Rheumatology

Question 1

DD of Rheumatoid artheritis

Answer 1

1. Rheumatoid disorder
   - SLE
   - Scleroderma
   - trauma, infection
2. Single joint
   - osteomyelitis
   - psoariatis arthritis
3. Persistent arthalgia
   - juvenile arthritis
   - hyper mobility syndrome
4. Leukemia
5. DM

Question 2

Diagnosis of Rheumatoid arthritis

Answer 2

• increase ESR
• increase CRP
• WBC: leucocytosis
• RBC: anemia
• Platelets: thrombocytosis

Question 3

Causes of Juvenile idiopathic Arthritis

Answer 3

• age: 1-3, 8-12 years old
• female
• unknown
• immuno genetic susceptibility
• cross host hypersensitivity to specific self antigen that cause increase T- cell reactivity

Question 4

Clinical picture of Juvenile idiopathic Arthritis

Answer 4

1. Symptom
   - morning stiffness
   - fatigue
   - warm joint
   - lack of motion
2. Sign
   - polyarthritis: more than 5 joint
   - rheumatoid nodule in elbow, achilles tendon
   - micrognathia
   - hoarness of voice

Question 5

Diagnosis of Juvenile idiopathic Arthritis

Answer 5

1. Increase
   - ESR, CRP
   - WBC, platelet
   - ANA
2. +ve rheumatoid factor
3. rheumatoid nodule
4. Bone xray
   - early : normal
   - late: periartical osteopenia

Question 6

Treatment of Juvenile idiopathic Arthritis

Answer 6

• NSAID: ibuprofen
• intra articular corticosteroid
• hydrochloroquine, sulfasalazin
• methotrexate

Question 7

Clinical picture of SLE

Answer 7

• fever, fatigue
• malar rash, photosensitive
• ulcer on palate
• raynoud phenomenon
• alopecia
• arthalgia, athritis
• depression, migrane
• endocarditis, myocarditis, HB
• hepatitis, hepatosplenomegally
• nephritis, nephrosis
• sjogen syndrome

Question 8

Diagnosis of SLE

Answer 8

• CP
• protenuria,RBC cast
• hemolytic anemia
• leukopenia, thrombocytopenia
• +ve anti ds DNA
• +ve anti smith ab
• +ve ANA
• present IgM, IgG

Question 9

Treatment of SLE

Answer 9

1. NSAID
   - for arthalgia, arthritis
   - 5-7mg/kg/day
2. Hydrochloroquine
   - for skin, fatigue, arthritis
   - 3-6mg/kg/day
3. Corticosteroid
   - prednisone 1-2mg/kg/day
   - control antibiotic production
4. In severe case:
   - cyclophosphamide 500-1000mg/m2/month to maintain renal function
   - azathioprine : prevent renal disease

Question 10

Definition Henoch schonlein purpura

Answer 10

Vasculitis characterise by

• leucocytic infiltration
• hemorrhage
• ischemia

Question 11

Clinical picture of Henoch schonlein purpura

Answer 11

• rash with palpable purpura
• arthritis
• abdominal pain
• hematemesis
• hematuria, proteinuria
• hepatosplenomegally

Question 12

Diagnosis of Henoch schonlein purpura

Answer 12

Lab:

• thrombocytosis, leukocytosis
• anemia
• increase ESR, IgA, IgM
• urine: albumin, RBC cast
• rheumatoid factor
• APP Ab

Question 13

Treatment of Henoch schonlein purpura

Answer 13

• adequate hydration
• pain control ( acetaminophen)
• aboid competitive sport
• oral/ IV corticosteroid
• colchicine 0.6mg/day (ttt rheumatoid nodule)
• aspirin 80 g ( ttt antiphospholipid Ab)