Clinical - Dis & ddx

Question 1

DDx - nodules (elbows)

Answer 1

• Rheumatoid nodules - firm, non tender
• Olecranon bursa - fluid filled, tender, transilluminate\
• Tendon xanthomata - over tendon
• Cutaneous sarcoid
• Granuloma annulare

Question 2

DDx - vasculitis & rheum dis

Answer 2

• Rheumatoid arthtisis
• Other causes polyarthritis: PAN, ANCA-vasculitides (EPG, MPA, GPA)
• Cryoglobulinaemia

Steroids - Purpura (look for other signs steroid)

Question 3

RA - other manifestations of dis

Answer 3

• Other MSK examinations: feet, knees, elbows, shoulder
• C-spine: atlantoaxial subluxation (cervial myelopathy)
• Eyes: episcleritis, scleritis, scleromalacia perforans, Cataracts, Sjogrn
• Anaemia: conj pallor
• Heart: pericarditis
• Skin: pyoderma gangrenosum
• Abdo: splenomegaly (Feltys), hepatosplenomegaly (2ndary amyloid)
• Kidneys: nephrotic syndrome (oedema, proteinuria)
• Nervous system: mononeuritis multiplex, polyneuropathy

Question 4

RA - possible causes of anaemia

Answer 4

• Anaemia of chronic dis
• Iron def (GI blood loss 2** NSAIDs)
• Folate def 2** MTX
• Perniciious aenamia (assoc AI dis)
• BM suppression (meds - SSZ, MTX, penicillamine)
• Feltys syndrome
• AIHA
• anaemia of renal dis