Rheum Flashcards
Pt don’t want you to move their joints
BBC joints:
- bugs
- blood (trauma, A/C, haemophilia)
- crystals
3 pattern of joint pain
Inflammatory
Mechanical
Fibromyalgia
Fat floating on blood from joint tap
Intraarticular #
Shoulders differential
- stiffness: PMR
- limited ROM: adhesive capabilities, glenohumeral OA
- weakness: polymyositis. cervical radiculopathy
- mostly pain: rotator cuff injury, acromioclavicular OA
PMR rare
< age 50
In Afro-Americans
PMR most common
In Caucasian women
PMR clinically
Not a myopathy (misnomer)
Not an arthritis
It’s a periarticular synovitis
Bilateral carpal tunnel sy
DMT2, amyloid, PMR, RA, pregnancy, hypothyroid
RS3PE - what is it? And Tx
Remitting seronegative symmetric synovitis w pitting edema (? variant of PMR)
Tx: low dose of prednisone
PMR -Tx
- 10-20 mg prednisone daily (sometimes need to split the dose)
- Begin taper at 4 wks; Tx for 24 months
- 10% remittent
- 10% will develop GCA
Rotator cuff muscles
Subscapularis - int rotation
Supraspinatus - abduction
Infraspinatus, teres minor - external rotation
A/C joint OA
Point tenderness at high overhead and cross body adduction
Rotator cuff injury - Tx
PT and adjunct steroid injection
Gardner’s rule 13
OA in unusual locations think unusual pathology
Popeye muscle
Rupture of the long head of biceps
Elevated CK DDx
Idiopathic CKemia
Heavy exercise
Metabolic (hypothyroid, hypoK)
Meds/drugs (EtOh, statins, BB, antiY, colchicine)
Muscle disease (PMR, DM, PM, IBM (incl body myositis), muscle dystrophy, metabolic myopathies)
PM mechanism
T-cell mediated endomysial inflammation causing myalgia and weakness
DM mechanism
B-cell mediated peri vascular and perimysial inflammation causing pain and weakness + skin changes
ANA and anti-Jo1 in DM/PM
ANA 80%
anti-Jo1: predict ILD
