Term
| young females 9:1, onset 20-40s, inc is african-americans, hispanic, native americans, can be due to sun exposure, estrogen, can be induced by procainamide, hydralazine, INH, quinidine (pos anti-histone ab's). triad of joint pain fever and malar butterfly rash, serositis (pericarditis, pleuritis), dicoid lupus is annular and heals w scarring, can cause glomerulonephritis, retinitis, oral ulcers, alopecia, ANA best first test, anti dsDNA 100% specific for SLE, APLS inc risk of arterial & venous thrombosis, pos anticardiolipin Ab ass w false pos VDRL/RPR, lupus anticoagulant, women w APLS may have frequent miscarriages. marange w sun protection, hydroxychloroquine for lesions, NSAIDs or acetaminophen |
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Definition
| Systemic Lupus Erythematosus (SLE) |
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Term
| thickened skin (sclerodactylyl), skin can bve tight and shiny due to fibrous collagen buildup, limited cutaneous w CREST (calcinosis cutis, raynauds, esophageal motility disorder, sclerodactylyl/claw hand, telangiectasia- MC type- affects face, neck and distal to elbows & knees. diffuse cutaneous- skin thickening of trunk & proximal extremities. diagnosis is pos anti-centromere Ab ass w Limited/CREST dz- most specific, better prognosis. pos anti-scl-70 ab ass w diffuse dz & multiple organ involvement, pos ANA, treat w DMARDs, corticoteroids, treat raynauds w CCBs or prostacyclin |
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Definition
| Scleroderma (systemic Sclerosis) |
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Term
| autoimmune disorder that attacks exocrine glands, salivary glands-> xerstomia (dry mouth) and lacrimal glands-> dry eyes (keratoconjunctivitis sicc) and parotid enlargement, thyroid gland dystundion common. primary occurs alone, secondary w other autoimmune disorders. HLA-DR52 in 85%, inc incidence of non-hodgkin lymphoma, dianosis w ANA, anti-SS-A (Ro) & anti-S-B (La), pos rheumatoid factor, pos schirmer test (dec tear production). Pilcarpine for xerstomia (cholinergic drug) w DUMBELLS S/Es, also streat w cevimeline to stimulate muscarinic cholinergic receptors |
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Definition
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Term
| widespread muscular pain, poor sleep/memory problems, may be due to inc in pain perception due to in substance P, middle aged women 9:1, extreme fatigue, sleep disturbances, diagnose w diffuse pain in 11 out of 18 tigger points >3 nonths and muscle biopsy shows moth-eaten appearance of type I muscle fibers- muscle damage. manage w exercise- swimming nad TCAs, SSNRI Duloxetine, SSRIs, Neurontin, Pregabalin |
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Definition
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Term
| causes synovitis, bursitis & tenosynovitis-> pain/stiffness of proximal joints (shoulder, hip, neck) in pts >50y. polymyalgia rheumatica is closely related to giant cell arteritis. clinical manifestations is bilateral proximal joint aching/Stiffness, morning stiffness>30mins of pelvic, neck and shoulder girdle- difficulty combing hair, putting on coat, getting out of chair. inc ESR, normochronic normocytic anemia, inc platelets. manage w low-dose corticosterooids, NSAIDs, methotrexate |
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Definition
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Term
| progressive symmetrical proximal muscle weakness (usually painless), inc muscle enzymes (aldolase, creatine kinase), inc ESR, pos muscle biopsy, abnormal EMG. pos anti-jo 1 ab (myositis specific ab)- ass w mechanic hands and interstitial lung fibrosis. pos anti-SRP ab- almost exclusively seen w PM, pos anti-Mi-2 ab- specific for dermatomyositis. muscle biopsy shows endomysial involvement (PM) or perifascicular/perivascular involvement (DrM), treat w high-dose corticosteroids 1st line |
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Definition
| polymyositis and dermatomyositis |
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Term
| heliotrope (blue-purple) upper eyelid discoloration, gottron's papulesL raised violaceous scaly eruptions on the knuckles, malar rash including nasolabial folds. diagnose w muscle enzymes: inc aldolase, cxreatine kinase, inc esr, inc incidence of malignancy |
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Definition
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Term
| poikiloderma: photosensitive, erythematous rash on face, neck, anterior chest "v sign", back and shoulders "shawl sign" |
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Definition
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Term
| uric acid deposition in the soft tissue, joints and bone. attacks due to purine-rich foods or diuretics (thiazides, loop), ACEI, Pyrazinamide, Ethambutol, Aspirin & ARBs (except Losartan), MC in men esp >30y. acute (80% monoarthropathy), podagra (1st MTP joint involvement MC), tophi deposition (chronic), nephrolithiasis and nephropathy. arthrocentisis shows negatively bifringent needle-shaped urate crystals. radiographs show mouse/rat bite punched-out erosions w overhanging margins. acute: NSAIDs drug of choice (Indomethacin, Naprosyn), avoid aspirine, Colchicine 2nd line. chronic: Allopurinol- take w meals, Febuxostat, Uricosuric- Probenecid&Sulfinpyrazone, Colchicine |
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Definition
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Term
| calcium pyrophosphate deposition in the joints/soft tissue, inc in elderly>60y, females. acute: red, swollen, tender joint, knee MC. cartilage- linear radiodensities seen on radiographs. diagnose w positively birefringent, rhomboid-shaped CPPD crystals (acute) acute treat w intraarticular corticosteroids 1st line, NSAIDs, colchicine. chronic: NSAIDs, colchicine, |
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Definition
