DM TO OSTEOARTHRITIS

Keratoderma blennorhagica

papulo squamous skin rash that appears most on sole and palms

Circinate balanitis

painless ulceration of the glans penis appears most, shallow ulcer in uncircumcised, circumcised: rash dry, plaque like hyperkeratotic resembles.

• KERATODERMA BLENNORHAGICA

• CIRCINATE BALANITIS

DERMATOLOGIC SYMPTOMS: REITERS DISEASE

Psoariatic Arthritis

An arthropathy associated with combined features of both RA and seronegatives spondyloarthropathies

LOM

Psoariatic Arthritis main problem

CAUCASIANS

EPIDEMIOLOGY: PSORIATIC ARTHRITIS

• Asymmetric oligoarthritis or monoarthritis

• Dactylitis

• Symmetric polyarthritis

• Arthritis mutilans

• pencil in a cup deformity

• Auspitz sign

• Koebner phenomenon

CLINICAL MANIFESTATION: PSORIATIC ARTHRITIS

Dactylitis

sausage digits

Arthritis mutilans

due to osteolysis of the phalanges of the MCP of the hand

pencil in a cup deformity

is a rare bone and joint condition usually associated with a severe form of arthritis called arthritis mutilans.

Auspitz sign

It typically occurs after scratching psoriasis plaques or other forms of skin scales.

Auspitz sign

refers to pinpoint bleeding under the skin's surface.

Koebner phenomenon

the appearance of new skin lesions on previously unaffected skin secondary to trauma.

Crohn’ disease

chronic affectation of any part of the GI tract to mouth up to the anus with skip lesions

• Crohn’ disease

• Ulcerative colitis

• Behcet’s disease

• Whipples disease

Inflammatory Bowel disease

Ulcerative colitis

chronic affectation of the ileum down to the anus

• ABDOMINAL PAIN

• VOMITING

• ARTHRITIS

CLINICAL MANIFESTATION: ULCERATIVE COLITIS

• ORAL ULCER

• UVEITIS

• SCROTAL ULCER

CLINICAL MANIFESTATION: BEHCETS DISEASE

• Wasting

• Hyperpigmentation

• Intestinal pain

• Pleurisy

• Pneumonitis

• Lympadenopathy

• Encephalopathy

• Steatorrhea

• Diarrhea

• Skin rash

• Eye inflammation

• Arthritis

• Subcuataneous nodules

• Endocarditis

CLINICAL MANIFESTATION: WHIPPLES DISEASE

BEHCETS DISEASE

is a chronic relapsing multi-systemic inflammatory disease of an unknown etiology characterized by repeated oral and genital ulcerations, ocular lesions, skin manifestations, arthritis, vasculitis, and gastrointestinal involvement.

DERMATOMYOSITIS-POLYMYOSITIS

inflammatory disease of muscle and skin often associated with profound weakness of all skeletal muscles, including the heart.

POLYMYOSITIS

skeletal muscle damaged by non-suppurative inflammatory processes characterized by lymphocytic infiltration.

DERMATOMYOSITIS

polymyositis plus skin rash.

• Group 1 - primary idiopathic PM

• Group 2 - primary idiopathic DM

• Group 3- DM-PM associated neoplasia

• Group 4- DM-PM associated vasculitis

• Group 5- DM-PM associated collagen vascular disease

• Group 6- inclusion body myositis

Subtypes of DM-PM

• proximal limb weakness

• Pain in buttocks & thigh

• heliotrope rash

• Periorbital edema

DERMATOMYOSITIS-POLYMYOSITIS Findings:

• Symmetric proximal muscle weakness

• Muscle pain

• Dysphagia

• Dysphonia

• Raynaud’s phenomenon

• Rash

• Joint pain

DERMATOMYOSITIS-POLYMYOSITIS Common Clinical Features:

SCLERODERMA

Progressive Systemic Sclerosis also known as?

Progressive Systemic Sclerosis

a systematic disorder of connective tissue in which proliferative vascular lesions and fibrosis occur that involve the skin, kidney, lungs, GIT and heart.

