- dysphagia
- GERD (severe reflux)
What is Mouse-like facies, and what is the associated diagnosis?
Dx: systemic sclerosis
Erosion of zygomatic arches due to tightening on skin, creating a pointier nose
Give 3 differentials for acro-osteolysis.
- Systemic Sclerosis
- SLE
- psoriatic arthritis
What are 2 causes of gout?
- ^purines in diet
- renal Dz (MC diabetes)
