Rheumatology Flashcards
Polyatricular symmetric arthritis seen in
RA
SLE
Hep B
Parvovirus B19
Monoarticular arthritis seen in
Osteoarthritis Crystal induced (Gout, pseudogout) Septic( gonococcus) Traumatic Hemarthrosis
What is migratory polyarthritis
Shifting of inflammation and pain from one joint to another and relieve of previous joint
Migratory arthropathy is seen in
Rheumatic fever
Disseminated gonoccocal
Lymes ds
Oligoarticular assymetric
Osteoarthritis of small joints of hands
Ankylosing spondylitis
Rarely polyarticular gout
Features of joint inflammation
Joint stiffness in morning >1hr Erythema Warmth Inc ESR Inc CRP
Eg of inflammatory arthritis
RA
What should be checked in synovial fluid
3cs:crystals
Cells
Culture
Gram stain
Diff bw crystals of gout and psedogout
Gout:negative birefringent, needle shaped
Pseudogout: positive, rhomboid shape
What is wbc range in synovial fluid of inflammatory arthritis
5000-50000 WBC/mm3
Wbc in septic arthritis
> 50,000 wbc/mm3
4 basic questions to be asked in case of evaluating a patient with arthrits
- distribution(asymm/symmetric) and no. Of joints (mono/poly)
- symptons acute/chronic
- systemic symptoms
- evidence of joint inflammation
Can ANAs be found in normal people?
Yes in 5% of normal person(especially speckled pattern)
ANA pattern in SLE
Peripheral/rim
Centromere ANA pattern seen in
CREST (c to remember)
ANA pattern seen in systemic sclerosis
Nucleolar
ANA mostly found in SLE
Anti dsDNA
Anti SM
Anti Ro
Specific ANA in drug indiced lupus
Anti -histone
ANA in CREST
Anti centromere
Anti RNP specific to
Mixed connective tissue ds(100%)
What is RF
Is an autoantibody against Fc portion IgG
Can RF be found in normal individuals
Yes 5%
cANCA and pANCA found in
C-wegeners granulomatosis
P- PAN, churg stauss
What are the common lab abnormalities ass with Anti phospholipid Ab syn
- Prolonged PTT
2. False positive RPR/VDRL
Distribution of joints affected in RA
Symmetric
Mostly of hands-wrist ,MCP, PIP.
NEVER:
DIP
joints of lower back (but cervical involovement seen in 25-80% :atlantoaxial subluxation)
Felty and kaplan syndrome
RA+ splenomegaly + neutropenia
RA+ pneumoconiosis
Predominant infilterating cell in RA
T lympocyte
Boutonnaires and swan neck deformity seen in
RA
Most likely reason in patient with RA who complains of occipital headache and upper extremity tingling sensation
Atlantoaxial subluxation
Most likely reason in patient with RA who complains of occipital headache and upper extremity tingling sensation
Atlantoaxial subluxation
Most common cause of disability in SLE
Lupus nephriti
Rash of SLE
Maculopapular which is photosensitive , leaves no scar
Butterfly shape
Not seen in drug induced lupus
Rash of DLE
Face and scalp
Circular rash
Raised rim
Disfiguring (central atrophy and scarring)
Pregant SLE patients need to bd screened for which Ab
Anti Ro/SSA
Passively cross placenta
Cause neonatal lupus and heart block
Symmetric polyarticular joint involvement in
RA SLE SSc Sjorgen Hep B Parvovirus B 19
What is CREST syndrome
C calcinosis R Raynauds E esophageal dysmotility S sclerodactyly T telengiectasia
What is primary raynauds phenomenon
Also called raynauds ds
Without associated underlying disease
Secondry: associated with disease eg scleoderma
How to differntiate be 1 and 2 raynauds on examination
Done by nailfold cappiloscopy test
Enlarged,dilated or absent nailfold capillaries noted in scleoderma and other AI ds.
What are seronegative arthropathies
AS
Reactive
Psoriatic
Enteropathic arthropathy
Called so because of absence of ANA and RF
Most common presentation of AS
Chronic lower back pain
Morning stiffness lasting atleast 1 hr improves with exercise
MC extraarticular manifestation of AS
Anterior uveitis
Aortic insufficiency leading to chf and 3 degree heart block
Reiters syndrome
Reiter’s Syndrome is a reactive arthritis that develops in response to an infection and characterized by a triad of arthritis, conjunctivits, and nonspecific urethritis.
Reiter syndrome) occurs after a nongonococcal urethritis (chlamydia, ureaplasma). These patients have distinct mucocutaneous manifestations: keratoderma blennorrhagica, circinate balanitis, oral or genital ulcers, conjunctivitis, and arthritis.
causes of ReA
- Post veneral -Urethritis
2. Post enteric -Diarrhoea caused by invasive org.( camp , shigella , salmonella)
Circinate balanitis
comprising a serpiginous annulardermatitisof theglans penis.
Circinate balanitis is the most common cutaneous manifestation of reactive arthritis
Keratoderma blennorrhagica
Keratodermablennorrhagicum meaning keratinized (kerato-) skin (derma-) mucousy (blenno-) discharge (-rrhagia) (also calledkeratoderma blennorrhagica)are skin lesions commonly found on thepalmsandsoles.
One of the manifestation of Re A
Psoritic arthritis hand changes
Typical skin rash Pencil in cup deformity Mouse ear appearance Nail pitting Sausage shaped finger
What is mc joint involved in osteoarthritis
Weight bearing joint(Knee,hip)
Small joints of fingers(PIP , DIP , base of thumb)
Monoarthritis/ assymetric oligarticular
Osteophytes in PIP and DIP
Bouchard
Herbeden nodes
Why serum uric acid level is not app for dx of gout?
The serum uric acid during the acute attack may be normal or low. On the other hand, many people have elevated serum uric acid levels and never develop gout. Thus, the serum uric acid level is of no value in the diagnosis of acute urate arthropathy. This is why the diagnosis is made by the analysis of synovial fluid.
Fish like scales seen in
Icthyoses
3 types
Icthyoses vulgaris AD
X linked icthyoses
Lamellar icthyosis
Icthyosis vegaris
AD
Deficiency in filagggrin
Both males and females
Small, branny , except on shins where large.
Pasted in centre with upturned edge.
Extensors of limbs, lower back.
Associated with- hyperlinear palms and soles, keratosis pilaris , atopic diathesis
X linked icyhyoses
Only males Deficiecy in steroid sulfate Large dark , tightly adherent Sites: generalised, flexures enctoached Ass: corneal opacities , cryptorchidism
