LMCC 2025-Rhumato

Monoarthrite ddx

-Arthrite septique

-Goutte

-Arthrite inflammatoire

-Trauma

Spondylite ankylosante examen physique

H 20-30 A

-Schober + (aug. distance entre 2 points < 5 cm)

-Distance occipu-mur > 2cm

-Diminution expansion thoracique

SA tests

-HLA B27 + (souvent)

-RX lombaire (bamboo, dagger sign)

-RX pelvis (sacro-ilite)

SA treatment

1. AINS

2. DMARDS

   • agents bio comme anti-TNF

   • si attente périphérique: dmards synthéthiques (SSZ ou MTX)

Syndrome anti-phospholipide

Autoimmune disease causing thrombosis of veins, arteries and small vessels.

Sx: miscarrages, AVC, EP, retinal thrombosis.

SAP criteria

Tx SAP

-Warfarine à vie (viser INR 2-3)

-Femmes enceinte: aspirine 75-150mg à partir de la 12e semaine + HBPM

Fibromyalgie

Dx d’exclusion.

Chronic, widespread body pain. This should be in at least 4/5 body regions (left and right upper body, left and right lower body and axial regions).

Giant cell arthritis (artérite temporale) tests

Echo: halo sign

Bx (inflammation granulomateux): gold standard

GCA tx

CS IV si sx visuels

CS PO haute dose 40-60mg DIE puis sevrer

Référence urgente en ophtalmo et rhumato

Goutte

Atteint + souvent 1ere MTP, mais peut aussi atteindre knees, ankles, midtarsal joints, wrists, elbows and small joints of the hands.

Goutte test dx

-Aspiration de l’articulation (GS): monosodium urate crystals with negative birefringence.

-Acide urique sérique

Goutte tx

1. AINS ad 1-2 jours post résolution (+ IPP) + Colchicine ad résolution de la dlr

2. CS PO si CI aux 1-2.

Allopurinol en chronique si >2 crises par an, Tophi, Érosions osseux

Apparences des aspirations en goutte vs pseudogoutte etc.

Goutte: aiguille, négativement biréfringeants

Pseudogoutte: rhomboid, positivement biréfringeants.

Pseudogoutte tx

Aigu: CS inj., cool packs, aspiration jointures.

Chronique: AINS + IPP, colchincine

Marfan sx

Autosomal dominant connective tissue disorder caused by mutations in the fibrillin 1 gene.

Osteoarthrite sx

-Crepitus

-Joint swelling

-Reduced motion

-Nodules d’Herberden et Bouchard

OA RX

Osteoporosis

GS: ODM

• T < -2.5

• Osteopénie si entre < -1 et -2.5

Calcium + vit. D sérique

Indications ODM

> 65 A

F ménopausée et H 50-64 A avec FDR

• Fx de fragilité

• Fx de hanche chez parent

• Tabagisme actif

• Forte conso ROH

• Usage CS

H, F < 50 ans avec FDR:

• Fx de fragilité

• Usage CS

• Hypert4

• Maladie de Cushing

• PAR

PMR sx

-Pain and stiffness of the neck, shoulders (bilateral) and pelvis.

-Systemic: weight loss, low-grade fevers, fatigue and anorexia.

PMR tx

CS PO

Polymyosite

Bilateral proximal muscle weakness (anterior neck flexors, ceinture pelvienne, épaules).

Systemic: Weight loss, Fevers, Anorexia, Fatigue, Arthralgia

Dermatomyositis sx

sx myosite + sx cutanés:

• Shawl sign

• V sign

• Papules de gottron

• Rash heliotrope

• Holster sign (erythema of the buttocks, hips and lateral thighs)

Myosite tests

CK

Antibodies to Jo-1 (polymyosite), Mi-2 (dermatomyosite) and ANA

EMG

Muscle biopsy

Myosite tx

1. CS PO haute dose

2. DMARDS

Arthrite psoriasique sx

Pain, stiffness and swelling of peripheral and/or axial joints, enthesitis (inflammation of tendons), dactylitis (painful swelling of a whole digit) and nail changes.

Arthrite psoriasique tests

-RX mains et pieds: pencil in a cup, deformation, etc.

-RX lombo-sacrée (trouvailles similaires à SA)

-PAS D’ANTICORPS

Arthrite psoriasique tx

AINS, DMARDS, CS inj.

Raynaud’s phenomenon

triggers: triggered by cold exposure, with other triggers including emotional stress, vibration injury, smoking and medications (e.g. beta-blockers).

tx: conservateur, nifedipine peut être considérer.

Arthrite réactive

-Within 4 weeks of an infection (ITSS or GI infx).

-Triad: can’t pee (urethrite), can’t see (uveite), can’t climb a tree (arthrite asymétrique).

Arthrite réactive tests

-Chlam/gono, culture des selles (c. diff), PCR viral

-Analyse liquide synovial (r/o septique, mais présence de leucocytose)

-RX des articulations

Arthrite rhumatoide

-Symmetrical synovitis affecting primarily the small joints of the hands (NOT IPD) and feet (MTP).

• Swan-neck deformity

• Boutonnière deformity

• Ulnar deviatioon

-Sx inflammatoire

-Peut atteindre plusieurs systèmes (pneumo, neuro, ophtalmo, cardio, etc.)

AR tests

FR +, anti-ccp +

AR tx

DMARDS

Sarcoidose

Granuloma formation in various organs, with the most commonly affected being the lungs.

Sx: fever, polyarthralgia, erythema nodosum, dry cough, dyspnoea, fatigue and weight loss.

sarcoidose tests

Calcium and ACE serum (↑), RXP, bx granulome.

Sarcoidosis tx

AINS, CS haute dose, immunosuppresseurs.

ES CS

Syndrome de sjogren

Autoimmune disorder characterised by destruction of the lacrimal and salivary glands causing drying of the eyes and mouth (+ Raynaud).

-Can be 2aire à SLE or RA

Sjogren tests

-Anti-Ro (SSA) and anti-La (SSB) antibodies

-Schirmer's test (which measures tear production): if less than 5 mm is wet after 5 minutes this is positive

-Echo and biopsy of the salivary glands

SLE

SLE tests

Anti-nuclear, anti-DNA and anti-Smith antibodies.

SLE tx

1. Hydroxychloroquine

2. CS, DMARDS, agents bio

Sclerodermie

Difference between limited vs. disseminated:
LcSSc (CREST syndrome) is more common and only peripheral skin is affected with slower progression of disease and later involvement of internal organs.

DcSSc affects truncal as well as peripheral skin and progresses more rapidly.

Sclerodermie tests

anti-Scl 70 (disseminated), anti-centromere (limited sclerodermie) and anti-RNA polymerase III antibodies

Sclerodermie tx

Regular monitoring for complications, physiotherapy to aid mobility and muscle strength, immunosuppressive treatment for dcSSc.