Rheum

Question 1

OA of 2nd, 3rd MCPs

Answer 1

Hemochromatosis, CPPD (chondrocalcinosis)

Question 2

Sjogren’s Syndrome

Answer 2

RA syndrome

• keratoconjunctivitis sicca + xerostomia (dry eyes + mouth)
• at higher risk of NHL
• anti-Ro, anti-La, ANA, RF
• need clinical + either Ab or salivary gland bx for Dx

Question 3

CREST Syndrome

Answer 3

• *CREST Syndrome (limited systemic sclerosis)**
• *C**alcinosis: calcium deposits on skin
• *R**aynaud’s
• *E**sophageal dysfunction: acid reflux
• *S**clerodactyly
• *T**elangiectasia

Question 4

Clinical Manifestations of Scleroderma

Answer 4

Question 5

Scleroderma

Testing

Treatment

Answer 5

**Testing: **

CBC, Cr, ANA
anti-topoisomerase 1/anti-Scl-70 (spec)
anti-centromere: favours CREST
PFT, CXR, Echo for pulm HTN

**Treatment: **
low-dose steroids (<20 mg/day), methotrexate, PPI’s, ACE-I

Question 6

Dermatomyositis Skin Changes

Answer 6

• *Gottron’s papules** (pink/purple flat-topped papules on dorsum of IP’s)
• *Gottron’s sign:** red patches over doral IP’s, MCP’s, elbows, knees, medial malls.
• *Heliotrope rash:** eyelid rash usually with edema
• *Shawl sign:** rash neck shest shoulders
• *Mechanic’s hands:** dark, dry, thick scale on palmar and lateral surface digits
• *Periungual edema**

Question 7

Classification Criteria for Idiopathic Inflammatory Myopathies

Answer 7

Question 8

Idiopathic Inflammatory Myopathies

Testing

Treatment

Answer 8

Testing

CK, LDH, AST, ALT ANA, anti-Jo-1 (DM), anti-Mi-2, anti-SRP
EMG, muscle biopsy
Malignancy surveillance (breast, lung, colon, ovarian)

Treatment
high-dose steroid (1-2 mg/kg/d) and slow taper
immunosuppressive agents
Plaquenil for DM rash

Question 9

Ankylosing Spondylitis Diagnostic Criteria

Answer 9

SI, back, hips, shoulders

Question 10

Enteropathic Arthritis

Answer 10

AS in the setting of IBD and parallel in course with IBD flares/severity

Question 11

Psoriatic Arthritis Features

Answer 11

Seronegative
10% of patients with psoriasis
asymmetric oligoarthritis (70%)
DIP with nail changes
symmetric poly (like RA)
sacroiliitis/spondylitis
dactylitis/enthesopathy

Xray- pencil-in-cup appearance at IP joints

Question 12

Reactive Arthritis

Answer 12

1) sterile arthritis after infection (rheumatic fever, post-viral)
2) seronegative spondyloarthropathy with peripheral arthritis >=1 month duration shortly after certain GI/GU infections

GI: Shigella, Salmonella, Campylobacter, Yrsinia
GU: Chlamydia, Mycoplasma

Arthritis, conjunctivitis, Urethritis/cervicitis

Peripheral asymmetric arthritis, spondylitis, enthesitis, dactylitis, iritis
Keratoderma blenorrhagicum (hyperkeratotic skin lesions on palms/soles)
Balanitis circinata (small shallow painless ulcers of glans penis and urethral meatus)
Oral ulcers, diarrhea

Question 13

Fibromyalgia

Answer 13

Dx: See WPS/SS scores on uptodate
Check TSH, ESR
Do not send ANA/RF unless clinical suspicion exists
Sleep study
Tx: low dose TCA (amitriptyline), SNRI (duloxetine), anticonvulsant (pregabalin, gabapentin)