Rheumatic Disorder (copy)

Types of articular rheumatic diseases

Gout, CPPD, Infectious arthritis, OA, soft tissue rheumatism

Types of systemic connective tissue disease

SLE, RA, SSc, SNSA, SS, PM and DM myopathies, vasculitis

Symptoms of ARTICULAR disorders

Joint pain and edema, stiffness, limited ROM, crackling sound, joint deformity, pain/limit ROM in active AND passive movement

Articular structures

Synovium, synovial fluid, articular cartilage, intraarticular ligaments, joint capsule and juxtaarticular bones

Non articular/periarticular structures

Supportive extraarticular ligaments, tendon, bursae, muscle, fascia, bone, nerve and overlying skin

NON articular disorder symptoms

Point/focal tenderness near articular structure elicit by SPECIFIC movement/position, pain/limit ROM ONLY IN ACTIVE MOVEMENT, lack of swelling/crepitation/instability, deformation

Inflammatory disorder characteristic

Cardinal sign of inflammation, systemic symptom, lab evidence of inflammation (ESR, CRP etc), morning stiffness that improve after activity

Cut off for acute and chronic rheumatic disease

Less than 6 wk = acute

More than 6 wk = chronic

Causes of acute monoarthritis

infectious or crystal induced (Gout, CPPD) → NEED TO DO SYNOVIAL FLUID ANALYSIS

Acute polyarthritis causes

Acute viral infection or early presentation of SLE or RA

Ddx of chronic mono oligoarthritis

Indolent infectious arthritis, reactive arthritis, psoriatic arthritis, OA

RA involved joints

SYMMETRIC knee and ankle

MCP and PIP + feet MTP

Cervical spine

OA involved joints

Hip, knees ankle

DIP, PIP and 1st CMP + 1st MTP in feet

Cervical and LS spine

Psoriatic arthritis involved joints

ASYMMETRIC knee and ankle

DIP + nail

LS spine and SI joint

Gout/CPPD involved joints

Knees and ankles + wrist in CPPD

Small joint of feet + MCP in CPPD

NO SPINAL INVOLVEMENT

Describe these lesions and the associated condition

Malar rash and discoid rash (annular polycyclic type) → SLE signs

Describe the lesion and the associated condition

Discoid rash of scalp + scarring alopecia + central hypopigmentation ; lupus profundus (Panniculitis + atrophy) → SLE

What is this and what disorder is associated with it

Rheumatoid nodule → firm painless over area of pressure and trauma → sign of RA

Describe the lesion and associated disorder

Guttage psoriasis (scale papules with erythema) and plaque psoriasis → psoriatic arthritis sign

Describe the finding and associated disorder

A = nail pitting

B = onycholysis

C = destructive change with nail loss and pustule formation

Signs of psoriatic arthritis

What is this

Circinate balanitis → painless erythematous papules → reactive arthritis

What is this

Keratoderma blennorrhagicum (early) → Reactive arthritis

What is this

Keratoderma blennorrhagicum (late stage see hyperkeratotic plaque) → Reactive arthritis

Describe the lesion and associated disorder

Gottron papule over IP and MCP; heliotrope with edema → Dermatomyositis sign

Describe the lesion and associated disorder

Leukocytoclastic vasculitis and palpable purpura → primary vasculitis

What is this

Saddle nose deformity → granulomatosis with polyangitis

What is this

Flexion contracture sclerodactyly → Systemic sclerosis

Synovial fluid shows urate crystals like this what disorder do you suspect

Needle shaped crystal → GOUT

Synovial fluid shows this what should you suspect

Rhomboid shaped → CPPD

Auto Ab SLE

Anti dsDNA and Sm

Auto Ab SSc

Anti topoisomerase 1 in dscSSc and anti centromere in lcSSc

Auto Ab PM

anti Jo-1

Auto Ab DM

Anti Mi-2

Auto Ab SS

Anti Ro anti La (SS-A and SS-B)

Auto Ab RA

ACPA and RF

When should you send ANA

Only if the there is CLEAR INDICATION → not for screening bc normal people can have ANA postiive

Describe the finding

Lt = bone erosion and cartilage loss

Rt = erosion and ankylosis

RA signs

Compare the left to right image

Normal on Lt vs OA on right