Progressive Systemic Sclerosis

skin changes responsible for the clinical appearance

• Raynaud’s phenomenon

• Symmetric polyarthritis

• Severe Htn

• Pulmonary fibrosis

• Dysphagia

• CREST syndrome

Progressive Systemic Sclerosis: CLINICAL MANIFESTATION

• Calcinosis

• Raynaud’s phenomenon

• Esophageal dysmotility

• Sclerodactlyly

• Telangectasia

CREST syndrome

Morphea

increased collagen in the trunk

En coup de bande

increased collagen in the extremity

En coup de sabre

increased collagen in the face

CALCINOSIS

The deposition of calcium in the skin, subcutaneous tissue, muscles and visceral organs.

• PROXIMAL SCLERODERMA

• SYMMETRIC THICKENING

MAJOR CRITERIA: PSS

• SCLERODACTYLY

• DIGITAL PITTING SCARS

• BIBASILAR PULMONARY FIBROSIS

MINOR CRITERIA: PSS

BIBASILAR PULMONARY FIBROSIS

honey comb lung or diffuse mottling on x-ray

gougerot’s disease

• SCLERODACTYLY

• DIGITAL PITTING SCARS

• BIBASILAR PULMONARY FIBROSIS Also known as

Sjogren’s Disease

Rheumatic condition affecting all exocrine glands

• Dryness of eyes, mouth, and vagina

• Vaginismus in females

• Keratoconjuctivitis sicca

• Lympadenopathy

• Xerostamia

• Arthritis

• Dyspareunia

CLINICAL MANIFESTATION: SJOGRENS DISEASE

Xerostamia

dryness of mouth

Keratoconjuctivitis sicca

dryness of eyes

• SCHIRMERS TEST

• ROSE BENGAL TEST

SJOGRENS DISEASE: LABORATORY EXAMINATIONS

DYSPAREUNIA

It is lasting or recurrent genital pain that occurs just before, during or after sex.

SCHIRMERS TEST

to see if your tear glands are producing enough tears to keep your eyes moist.

SCHIRMERS TEST

The test is performed by placing filter paper inside the lower lid of the eye. After 5 minutes, the paper is removed and tested for its moisture content.

ROSE BENGAL TEST

evaluates the integrity and stability of the mucin layer of the precorneal tear film.

ROSE BENGAL TEST

It is a red dye that stains damaged or devitalized epithelium, mucus and stroma following disruption or instability of the mucin layer of the tear film.

reactive arthritis

Reiter’s disease Also called as?

Reiter’s disease

A form of peripheral arthritis, often accompanied by one or more extra articular manifestation after infection.

• POST ENTERIC

• POST VENEREAL

• (+) HLA B-27

ETIOLOGY: REITERS DISEASE

9:1

EPIDEMIOLOGY: REITERS DISEASE

if generally acquired

1:1

EPIDEMIOLOGY: REITERS DISEASE

if enterically acquired

• URETHRITIS

• CONJUNCTIVITIS

• ARTHRITIS

CLINICAL MANIFESTATION: REITERS DISEASE

• MILD DYSURIA

• OCASSIONALY PROSTATIS

• EPIDYMITIS

CLINICAL MANIFESTATION (MALE): REITERS DISEASE

• DYSURIA

• VAGINAL DISCHARGE

• VAGINITIS

CLINICAL MANIFESTATION (FEMALE): REITERS DISEASE

URETHRITIS

1^st manifestation occurs in both post venereal and post enterical

CONJUNCTIVITIS

2^nd manifestation occurs in both post venereal and post enterical

ARTHRITIS

Appears last in both post venereal and post enterical

Ankylosing Spondylitis

Seronegative Spondyloarthropathy that involves the enthesis of the vertebral spine.

• Enthesitis 

• Pericarditis

• Aortitis

• Anterior uveitis

• Bamboo spine

• Kyphotic posture

• Sacroilitis

CLINICAL MANIFESTATION: ANKYLOSING SPONDYLITIS

ENTHETITIS

is inflammation of the entheses (singular: enthesis)), the sites where tendons, ligaments and joint capsules attach to bones.

