Rheumatology Flashcards
Normals ESR
Men < 50: 15 mm/hr.
Men > 50: 20 mm/hr
Women < 50: 20 mm/hr
Women > 50: 30 mm/hr
Normal CRP
0.8 mg/L
Rheumatoid factor (RF)
- RF positivity is associated with more aggressive disease and more extra-articular manifestations
- sensitivity is equal to anti-CCP for diagnosis of RA
Anti-CCP
- strong predictor of erosive disease
Anti-DNA topoisomerase I (Scl-70) antibodies
diffuse cutaneous
systemic sclerosis
DMARDs in pregnancy
cytotoxic and teratogenic
- prescribe corticoseteroids
MS prevalence in Aus
1:1000
CREST syndrome
(Calcinosis cutis,
Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia)
diagnosis of CREST syndrome
anti-centromere antibodies
CREST syndrome is a limited form of systemic sclerosis (scleroderma), characterized by a specific set of symptoms. The acronym “CREST” stands for:
- Calcinosis: Calcium deposits under the skin, which can feel like small, hard nodules and may cause pain or skin ulcers.
- Raynaud’s phenomenon: Episodes of vasospasm in the fingers and toes, typically triggered by cold or stress, leading to color changes (white, blue, and red) and sometimes pain or numbness.
- Esophageal dysmotility: Difficulty swallowing due to problems with the movement of the esophagus, often leading to acid reflux and heartburn.
- Sclerodactyly: Thickening and tightening of the skin on the fingers, causing them to become stiff and shiny.
- Telangiectasia: Small, dilated blood vessels near the surface of the skin, often appearing as red spots, particularly on the face and hands.
The diagnosis of CREST syndrome is primarily based on clinical findings and a combination of patient symptoms and signs. Here are the steps usually involved:
- Clinical Evaluation: A thorough history and physical examination are crucial. The presence of any combination of the five CREST features (Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia) can lead a clinician to suspect CREST syndrome.
-
Laboratory Tests:
- Antinuclear Antibody (ANA) Test: This is usually positive in patients with CREST syndrome, indicating an autoimmune process.
- Anti-centromere Antibody: A specific type of ANA that is highly associated with CREST syndrome. The presence of anti-centromere antibodies supports the diagnosis.
- Other Antibodies: Although less common, tests for other antibodies like anti-Scl-70 can sometimes be performed, especially if the clinical picture is not typical.
-
Imaging and Other Studies:
- X-rays: Can show calcinosis or other abnormalities.
- Esophageal Manometry: This test can assess the function of the esophagus, especially useful in diagnosing esophageal dysmotility.
- Capillaroscopy: A test where a small microscope is used to look at the tiny blood vessels in the nail beds. Changes in these vessels can be indicative of systemic sclerosis, including CREST syndrome.
- Differential Diagnosis: It is essential to differentiate CREST syndrome from other conditions that may present with similar symptoms, such as other forms of systemic sclerosis, primary Raynaud’s phenomenon, or autoimmune diseases like lupus or rheumatoid arthritis.
Once a diagnosis is made, the management focuses on symptom relief and preventing complications. Treatment often includes medications for managing symptoms like Raynaud’s phenomenon and acid reflux, as well as monitoring for potential complications associated with systemic sclerosis.
elderly px + elevated ESR + CRP pain and stiffness in hips and shoulders in the morning
Polymyalgia rheumatica
Polymyalgia rheumatica underlying pathology
giant cell arteritis
headaches over 50 + Fever + Anemia + High ESR
Giant cell arteritis
face rash + URTI + migrating athralgia
Parvovirus-associated arthritis
Parvovirus-associated arthritis investigation
diagnostic: detection of parvovirus B19 specific IgM antibodies
Giant cell arteritis investigation
1- Elevated ESR.
2- Normochromic or slightly hypochromic anemia.
3- Liver function abnormalities-increased alkaline phosphatase levels
diagnostic: Temporal artery biopsy
Giant cell arteritis management
- glucocorticoid prednisolone
rheumatoid nodulosis
Local glucocorticoid injections
RA medication with methotrexate and
other DMARDs can increase the frequency and number of rheumatoid nodules—a
condition known as accelerated nodulosis.
Treatment consists of intralesional steroid injection to decrease size
NSAIDs may improve the pain but does not reduce the size and number of nodules
Malar rash (butterfly rash),
- highly specific for
the diagnosis of SLE - flat, scaly, non-pruritic and
characteristically spares the nasolabial fold
SLE management
long term cornerstone: hydroxychloroquine
proximal muscle weakness and pain and a heliotrope (lilac color of the periorbital) rash about her eyes.
dermatomyositis
(This rash surrounds both eyes and may extend
onto the malar eminences, the eyelids, the bridge of the nose, and the forehead)
Back pain caused by an inflammatory condition
(rheumatoid arthritis, ankylosing
spondylitis, Reiter syndrome)
focal and segmental glomerulonephritis + cytoplasm ANCA antibodies+ affecting upper airway
Wegener granulomatosis (WG)
vasculitis of small and medium
sized arteries and veins
C-ANCA
Wegener granulomatosis (WG
female + widespread pain> 3 months + Fatigue and sleep difficulties + Normal CRP, ESR
fibromyalgia