Characteristic Presentation Flashcards
Fatigue, malar rash, inflammatory and symmetric joint pain, photosensitivity
SLE (may also see discoid lesions, Reynaud’s, myalgias, pericarditis/endocarditis, pleuritis, hemolytic anemia, proteinuria/GN, impaired immune response, nausea/vomiting/dyspepsia, seizures/psychosis)
Treatment: NSAIDS for mild symptoms, corticosteroids for exacerbations and severe manifestations, hydroxychloroquine (constitutional/cutaneous/articular), and cyclophosphamide (glomerulonephritis)
SLE syndrome without CNS or kidney involvement
Drug-induced lupus
Treatment: remove offending drug (hydrazine, procainamide, isoniazid, chlorpromazine, methyldopa, quinidine)
Raynaud’s, sclerodactyly, dysphagia, pulmonary HTN
Diffuse scleroderma (can have renal malignant HTN, pulmonary HTN/interstitial fibrosis, or pericardial/myocardial involvement)
Treatment: symptomatic, treat complications
Raynaud’s, sclerodactyly, dysphagia, calcium deposits, telangiectases under nails
CREST (cutaneous limited–no renal/pulmonary/cardiac findings)
Treatment: symptomatic
Dry eyes/mouth, arthalgias, interstitial nephritis, vasculitis, positive Schirmer test
Sjogren’s (Dx: Schirmer test for lacrimal gland output, salivary gland biopsy)
Treatment: pilocarpine/cevimeline (increase secretions), artificial tears, NSAIDS
Pulmonary manifestations, esophageal dysfunction, polyarthritis, sclerodactyly, cutaneous findings, myopathy, Raynaud’s
Mixed connective tissue disease (SLE, RA, systemic sclerosis, polymyositis)
Treatment: varies depending on which disease predominates
Fatigue and symmetrical joint pain in PIP/MCP/wrist/knees, morning stiffness which improves throughout day, subcutaneous nodules over extensor surfaces
RA
Treatment: NSAIDS/low dose corticosteroids and DMARDS (methotrexate with folate, leflunomide, or hydroxychloroquine)
Anemia, neutropenia, splenomegaly, RA
Felty’s syndrome
50 year old man with podagra and fever
Gouty arthritis (Dx: needle shaped negatively birefringent urate crystals in synovial fluid)
Treatment: bed rest, indomethacin, colchicine, corticosteroids (oral or intra-articular injection)
Prophylactic: allopurinol (xanthine oxidase inhibitor decreases uric acid synthesis), probenecid (uricosuric drugs increase renal excretion of uric acid)
Acute onset of severe unilateral knee or wrist pain with erythema, swelling, and warmth
Pseudogout, also called calcium pyrophosphate deposition disease (Dx: weakly positively birefringent rod-shaped and rhomboidal crystals in synovial fluid)
Treatment: treat underlying disease (hemochromatosis, hyperparathyroidism, hypothyroidism, Bartter’s syndrome) and manage symptoms with NSAIDS, colchicine, and intra-articular corticosteroid injections
Subacute onset of weakness of neck flexors, shoulder girdle, and pelvic girdle muscles with myalgias and rash around eyes, bridge of nose, and cheeks
Elevated CK, AST, ALT, and LDH
Dermatomyositis (can be associated with vasculitis)
Types of rashes: heliotrope, Gottron’s papules (scaly lesions over knuckles), V sign (rash on face, neck, anterior chest), shawl sign (rash on shoulders, upper back, and elbows), periungual erythema with telangiectases
Treatment: corticosteroids and immunosuppression (methotrexate, cyclophosphamide, chlorambucil)
Weakness of shoulders and pelvic muscles, dysphagia, and myalgias
Polymyositis
Treatment: corticosteroids and immunosuppression (methotrexate, cyclophosphamide, chlorambucil)
Older man with progressive asymmetrical weakness of quadriceps, forearm flexors, tibialis anterior, and facial weakness with loss of deep tendon reflexes and dysphagia
Inclusion body myositis
Treatment: poor response
Weakness of shoulders and pelvic muscles, dysphagia, and myalgias
Polymyositis
Treatment: corticosteroids and immunosuppression (methotrexate, cyclophosphamide, chlorambucil)
Older man with progressive asymmetrical weakness of quadriceps, forearm flexors, tibialis anterior, and facial weakness with loss of deep tendon reflexes and dysphagia
Inclusion body myositis
Treatment: poor response