Sacroiliitis

is an inflammation of the sacroiliac joint (SI), usually resulting in pain

SACROILITIS

HALLMARK: ANKYLOSING SPONDYLITIS

• SACROILITIS

• DACTYLITIS

• TENDERNESS OVER THE SACROILIAC JOINT

SIGNS AND SYMPTOMS: ANKYLOSING SPONDLYLITIS

Gouty Arthritis

Crystal deposition of monosodium urate in the joint

Gouty Arthritis

Primarily affects peripheral joints particularly in the lower extremities

Gouty Arthritis

The joint lesions consist of creamy or chalky deposits of sodium urate surrounded by foreign body inflammatory reaction they occur in the synovium, ligaments, articular cartilage and periarticular bone.

tophi

Such urate deposits, know as ——— are sometimes found in the cartilage of the ears. They occur also in subcutaneous tissue, fascia, kidneys, heart and other viscera

• Swelling 

• Erythema

• Warmth

• Tenderness

Sign of acute gouty arthritis

• Intense joint pain

• Lingering discomfort

• Inflammation and redness

• Limited range of motion

• PODAGRA

SIGN AND SYMPTOMS: GOUTY ARTHRITIS

PODAGRA

most common symptom in 50% gout cases. It is a red, tender, swollen, hot joint usually the metatarsal-phalangeal at the base of the great toe.

• HOSPITALIZATION

• INFECTION

• TRAUMA

• STRESS

• STARVATION

• SURGERY

PROVOCATIVE FACTORS: GOUT ARTHRITIS

Steatorrhea

Means that you have excessive amounts of fat in your poop. Fatty poops are different from normal poops. They tend to be looser, smellier and paler in color, like clay. They might float.

PSEUDOGOUT/Calcium Pyrophosphate Deposition Disease ( CPDD)

is a form of arthritis characterized by sudden, painful swelling in one or more of your joints. These episodes can last for days or weeks.

KNEE

PSEUDOGOUT/Calcium Pyrophosphate Deposition Disease ( CPDD): The most commonly affected joint?

• Swollen

• Warm

• Severely painful

SYMPTOMS: PSEUDOGOUT/Calcium Pyrophosphate Deposition Disease ( CPDD)

Pseudogout

is a form of arthritis caused by calcium pyrophosphate crystal deposits in a joint, most commonly the knee.

Pseudogout

It is characterized by sudden and intense redness, warmth, pain, and swelling in one or more joint.

Gout

is caused by sodium urate crystals

pseudogout

is caused by calcium pyrophosphate crystals

Chondrocalcinosis

is a painful type of arthritis that causes calcium pyrophosphate crystal deposits in the joint tissues. It can lead to inflammatory attacks and cartilage damage. 

Gouty tophi

are nodular masses of monosodium urate crystals deposited in the soft tissues of the body.

Osteoarthritis

Most common type of arthritis, an asymmetrical non-inflammatory disease that has no systematic component

Osteoarthritis

The progressive destruction of articular cartilage and the formation of bone at the margins of the joint

Cartilage degeneration

Osteoarthritis: HALLMARK

• Mechanical

• Dystrophic

• Genetic factor

ETIOLOGY: Osteoarthritis

• Trauma/repetitive microtrauma

• Immobilization

• Obesity

Factors that related to aging

• trauma

• joint shape

• repetitive use

• occupation

• recreational activities

mechanical factors

• body built

• heredity

• osteoporosis

• smoking

factors that increase susceptibility for OA

• injury

• infection of the joint

• metabolic arthritis

• non-specific inflammatory disorder of the joint

• repeated hemarthrosis

Conditions capable of initiating cartilage lesions

• CHANGE IN ARTICULAR CARTILAGE

• PROSTEOGLYCAN SWELL

• CHANGES IN PROSTEOGLYCAN COMPOSITION

OSTEOARTHRITIS: ACUTE STAGE

• PROSTEOGLYCAN CONTENT LOSS

• LOSS OF ELASTICITY

• FORCE IS DESTROY

• JOINT SPACE NARROWING

OSTEOARTHRITIS: LATE STAGE

• Primary or idiopathic OA

• Secondary  OA

Classification: OSTEOARTHRITIS

Primary or idiopathic OA

Used to designate cases in which no underlying cause for the joint disease is clearly apparent

Primary or idiopathic OA

CLASSIFICATION OA: Affecting 3 or more joint

Secondary  OA

CLASSIFICATION OA: May result from the any condition that disburst normal function

Secondary  OA

CLASSIFICATION OA: Caused by injury, fracture or occupation- related task

• Pain reliever by rest

• Cartilage degeneration

• Acute inflammatory flare

• Pain on passive movement and crepitus

Clinical features: OA