Term
Fatigue, fever, weight loss and dyspnea, malar skin rash and joint pains
There may also be chest pain, heart murmurs [Libman-Sack endocarditis], peripheral neuropathies, cranial nerve deficits, depression and psychosis |
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Definition
| SYSTEMIC LUPUS ERYTHEMATOSUS |
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Term
ACR criteria-there should be at least 4 out of the following: [MD Soap Brain]
• Malar rash
• Discoid Rash
• Serotitis
• Oral ulcers
• Arthritis
• Photosensitivity
• Blood: leucopenia or thrombocytopenia
• Renal: proteinuria
• Anti-Nuclear Antibodies
• Immunological:
o Anti-ds DNA antibodies
o Anti-Sm antibodies
• Neurological: psychosis |
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Definition
| SYSTEMIC LUPUS ERYTHEMATOSUS |
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Term
Presence of Anti-Nuclear and Anti-dsDNA antibodies are diagnostic
CBC might show an anemia of chronic disease-normocytic, normochromic anemia together with a leucopenia and thrombocytopenia
Urinalysis may show proteinuria, hematuria and red blood cell casts
The presence of red blood cell casts is indicative of glomerulonephritis |
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Definition
| SYSTEMIC LUPUS ERYTHEMATOSUS |
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Term
Limited disease in 80%:
thickened skin lesions
skin is shiny and taut |
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Definition
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Term
Diffuse systemic in 20%:
CREST [Calcinosis cutis, Raynaud’s phenomenon, Esophageal hypomotility, Sclerodactyly and Telangiectasia] syndrome
Raynaud’s phenomenon is present in both types [initial complaint in 70% of patients]:
exposure to cold causes the fingers to go white [due to vasoconstriction], then blue [cyanosis] then red [due to vasodilation]
Joint pains and crepitus due to synovitis
Shortness of breath due to lung involvement
Dysphagia due to esophageal involvement
Hypertension from renal involvement
Erectile dysfunction and hypothyroidism may also occur |
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Definition
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Term
Chest x-ray may show pulmonary fibrosis
X-rays of affected hands may show calcinosis cutis [soft tissue calcification] with acro-osteolysis [resorption of the terminal tufts of the distal phalanges] |
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Definition
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Term
American College of Rheumatology requires 4 or more of the following:
• Morning stiffness lasting more than 1 hour
• Three or more joints are affected
• Bilateral presentation from distal to proximal
• Arthritis involving the wrist, MCP and PIP joints
• Positive Rheumatoid Factor
• Subcutaneous nodules over bony prominences
• Typical radiological changes: bony erosions (pannus formation), joint space narrowing, soft tissue swelling
Might be associated with Sjögren’s syndrome: dry eyes (xeropthalmia) and
dry mouth (xerostomia); autoimmune attack on the glands that produce tears
and saliva |
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Definition
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Term
| Bracelet test [squeezing the wrist between the thumb and the index finger like a bracelet] may be positive, X-rays will show symmetrical bilateral intra-articular [rat bite] erosions, periarticular osteoporosis with ulnar deviation at the MCP joints |
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Definition
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Term
Arthritis [usually one joint-low back pain or heel pain], conjunctivitis and urethritis (burning on urination) [can’t pee, can’t see, can’t dance with me], can’t have a baby with me if there is subsequent infertility; there may be mouth ulcers and skin lesions on the palms and soles
Investigations Complete Blood Count will show a leukocytosis |
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Definition
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Term
Red plaques or silvery scales on the scalp, back of the neck and the extensor surfaces of the elbows and knees; Involvement of the fingers or toes may create “sausage digits”
There may be associated with pitting of the nails and onycholysis [separation of the nail plate which begins distally and spreads proximally]
Some patients [20%] develop small joint arthropathy: joint pains |
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Definition
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Term
Biopsy is usually not needed to confirm the diagnosis
X-rays of involved hands may show asymmetrical DIP joint involvement with the typical “cup and pencil” deformity [erosion of one end of the bone with expansion of the base of the contiguous phalanx in an asymmetrical pattern] |
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Definition
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Term
Morning stiffness lasting less than one hour; pain worse with use
Investigations X-ray of the affected weight bearing joint will show typical findings:
narrowing of the joint space
subchondral sclerosis [aka eburnation]
marginal osteophytes [hallmark sign]
subchondral cysts [aka geodes] |
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Definition
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Term
| The typical x-ray picture shows a triangular area of sclerosis on the inferior aspect of the iliac side of a normal sacro-iliac joint. May see paraglenoid sulci due to stress hypertrophy from altered weight-bearing and the inferior glenoid artery pounding on the sacrum |
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Definition
| OSTEITIS CONDENSANS ILII (aka Osteitis Triangularis aka Hyperostosis Triangularis) |
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Term
Sudden onset of pain, swelling and redness of the first metatarsophalangeal joint (podagra); other joints may be affected singularly-knee and ankle. Asymmetrical distribution.
Tophi may be present in the ear or in the skin over the joints with chronic gout |
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Definition
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Term
Uric acid levels may or may not be elevated in the acute phase (in blood and
urine)
X-ray will show soft tissue swelling initially
Later there is bony erosion with overhanging edges and joint space narrowing
May be confused with pseudo-gout [Calcium Pyrophosphate Dihydrate Deposit Disease] in which there will be linear calcification in the articular cartilage
Joint aspiration will reveal uric acid crystals |
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Definition
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Term
May present as an incidental finding or with painful joints
Investigations Typical x-ray will show chondrocalcinosis [linear calcification in the articular cartilage]
Joint aspiration will reveal calcium crystals |
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Definition
| CALCIUM PYROPHOSPHATE DEPOSITION DISEASE [Pseudogout] |
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Term
Modified New York criteria:
• low backache > 3 months duration, better with exercise not with rest
• limitation of lumbar spine movement in sagittal and coronal planes
• bilateral sacroiliac tenderness
• decreased chest expansion with inspiration |
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Definition
| ANKYLOSING SPONDYLITIS [Marie-Strumpell disease] |
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Term
| The patient eventually will have loss of lordosis of the spine and have an increase in kyphosis, with gradual stiffening and loss of chest expansion (due to involvement of the costotransverse joints). Fatigue is a common complaint with associated anemia, iritis and osteopenia. Peripheral joints are affected 50% of the time |
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Definition
| ANKYLOSING SPONDYLITIS [Marie-Strumpell disease] |
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Term
Forrestier’s Bowstring Sign [lateral bending reveals ipsilateral tightening and contracture of the paraspinal musculature] may be positive
Chest Expansion Test [measure at the 4th intercostal space, normal is 1.5-3 inches, decrease may show AS]
Lewin Supine Test [patient is unable to do a sit-up] may be positive
An AS patient may also have a positive Yeoman’s, Patricks or other SI orthopedic test |
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Definition
| ANKYLOSING SPONDYLITIS [Marie-Strumpell disease] |
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Term
SI joint x-rays-moderate to severe sacroilitis [subchondral bony erosions on the iliac side of the SI joint initially followed by Romanus lesions [erosions of the corners of the vertebral bodies], then shiny corners, marginal syndesmophytes, dagger sign and finally the bamboo spine years later
Elevated ESR and C-Reactive Protein will be seen along with a +HLA-B27
Alkaline phosphatase may be raised when there is active bone remodeling |
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Definition
| ANKYLOSING SPONDYLITIS [Marie-Strumpell disease] |
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Term
| Sjögren’s syndrome:dry eyes |
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Definition
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Term
| Sjögren’s syndrome:dry mouth |
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Definition
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