Seropositive Arthritis: Rheumatoid, Lupus, Scleroderma, Vasculitis, Sjogrens Flashcards
Characteristics of seropositive arthritides
High in native Americans
Females 30-50
HLA DR4
Female prevalence
Often accompanied by vasculitis, Sjogrens, Raynaulds
Rheumatoid
- presentation, pathophysiology
- investigations, diagnosis
Synovial inflammation => joint damage
Swollen, painful symmetrical PIP, MCP
No enthesitis
Morning stiffness worse with rest
Insidious onset
Cervical subluxation
Swan neck
Rheumatoid nodules
Clinical diagnosis from Hx and Ix RF - more sensitive CCP - more specific Xray - LESS -Loss of joint space -Erosions -Soft tissue swelling -Soft bones
Rheumatoid
-management
Initial - methotrexate
Acute - CS
Monitor response with CRP, DAS28
TNF inh - 2 fails with DMARDs
Rheumatoid
-complications
Resp
- IDL
- pleural effusion
- pulmonary nodules
- methotrexate pneumonitis
Eyes - inflammation
Increased inflammation => osteoporosis, CVD
Due to medication - IC
Impact of condition - depression
SLE
- epidemiology
- pathophysiology
- drug causes of lupus
Female 20-40
Afro Caribbean, Asian
T3 hypersensitivity - HLA B8, DR2-3
-immune complex formation => deposits in tissues
Procainamide, hydralazine
SLE
-presentation
General -fatigue, fever, mouth ulcers, lymphadenopathy Skin -photosensitivity -malar/discoid in sun exposed areas/non scarring alopecia -Raynaud's, nailfold capillaries MSK -non erosive arthritis CV -pericarditis -pulmonary fibrosis, PLEURISY Renal -glomerulonephritis Psych -A+D
SLE
- investigations
- management
- complications and management
Autoantibodies
-ANA, dsDNA
LOW CRP COMPLEMENT, HIGH ESR
Initial - HCQ + NSAID
-can add DMARD
Nephritis, psychiatric - Immunosuppresant
Lupus nephritis => ESRF
- regular urinalysis for proteinuria
- renal biopsy - diffuse proliferative GN due to immune complex deposits (most severe and common)
Management
-HTN + CS + azathiopurine
Systemic sclerosis
- pattern of disease
- diagnosis, investigations
- management
Sclerosis of skin and connective tissue
CREST - face, distal limb
- calcinosis
- Raynauds
- Esophageal dysmotility
- Sclerodactyly
- Telangiectasia
Diffuse - trunk, proximal limb
Scleroderma - no int organ involvement
-sclerosis of skin
ANA in all
CREST - anti centromere
Diffuse - anti scl70
Early - low dose steroid
Late - symptomatic
Giant cell/Temporal arteritis
- epidemiology
- presentation
- diagnosis, investigations
- management
50+, rapid onset
Temple tenderness, pain Jaw pain when eating Headache Double vision, vision loss Fatigue, low fever, anorexia, night sweat PMR overlap
DEFINITIVE - temporal artery biopsy
High ESR, CRP
CS => dramatic rapid response
Kawasaki disease
- epidemiology
- presentation
- diagnosis, investigations
- management
U5
5+ days of high fever - antipyretic resistant
Conjunctival redness
Bright red cracked lips + strawberry tongue
Cervical LN
Red palmar, plantar surfaces => peel
Clinical diagnosis
HIGH DOSE ASPIRIN => REDUCE CAA
IVIG
Echo => check for coronary artery aneurysm
Behcet disease
- epidemiology
- presentation
- diagnosis
- management
Young adults, men 20-40
Eastern Med
Oral, genital ulcers, anterior uveitis
Thrombophlebitis, DVT
Clinical diagnosis
CS
-DMARD, biologics if needed
Polymyalgia rheumatica
- epidemiology
- presentation
- diagnosis, investigation
- management
Common in older adults - 60+, rapid onset
Aching, morning stiffness in proximal limb
-WEAKNESS IS NOT A SYMPTOM
Mild joint pain, fatigue, low grade fever, anorexia, night sweats
High ESR, CRP
CS => dramatic rapid response
Sjogrens
- epidemiology
- presentation
- diagnosis, investigations
- management
Female
Dry eyes, mouth, vagina
Muscle, joint pain, Raynauds
Clinical diagnosis
Schirmer’s test - assess tear production with filter paper
AntiRo, La - not specific
Artificial saliva, tears
Pilocarpine