| Calcium pyrophosphate dihydrate deposition disease. pseudogout (acute arthritis), chondrocalcinosis (cartilage calcification), chronic CPPD that resembles RA-0 inflammatory arthritis, OA w CPPD (resembles osteoarthritis- treat like OA) |
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Term
| MC associated w immobility, crush injuries, overexertion, seizures, burns. can be caused by statins, niacin, fibrates (drugs that inhibit the CP450 system- ex macrolides and Verapamil & diltiazem). labs inc CPK >20,000, inc LDH, ALT, hyperkalemia, hypocalcemia, UA is dark urine pos for heme but neg for blood, treat w IV saline, mannitol, bicarbonate. complications are acute kidney injury- acute tubular necrosis |
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Definition
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Term
| mono or polyarthritis in children <16y. pauci-articular: <5 joint involvement, type 1- iridocyclitis (anterior uveitis). systemic/acute febrile (still's disease): daily arthritis, diurnal high fever, salmon-colored/pink migratory rash. polyarticular: arthritis>/= 5 small joints, most similar to adult RA, inc risk of iridocyclitis. inc esr and crp. pos ana in oligoarticular. treat w nsaids/corticosteroids, methotrexate, leflunomide, eye exams |
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Definition
| juvenile idiopathic arthritis (rheumatoid) |
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Term
| articular cartilage damage and degeneration, obesity big RF. MC in weight-bearing joints, sclerosis and osteophyte formation in joint space, evening joint stiffness that dec's w rest and worsens throughout the day and w changes in weather. hard bony joints (osteophytes)- heberden's node (DIP) and bouchard's node (PIP). acetaminophen preferred intiial tx then NSAIDs, intraarticular corticosteroid injections, sodium hyaluronate, glucosamine & chondroitin, knee repalcement |
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Definition
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Term
| joint destruction due to pannus, t-cell mediated, inc risk in females. small joint stiffness (MCP, PIP, knee, MTP, shoulder, ankle), morning joint stiffness >60min after initiating movement that improves later in the day, symmetrical swollen tender erythematous boggy joint, boutonniere deformity (flexion at PIP, hyperextension of DIP), swan neck deformity (flexion at DIO hyperextension at PIP), ulnar deviation at MCP joint, felty syndrone triad, caplan syndrome, RF test, pos anti-cyclic citrullinated peptide ab's most specific for RA, arthritis >/= 3 joints, radiologic findings: narrowed joint space- osteopenia.erosions. prompt initiation of DMARDs reduces permanent joint damage ex Methotrexate 1st line, NSAID 1st line for pain control, corticosteroids 2nd line. 1st line DMARD in active is methotrexate |
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Definition
| rheumatoid arthritis (RA). felty's syndrome = triad of RA, splenomegaly, dec WBC/repeated infections. caplan syndrome: pneumoconiosis + RA |
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Term
| vasculitis of the extracranial branches of the carotid artery, mostly affecxts cranial arteries of head and neck. headache most common symptom, jaw claudicxation w mastication, acute vision disturbance- amaurosis fugax, thickened temporatl artery, aortic aneurysm. blindness MC complication. ESR >/= 100. inc CRP. biopsy shows mononuclear lymphocyte infiltration, multinucleated giant cells, lamina cell degradation. manage w high-dose corticosteroids, start prednisone if suspicion. hallmark: headache, scalp tenderness, jaw claudicaiton, fever, visual changes |
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Definition
| giant cell (temporal) (cranial) arteritis |
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Term
| recurrent, painful oral and genital ulcers (aphthous). manage w corticosteroids during flares |
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Definition
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Term
| young male predominance <40y, patients develop uveitis & sacroliitis, pos HLA-B27, neg ANA and RF, pos enthesitis (inflammation where ligamants and tendons insert into bone), PEAR: Psoriatic arthritis, Enteropathic arthritis, Ankylosing spondylitis & Reactive arthritis |
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Definition
| Seronegative Spondyloarthropathies |
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Term
| asymmetric arthritis may mimic RA but affects DIP joint, dactylitis (sausage digits), sacroiliac arthritis (sacroiliitis), chronic uveitis, signs of psoriasis: pitting of the nails. x-ray: pencil in cup deformity, pos HLA-B27, inc ESR. management NSAIDs 1st line |
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Definition
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Term
| associated w IBD chrons ,Ulcerative colitis, seronegative spondyloarthropathy |
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Definition
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Term
| axial skeleton & sacroiliac joints c progressive stiffness, chronic low back pain: morning stiffness w dec ROM, back stiffness decreases w exercise/activity. peripheral arthritis may develop bilateral sacroiliitis, inc ESR, pos HLA-B27, bamboo spine- squaring/bridging of the vertebral bodies, manage w NSAIDs |
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Definition
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Term
| autoimmune response, arthritis w asymmetric inflammation, conjunctivitis/ uveitis, urethritis. MC Chlamydia. Triad: conjunctivitis, urethritis & arthritis), keratoderma blennorrhagicum (hyperkeratotic lesions on palms/soles), pos HLA-B27, synovial fluid wbc over 1,000-8,000, fluid bacterial cx neg. manage w NSAIDs |
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Definition
| reactive arthritis (reiter's syndrome) |
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