part 2 RA sem1

What condition is this?

• Common in Female

• 15-45 y/o

• Type of arthritis: Non-Erosive

• Common on African Americans/ Hispanics

• Systemic

• 11 criterias (4 or more manifestations for (+) ____)

→ DOPAMIN RASH

Systemic Lupus Erythematosus

Enumerate the DOPAMIN RASH

o D – Discoid Rash (when heals, leaves a scar)

o O – Oral Ulcer – you are immunocompromised (singaw) § Immunologic disease

o P – Photosensitivity

• Presence of sun exposed areas of the body

o A – Arthritis (Jaccoud’s Arthritis)

• non erosive but deforming

• MC swan neck deformity that is reversible (since the problem is not erosive but capsular laxity)

o M – Malar (aka Butterfly rash)

• Over malar eminence

• Forehead, nasal fold is spared

o I – Immunologic

• Infection – MC cause of mortality

• CNS lupus

• Renal

• Cardiac Involvement

o N – Neurologic

• Psychosis, CVA manifestation

• Mov’t disorders

o R – Renal

• Lupus Nephritis

• Undergo Dialysis

o A – ANA (+)

• 99% with ANA, have SLE

o S – Serositis – inflammation of serous membrane

• Heart – pericarditis

• Lungs - pleuritis

o H – Hematologic

• Felty’s syndrome

Among the 11 criterias on SLE:

• when heals, leaves a scar

D – Discoid Rash

Among the 11 criterias on SLE:

• you are immunocompromised (singaw)

• Immunologic disease

O – Oral Ulcer

Among the 11 criterias on SLE:

• Presence of sun exposed areas of the body

P – Photosensitivity §

Among the 11 criterias on SLE:

• non erosive but deforming

• MC swan neck deformity that is reversible (since the problem is not erosive but capsular laxity)

A – Arthritis (Jaccoud’s Arthritis)

Among the 11 criterias on SLE:

• Over malar eminence

• Forehead, nasal fold is spared

M – Malar (aka Butterfly rash)

Among the 11 criterias on SLE:

• Infection – MC cause of mortality

• CNS lupus

• Renal

• Cardiac Involvement

o I – Immunologic

Among the 11 criterias on SLE:

• Psychosis, CVA manifestation

• Mov’t disorders

N – Neurologic

Among the 11 criterias on SLE:

• Lupus Nephritis

• Undergo Dialysis

R – Renal

Among the 11 criterias on SLE:

• 99% with ANA, have SLE

o A – ANA (+)

Among the 11 criterias on SLE:

• inflammation of serous membrane § Heart – pericarditis § Lungs - pleuritis

S – Serositis –

Among the 11 criterias on SLE:

• Felty’s syndrome

o H – Hematologic

What condition is this?

• (-) rheumatoid factor

• Involvement of the spine

• (+) HLA B27 - spondyloarthropathies

• F=M

• Arthritis type: Enthesisitis – inflammation of the enthesis; connection of tendon to ligament to bone

• Types: 4 spondyloarthropathies (PARI)

o Psoriatic

o Ankylosing Spondylitis (AS)

o Reiter’s (syndrome)

o Inflammatory Bowel Syndrome (IBD/S)

Seronegative Spondyloarthropathies

What type of Arthritis does Seronegative Spondyloarthropathies have?

Enthesisitis - – inflammation of the enthesis; connection of tendon to ligament to bone

What are the types of Seronegative Spondyloarthropathies?

o Psoriatic

o Ankylosing Spondylitis (AS)

o Reiter’s (syndrome)

o Inflammatory Bowel Syndrome (IBD/S)

What type of Seronegative Spondyloarthropathies is this?

• with joint involvement (Psoriatic Arthritis)

• Affecting skin

• With spine involvement (Asymmetric)

• Involvement of DIP joint , next is knee joint (WB)

• Manifestations

  • Oligoarticular

  • Auspitz sign

  • Koebner Phenomenon

  • Onycholysis

  • “Pencil in a cup“ deformity

  • (+) Dactylitis (Sausage Digits)

1. Psoriasis/Psoriatic Arthritis

Enumerate the manifestations of Psoriasis / Psoriatic Arthritis

• Manifestations

  • Oligoarticular

  • Auspitz sign

  • Koebner Phenomenon

  • Onycholysis

  • “Pencil in a cup“ deformity

  • (+) Dactylitis (Sausage Digits)

A manifestation of Psoriasis/Psoriatic Arthritis

• 4 or less joints affected progresses to Polyarthritis

Oligoarticular

A manifestation of Psoriasis/Psoriatic Arthritis

• bleeding when removal of skin

Auspitz sign

A manifestation of Psoriasis/Psoriatic Arthritis

• common on knuckles; elevated skin lesions

• Koebner Phenomenon –

A manifestation of Psoriasis/Psoriatic Arthritis

• Nail lysis

• Onycholysis –

A manifestation of Psoriasis/Psoriatic Arthritis

“Pencil in a Cup“ deformity

A manifestation of Psoriasis/Psoriatic Arthritis

(+) Dactylitis (Sausage Digits)

What type of Seronegative Spondyloarthropathies is this?

