Clinical Approach to Rheumatic Disease Lecture Powerpoint

Question 1

Bechet’s syndrome

Answer 1

Autoimmune disease state more common in turkish and korean populations causing inflammation of blood vessels thruout the body that sees recurrent oral and vaginal ulcerations

Question 2

HLA B27 gene

Answer 2

Found in 20% of population, up to 90% presence in patients with ankylosing spondylitis

Question 3

Geling phenomenon

Answer 3

Sees individuals that are stiff after prolonged periods of inactivity (sitting for long period of time or sleep), patients with osteoarthritis will be stiff for short time while inflammatory disease patients such as arthritis will be stiff for hours potentially after inactivity

Question 4

Degenerative vs inflammatory distribution

Answer 4

Helps differentiate osteoarthritis from rheumatoid, degenerative affects DIP, PIP, cervical spine, lumber spine, hips, knees, and MTP joints, while inflammatory tends to spare the DIP and lumbar areas, degenerative has hard boney enlargement while inflammatory has softer synovial inflammation

Question 5

Monoarthritis commonly presents in these diseases (5)

Answer 5

• gout (more common in 40+)
• pseudogout (more common in 85+)
• septic arthritis
• osteoarthritis
• lyme disease

Question 6

Symmetrical polyarthritis most commonly presents in these diseases (4)

Answer 6

• RA
• lupus
• degenerative osteoarthritis
• juvenile idiopathic arthritis

Question 7

Asymmetrical pauciarticular (oligoarticular) most commonly presents in these diseases (5)

Answer 7

• psoriatic arthritis
• reactive arthritis/reiter’s
• microcrystalline gout
• lyme
• juvenile idiopathic arthritis

Question 8

ASAS criteria for inflammatory back pain

Answer 8

• improvement with exercise
• pain at night
• insidious onset
• age less than 40
• no improvement with rest

(4-5 of these features)

Question 9

Functional classification of rheumatic disease

Answer 9

I - completely able to carry out all usual duties of daily living
II - able to perform self care and vocational activities but with limited avocational activities
III - able to perform usual self care activities but limited in vocational activities
IV - limited ability to perform self care even

Question 10

Periungual telangiectasias

Answer 10

Small dilated blood vessels in the periungual area (around the nail) almost always indicative of connective tissue disease such as lupus, scleroderma, or myositis

Question 11

Malar rash

Answer 11

A butterfly rash that spares the nasolabial folds, has photosensitivity pattern and is highly suggestive of lupus

Question 12

Onycholysis

Answer 12

Lifting off of nail off bed causing white appearance deep in nail bed, indicative of psoriatic nails and could later on see osteoarthritis of the DIP joint

Question 13

Palpable purpura

Answer 13

Small slightly raised red spots that is indicative of vasculitis

Question 14

Pyoderma gangrenosum

Answer 14

Inflammatory noninfectious ulceration found often in inflammatory bowel diseases, RA, and SLE

Question 15

Sicca complex

Answer 15

Dry eye and dry mouth (xerostomia), also known as sjogren’s syndrome

Question 16

Patients with bilateral general extremity muscular weakness (not necessarily pain, may have difficulty standing off toiet!!!) might have what neurological manifestation of rheumatic disease?

Answer 16

Polymyositis

Question 17

FABER test for hip disease

Answer 17

Flexion, abduction, external rotation

Question 18

Hip disease causes pain in the….

Answer 18

….anterior groin and thigh