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Rheumatology Disease (TQ)

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cihidobu's version from 2016-08-15 16:40

Bone + Joint + Skin disease

Question Answer
Osteoarthritis (wear and tear)PIP (Bouchard node) + DIP (Heberden node) + Bone spurs + Osteophytes, worse w/ activity
Rheumatoid Arthritis (autoimmune IgG)Symmetric MCP + Swan neck + Boutonneire + Pannus + Symmetrical + Ulnar deviation + Swan-neck deformity, HLA-DR4, vasculitis/baker cyst, IgM against Fc of IgG, amyloidosis
Sjogren (Lymphocytes)Arthritis + dry eyes + dry mouth
Gout (Uric Acid)Monosodium Urate crystals, HGPRT deficiency, Big toe (MTP) (Podagra) + Tophus in external ear + olecranon bursa + achilles tendon, renal failure, worse / alcohol or meat. Negative birefringent, yellow-parallel
PseudogoutKnee pain, Calcium Pyrophosphate dihydrate, rhomboid crystals, positive birefringence
Infective ArthritisArthritis from STD, 1 joint (knee), N. gonorrhea or S. aureus. ↑ESR, fever + ↑ WBC
Psoriatic ArthritisPsoriasis + joints + sausage fingers + pencil in cup
Ankylosing SpondylitisSacroiliac joint + bamboo spine + Uveitis + Aortic Regurgitation (aortitis)
Reactive Arthritis (Reiter's Syndrome)Can't see, Can't pee, Can't climb a tree from GI/Chalamydia infection
Polymyalgia RheumaticaMuscle pain + joint pain from Temporal arteritis
FibromyalgiaChronic muscle pain
PolymyositisProximal muscle weakness, endomysial (skeletal muscle only)
Dermatomyositisskin + skeletal muscle --> Muscle weakness + Gottron's Papules, Heliotrophe rash, anti-JO-1, perimysial (near skin)
SclerodermaCREST
Myasthenia GravisAuto-antibodies against ACh receptor, THYMOMA, muscle weakness worse w/ use, Tx = ACh (rest)
Lambert-Eaton SyndromeAuto-antibodies against Ca2+, Small Cell Lung Cancer, muscle weakness better w/ use
Duchenne Muscular Dystrophydeleted dystrophin gene (muscle anchor --> connects to ECM), skeletal muscle --> replaced by fat. Pseudohypertrophy of calf, ↑CK
Becker Muscular Dystrophymutated dystrophin, less severe form of Duchenne Muscular Dystrophy
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DiseaseCauseAntibodies/Markers/LabsClinical PictureTx
Osteoarthritiswear and tear(old age, obesity)not-autoimmuneDIP (Heberden's), PIP (Bouchard), Osteophyte (bone spurs). NO MCP
Pain in weight bearing joints (worse w/ use). Non-inflamamtory. No systemic symtoms
#1=Acetaminophen
#2=NSAIDS + Steroids
Rheumatoid Arthritisautoimmune - inflammation + destruction of synovial joints. (TYPE III Hypersensitivity)Rheumatoid Factor, anti-IgG Ab, Anti-CCP, HLA-DR4Pannus (inflammatory granulation tissue that invades the joint) on MCP + PIP. NO DIP Ulnar deviation fo fingers, subluxation Baker's cyst in popliteal fossa.

Boutonneire Deformity = extensor tendon on back of fingers ruptures, PIP joints poke through --> flex at PIP, extend at DIP
Swan neck deformity = extend PIP, flex DIP

Better w/ use. (Morning stiffness). Symmetric joint involvement + Systemic symptoms (fever, fatigue, pleuritis, pericarditis)
#1=Celecoxib (COX-2 inhibitor) + Steroids
#2=DMARDs (Methotrexate, TNF-alpha inhibitors)
Sjogren's Syndromelymphocytes infiltrationSS-A (Ro), SS-B (La)Dry eyes, Dry mouth, Arthritis
(Xerophthalmia), (Xerostomia)
↑ risk of B-cell lymphoma, ↑parotid, ↑dental carries
Gout↑ uric acid (HGPRT, lesh-nyhan, ↓ uric acid secretion,↑ cell turnoverNegative birefringent. Yellow-Parallel.
Monosodium Urate Crystals
Asymmetric joint distribution.
Painful, swollen MTP (1st toe) = Podagra
Tophus in external ear + olecranon bursa + achilles tendon
Acute=Indomethacin,Steroids, Colchicine

Chronic=Allopurinol
PseudogoutPositive birefringent
Blue-Parallel
Calcium Pyrophosphate Cyrstals
Large joints (Knee)Acute=NSAIDS, Colchicine, Steroids
Infectious ArthritisS. aureus, Streptococcus, Neisseria gonorrhoeaseAsymmetrical migratory arthritis
STD = synovitis (knee), tenosynovitis (hand), dermatitis (pustules)
Osteonecrosis (Avascular necrosis)trauma, steroids, alcohol, sickle cellFemoral head = infarction of bone and marrow
Seronegative SpondyloarthropathiesNo rheumatoid factorHLA-B27 (PAIR) = HLA MHC Class I
Psoriatic ArthritisPsoriasis + joint pain/stiffness.
Asymmetric.
Dactylitis ("sausage fingers"), "Pencil-in-cup"
Ankylosing SpondylitisSacroiliac Joint + Spine + Uveitis + Aortic Regurgitation

Stiff spine = fusion of joints --> Bamboo spine
Inflammatory Bowel DiseaseCrohn's disease + Ulcerative colitis
Reactive ArthritisPost-GI infections or Chlamydia infectionCan't see, Can't pee, Can't climb a tree
Conjunctivitis, Urethritis, Arthritis
Systemic Lupus Erythematosus
Sarcoidosis
Polymyalgia RheumaticaTemporal (Giant Cell) arteritis↑ ESR, normal CKJoint Pain in shoulder + hips & fever + malaise + weight loss.
NO MUSLCE WEAKNESS
Corticosteroids
FibromyalgiaChronic muscle pain w/ stiffness + poor sleep + fatigue
PolymyositisCD8+ T-cells infiltration↑ CK, positive ANA, positive anti-JO-1 ANTIBODIESMuscle inflammation --> Muscle Weakness
Proximal muscle weakness, ENDOMYSIAL inflammation
Steroids
DermatomyositisCD4+ T-cells infiltration↑ CK, positive ANA, positive anti-JO-1 ANTIBODIESPolymyositis (Muscle weakness) + RASH
Gottron's Papules, Heliotrophe rash (around eyelids), "shawl & face" rash, "mechanic's hand"
↑ risk of cancer
PERIMYSIAL~ inflammation
Steroids
Myasthenic Gravisautoantibodies against ACh receptorPtosis, Diplopia, Weakness WORSE W/ USE
associated w/ THYMOMA
↑ Ach (Pyridostigmine)
Lambert-Eaton Myasthenic Syndromeautoantibodies against pre-synaptic Ca2+ channels = ↓ ACh releaseProximal muscle weakness
Weakness IMPROVES W/ USE
associated w/ SMALL CELL LUNG CANCER
SclerodermaDiffuse = Anti-Scl-70 Ab (anti-DNA topoisomerase I)

Local (CREST) = anti-centromere Ab
↑ fibrosis & collage deposit throughout the body (SKIN = puffy, taut, NO WRINKLES).
Sclerosis of kidney, lung, heart, GI

Diffuse = skin + rapid + visceral involvement
CREST = calcinosis + raynaud + esophageal dysmotility + sclerodactyly + talangiectasia
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