Rheumatology

Question 1

-Autoimmune dz–> inflamm. & multiple organ involvement and connective tissue
-MC minority women 20-40s
-Triad of sxs: 1)Arthalgias 2) fever, 3) malar rash
can have systemic sx (glomerulonephritis, alopecia)
-Dx: ANA, RF
-Tx: Symptomatic, methotrexate, sun protection, exercise, NSAIDS, corticosteroids

Answer 1

SLE

systemic lupus erythematous

Question 2

-Autoimmune destruction of salivary and lacrimal glands
Often seen 2/2 other connective tissue disorders (SLE, RA)
MC middle aged women
-Dx: RF, ANA, anti-Ro Antibodies
-Tx: symptomatic

Answer 2

Sjogrens

Question 3

-Pain/stiffness in neck, shoulders, pelvic girdle, often with constitutional symptoms. Temporal arteritis assoc. 30%
women> men. MC >50.
-Stiffness worst after rest & in AM
MSK sxs bilateral, proximal and symmetrical
-Dx: ESR++
-Tx: steroids

Answer 3

Polymyalgia Rheumatica

Question 4

Chronic Synovitis–> hyperplasia–>excess tissue–>joint/surrounding tissue damage (t-cell mediated)

• Sx: Small joint stiffness, worse with rest; AM stiffness >30mins after start moving; symmetric arthritis–>swollen, tender, erythematous, BOGGY joints; wrist, MCP, PIP
• Dx: RF; ulnar deviation on XRAY, anti-cyclic abs
• Tx: DMARDS–>methotrexate

Answer 4

RA

Question 5

• Inflamm. arthtis. Often mild, intermitnent affecting a few joints. commonly seen before skin manifestations. Asymmetric arthritis. Nail pitting, sausage fingers
• Dx: ESR+, normocytic, normochromic anemia, “pencil in cup” deformity on xray
• Tx: NSAIDS–>methotrexate

Answer 5

Psoriatic arthritis

Question 6

• Sequela to STIs (CT MC) or gastroenteritis
• Asymmetric arthritis, often large joints below waist
• Leading cause of non traumatic mono arthritis.
• Men>women
• Tetrad: urethritis, conjunctivitis, oligoarthritis, mucosal ulcers (can’t see, can’t pee, can’t climb a tree)
• Dx: HLA-B27, X-ray may show damage, CSF culture usually negative
• Tx: PT & NSAIDS. Abx at time of primary infection good, but not helpful later

Answer 6

Reactive Arthritis (aka Reiter Syndrome)

Question 7

• Chronic inflamm. arthropod of axial skeleton & SI joint
• Progressive vertebral fusion
• Sx: Chronic LBP, AM stiffness, decreased ROM, 30-40ys, men>women
• Dx: ESR++, HLA-B27, Bamboo spine on xray
• Tx: 1 NSAIDS/PT–>TNF-alpha inhibitor–>steroids

Answer 7

Ankylosing spondylitis

Question 8

-Forward slipping of vertebrae (step off)
-Sx: back pain, +/- sciatica
-Dx: Oblique films
-Tx: low grade: symptomatic, PT, bracing
High grade: Surg

Answer 8

Spondylothesis

Question 9

-Defect of pars of vertebrae–>MC seen 2/2 repetitive hyperextension trauma. MC back pain in

Answer 9

Spondylolysis

Question 10

• Gradual destruction of joints in pts w/ neurosensory loss
• Common in those with DM
• Sx: Red, hot, swollen foot, pain (even with sensory loss), “rocker bottom foot,” degeneration on X-ray
• Tx: offloading of pressure (no weight bearing 4-5 months

Answer 10

Neuroarthropathy