Rheuma 2 Flashcards
Scleroderma forms
Systemic/Scleroderma
Diffuse cutaneous
Limited cutaneous scleroderma
CREST Syndrome
CREST Syndrome
Calcinosis cutis Reynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasis
Most frequently involved organ in limited and diffuse cutaneous
Skin 90% and 100%
Raynaud 99 and 98
Esophageal involvemement 90 both
Clinical manifestation consistent with limited cutaneous systemic scleroderma
Sclerodactyly
Shawl sign
Heliotope rash
Dermatomyositis
Stiffness of a joint due to abnormal adhesion and rigidity of bones of joint
Ankylosis
Infalmmation of vertebrae
Spondylitis
Begins in 2nd and 3rd decade
M>F 2-3:1
Ankylosing spondylysis
AS and Reiter’s are associated with
HLA B27
AS manifestation
Dull pain in lumbar or gluteal region
Low back morning stiffness of up to few hours duration
Bony tenderness
Pain in AS
Improves with activity
Returns with inactivitg
Measures ability of px to flex lower back
Modified Schober’s
Modified Schober’s marker
L5
5cn below and 10cm above
Touch toes with knees straight
LOM in <5cm difference between 2 points
Restriction: distance bet two points do not inc by at least 5cm
Most serious complication in AS
Spinal fracture (cervical)
Extraarterial manifestation of AS
Anterior uveitis 40%
Inflammation of colon ileum
Psoariasis
Aortic insuff
Dx of AS
Chronic > or equal to 3 months back pain should have 4 or more of these
Age below 49 Insidious Improves with exercise No improvement with rest Pain at night with improvement upon getting up
Earliest radiographic change in AS
Blurring of cortical margins of subchondral bone
Erosion pseudowidening of js
Sclerosis
AS best visualized by
MRI
AS tx
NSAIDs
Anti TNF alpha
Infliximab
Surgical indication for AS
Severe hip joint arthritis
Pain and stiffness relieved by THA
Acute nonpurulent reactive arthritis complicating an infection elsewhere
Triad
Reiter’s syndrome
Conjunctivitis
Arthritis
Nongonoccocal urethritis/cervicitis
Reiter’s syndrome gene
HLA B27
60-85% positive
Reiter’s bacteria
Salmonella
Chlamydia
Yersinia
Reiter’s is presumed to be acquired
sexually esp if with new partner
Inflammation of enthesis where tendon and ligaments insert to bone
Enthesitis
Musculoskeletal manif of Reiters
Arthritis
Dactylitis (sausage digit)
Tendinitis and fasciitis
Spinal and LBP
Urogenital manifestation of Reiters
Urethritis
Cervicitis
Ocular manifestation of Reiter
Conjunctivitis
Anterior uveitis
Mucocutaneous lesions in Reiters
Keratoderma blenorrhagica (vesicle -> hyperkeratotic) of soles and palms Oral ulcer
Oral apthuous ulcer
Genital ulcer
Behcet’s syndrome
Circinate balanitis is found in
Onycholysis
Reiter’s
Less frequent manifestation of reiterks
Aortic insufficiency
Cardiac manif
Reiter’s tx
Indomethacin
If refractory
Azathioprine then Methotrexate
Neutropenia
Splenomegaly
Nodular RA
Felty’s syndrome