• Common in Male - 20-40 years old

• Systemic, symmetric and inflammatory

• Other names

  • Marie Strumpell Disease – Ascending type – condition starts distally

  • Von Bechterev – Descending – proximal to distal

• Manifestation

  • Kyphosis deformity

  • Most common affected peripheral joint is the Shoulder joint – leads to permanent stiffness – that leads to kyphosis

  • Morning back pain, SI joint affectation (Sacroilitis)

• Special test:

  • Patrick’s, FABERE, Figure of 4

  • Gaenslen’s Test

  • Schober’s Test

  • Occiput to Wall test

  • Pelvic Rock/ Compression

• Calcification of IV Disc (annulus fibrosus) connecting vertebrae

  • Syndesmophytes – vertical running bony spurs running along the spine

• Lung problems – chest expansion (Chronic Restrictive Lung Disease/CRLD)

  • Kyphotic posture – difficulty exhaling – because when exhaling, you extend your back to expand the chest but due to kyphotic posture, pt cannot expand their chest = CRLD

• Extra articular:

  • Heart: Aortitis – inflammation of the aorta

  • Eyes: Anterior Uveitis

• X-Ray finding: Bamboo Spine Deformity

  • Management: Best exercise: Swimming (back stroke)

• DDx

  • DISH (Diffuse Idiopathic Skeletal Hyperostosis) or Forestier’s Disease >40 y/o Non systemic § § § § Calcification of Anterior Longitudinal Ligament (ALL) X-Ray finding: Bamboo Spine

2. Ankylosing Spondylitis

Other name for Ankylosing Spondylitis if it’s ascending type - condition starts distally

Marie Strumpell Disease

Other name for Ankylosing Spondylitis if it’s descending type - proximal to distal

Von Bechterev

Enumerate the manifestations of Ankylosing Spondylitis

o Kyphosis deformity

o Most common affected peripheral joint is the Shoulder joint – leads to permanent stiffness – that leads to kyphosis

o Morning back pain, SI joint affectation (Sacroilitis)

Enumerate the special tests that are used for Ankylosing Spondylitis

o Patrick’s, FABERE, Figure of 4

o Gaenslen’s Te

o Schober’s Test

o Occiput to Wall test

o Pelvic Rock/ Compression

Under Ankylosing Spondylitis, what is this?

vertical running bony spurs running along the spine

Syndesmophytes

In Ankylosing Spondylitis, there are lung problems where the pt experiences difficulty breathing due to having a kyphotic posture. This will lead to a condition called?

Chronic Restrictive Lung Disease/CRLD

In Ankylosing Spondylitis, there are extra articular problems such as the inflammation of the aorta. What is this condition called?

Aortitis

In Ankylosing Spondylitis, there are extra articular problems such as the inflammation of the uvea. What is this condition called?

Eyes: Uveitis

In Ankylosing Spondylitis, what do you call the X-ray Finding in the spine? What is the best exercise to manage this?

Bamboo Spine Deformity

Swimming (back stroke)

What is the Ddx for Ankylosing Spondylitis?

DISH (Diffuse Idiopathic Skeletal Hyperostosis) or Forestier’s Disease

In DISH (Diffuse Idiopathic Skeletal Hyperostosis) or Forestier’s Disease, there is calcification in what lligament?

ALL (Anterior Longitudinal Ligament)

What type of Seronegative Spondyloarthropathies is this?

• A sexual disease

• Due to STD, common on sexually active males

  • 9:1

  • Chlamydia – a common STD; affects males

• Female: Food Born 1:1, because of Salmonella

• Asymmetric – 1 part of the body is affected

• Cause: Infection + HLA B27

• Ankle joint is most commonly affected

• Triad

  • Conjunctivitis – inflammation of the eye

  • Urethritis – inflamed urethra

  • Arthritis (Enthesis) – inflammation of the enthesis (a connective tissue between tendon or ligament and bone

• Mnemonics:

  • C – Conjunctivitis

  • U – Urethritis

  • K – Keratoderma Blennorhagicum

    • Seen in the palm/ soles of the foot

  • A – Arthritis (Enthesitis)

  • C – Circinate Balanitis, inflammation of penis

3. Reiter’s Arthritis

In Reiter’s Arthritis, this is a common STD; affects males

Chlamydia

In Reiter’s Arthritis, females are also affected due to food born and the ratio is 1:1. This happens because of this condition

Salmonella

What joint is affected in Reiter’s Arthritis?

Ankle joint is most commonly affected

Triad in Reiter’s Arthritis?

• Triad

a. Conjunctivitis – inflammation of the eye

b. Urethritis – inflamed urethra

c. Arthritis (Enthesis) – inflammation of the enthesis (a connective tissue between tendon or ligament and bone

Mnemonics in Reiter’s Arthriitis

• Mnemonics: o C – Conjunctivitis o U – Urethritis o K – Keratoderma Blennorhagicum § Seen in the palm/ soles of the foot o A – Arthritis (Enthesitis) o C – Circinate Balanitis, inflammation of penis