Rheumatology Flashcards
SLE diagnostic criteria
Clinical
- Acute lupus rash
- Chronis lupus rash
- Oral ulcers
- Non-scarring alopecia
- Synovitis
- Serositis
- Renal disorder
- Neurological disorder
- Haemolytic anaemia / leucopaenia / thrombocytopaenia
Immunological
- ANA
- Anti-ds DNA
- Anti-sm
- aPL antibody
- Low compliment
- Direct combs test (absence of haemolytic anaemia)
Drug induced lupus
Procainamide
Hydralazine
Methyldopa
Chlorpromazine
Isoniazid
Quinidine
Minocycline
Anitphosphlipid syndrome
40% SLE patients
3 antibodies - lupus anticoagulant, anti-cardiolipin, anti-B2-glycoprotein
Common clinical features
- Venous thrombosis
- Arterial thrombosis
- Recurrent miscarriage
- Livedo reticularis
- Thrombocytopaenia
Ix
- Elevated PT in context of normal INR
- VDRL +ve (cardiolipin assay)
Mx
- Anticoagulate
Giant Cell Arteritis
Temporal Areritis
Large - medium vessel vasculitis
Most commonly associated with branches of external carotid, but can affect carotid, sublcalvian, aortic, iliac, vertebral vessels as well
American College of Rheumatology Classification
- Age > 50
- New onset localised headache
- Tender or decreased pulse over temporal artery
- ESR > 50mm/hr
- Biopsy - mononuclear infilatrate or granulomatous inflammation
Also associated with
- Visual loss - most important preventable feature
- Jaw claudication
- PMR
Mx
- Visual symtpoms - IV methypred + aspirin
- No visual symptoms - PO pred 40-60mg + aspirin
Behcets Disease
Small vessel disease affecting any organ system
Classic triad
- Oral ulcer (painful, necrotic yellow base, lone or crops of <10)
- Genital ulcer
- Eye - Uveitis, iritis, optic neuritis, hypopyon
Ix - Pathergy test (sterile needle into pt forearm, >2mm erythema at 24 hours considered positive)
False +ve - Sweet’s syndrome and pyoderma gangrenosum
Mx
* Rapid referral of visual symptoms
* Cutaneous - topical steroid
* Severe mucocutaneous - PO steroid, colchicine
* Systemic - immunosuppression
Reactive Arthritis
Reiter’s syndrome
Post-infectious arthritis - days to weeks
Mono or oligoarticular pattern
HLA-B27 association 80%
M:F = 9:1 for STI related, but equal for GI related
Peak age 35 yrs
Classic triad - so considered subtype
* Arthritis
* Non-gonococcal urethritis
* Conjunctivitis
May also see enthesitis / dactylitis / mucocutaneos
Ix
RhF negative
Inc ESR and WCC
Joint aspirate - WCC 5000-20,000
Mx
* 80% resolves in 6 months
* Most usually within 1 yr
* Medical
* NSAIDs
* Steroids - PO / IA or TOP for eye
* DMARDS
Polyarteritis Nodosa
Small-medium vessel necrotising vasculitis with immune-complex deposition of arteries
Characteristic renal and visceral involvement with sparing of pulmonary circulation
M>F, 40-60yrs
Systemic involvment
- PNS 50% - sudden onset, mononeuritis multiplex or polyneuropathy
- Renal 25% - asymptomatic
- GI 40% - AP, infarction, haemorrhage, derranged LFTs
- Derm - palpable purpura, levido reticularis, ischaemic digits, Raynaud’s
- Cardiac - MI, pericarditis, CCF, cardiomyopathy
Associations with Hep B, TB, Strep, otitis media
Erythema nodosum
- Viral URTI
- Streptococcal infection
- TB
- Sarcoidosis
- Penicillin
- Sulfonamides
- OCP
- Phenytoin
- IBD
- SLE
- Hitoplasmosis
- Salmonella
- Yersinia
- Chlamydia infections
- Coccidiomycosis
- Psittacosis
Wegeners
RA - Articular findings
Chronic arhtropathy over weeks
Morning stiffness
Symmetrical
May have extra-articualr manifestations
Physical deformity inidicted irreversible articular damage
**MCPs **- Volar subluxation, ulnar deviaiton, Flexion contractures, arthrodesis
Swan Neck - hyperextension PIP and fixed flexion of DIP
Boutonniere - Fixed flexion PIP and extension DIP
Z Deformity - hyperextension IPJ, fixed flexion/subluxation MCPJ
Popliteal cyst
Cervical Spine involvement - atlantoaxial instability
TMJ
RA Extra- Articular Manifestations
Rheumatoid Nodules - 25-50%, elbows, sacru, occiput, hand
Vasculitis - small to med vessels, associated with deep ksin ulcers, digital ischaemia and gangrene
Nerve entrapment - median, ulnar, peroneal, plantar
Ocular Disease - Sjogrens, ueviitis, episcleritis
Pulmonary - RA nodules, Fibrosis, Pl effusions, Caplan’s syndrome
CVS - AR, MR, pericarditis
Other - splenomegaly, lymphadenopathy, amyloidosis, muscle atrophy, tenynovitis
RA Diagnostic Criteria
4 of the following
* Morning stiffness > 1 hour for 6/52
* Arthritis of 3 joints for 6/52
* Arthritis of hand joints (proximal interphalangeal, metacarpophalangeal, or wrist) for 6/52
* Symmetrical arthritis 6/52
* Rheumatoid nodules
* RhF +ve
* XR changes - erosions, subchondral bone detrusciton, periarticular osteopenia, diffuse osteoporosis
Cervical Myelopathy
Rheumatoid factor
Sjogren’s Syndrome
Primary - absent connective tissue disease
Secondary - more commonly associated with RA ( SLE, PAN, scleroderma, polymyositis)
Features
Dry eyee
Dry mouth
Loss of secretion in resp tract, vagina and skin
Symptomatic treatment
