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rheumatology-notes-syrian-student.html

Migratory arthropathy >> Lyme + gonococcus + RF angoid streaks >> paget

Pulmonary involvement in RA occurs exclusively in men PMR >> low dose steroid will work dramaticly
Sjogren associates with RA , SLE , PBC Avascular necrosis in SCD >> aspirates is NOT inflammatory
Wegner > necrotizing GN SCD >> high GOUT
SLE , Trauma , DJD >> aspiration >> 500-2000 wbc lymphocytes Acute sickle arthritis >> inflammatory
Peripheral ANA >> SLE Hydralazine+ minocyline >> ANCA(+) >> Tx cyclophosph+steroid
Nucleolar >> sys. SCL p-ANCA >> Crhon + PSC
Speckled >> NL idiopathic crescentric GN >> p-ANCA
Centromere >> limited SCL + PBC stickler >> collagen type II
Anti-DS >> indicator of disease activity + lupus nephritis RA >> large B cell lymphoma (NHL)
Hemochromatosis >> MCP asymmetric C1C2 subluxation >> if aSx >> nothing
Antiphospholipid antibody >> 1at trimester abortion HA >> NSAID
Smoking is the only environmental risk factor for RA (sun for SLE) LGL >> dont do splenectomy
Ptn with RA will improve if he suffers fron HIV (T cell infiltrating ) LGL may progress to leuckemia
RA > ulnar deviation of digits , radial of the wrist Leflunamide >> no pulm. But diarrhea , alopecia
MTX may flare rheumatic nodules SSZ > reversible oligospermia
COX-2 inhibitor >> removing the protective effects of fatty acids HCQ >> OK with preg.
Cox-2 reduces pl inhibition and ASA-induced asthma Cyclophosph for ILD in RA (remember shekri)
Gold >> nephritic , stop if rash , metallic taste , proteinuria , low WBC IMMUNOsupressors in preg.
Felty >> G-CSF CI: leflunomide , MTx , MFF
Infliximab >> high rate of autoantibody >> use it with MTX ( TB more Potentially safe : steroid , HCQ , SSZ , AZA , 6MP
common with infliximab ) Infliximab >> category B (FDA)
Adalilumab >> long half-life Threats >> cyclophsoph
Anakinra >> IL1 antagonist SI >> symmetric in AS,UC
HLA D4 = aggressive RA (2-3 >> SLE) SI >> asymmetric in reiter , psoriasis
Inflammatory >> symmetric joint space narrowing MRI with gadolinium for detecting xray(-) SI
DJD >> asymmetric joint space narrowing Reiter >> usually large joints of lower ex.
SLE >> PainleSS oral ulcers HCQ shouldnt be used in psoriasis nor BB , steroid
SSA + SLE + pregnancy >> 3 HB OA >> if NSAID CI >> Tramadol
SSA + Sjogren + pregnancy >> NO 3HB Chronic gout >> UA should be less than 6.4 mg/dL
SLE + arthritis + pleurisy >> Rx: NSAID Tophaceous deposits or >60yrs >> use allopurinol not probenicide
Steroid creams for skin in sle If renal tansplant + cyclosporine + diuretics >> Gout >> intraarticular
SKIN + ARTHRITIS >> Hydorxychloroquine in SLE steroid injection
Drugs known to cause SLE in nl population are not necessary CI in ptn with Contrary to other manifestation og Hch >> removal of iron wont reverse
SLE joint disease
No hair loss , renal , CNS , skin in Rx-induced SLE Hydroxyappetite >> wont be seen under microscooe ( but electron
Quinidine >> ANA(-) SLE microsope will show them)
TNF + INF >> DS(+) SLE HAA >> Tx is the same for pseuogout and gout
Minocycline + hydralazine >> anti=histone (-) SLE but ANCA(+) Whipple >> hyperpigmentation , memory loss , dementia
Large intestinal diverticula >> SCL Tx PCN , streptomycine , TMP/SMX
Pulm HTN limited >>> sys.SCL Adult still >> lymphadenopathy + sore throat + cervical spine
ILD >> sys.SCL (doesnt occur in limited) Lupus nephritis << diffuse proliferative is the most common and the worst
1-2 raynaud >> nailfold capillaroscopy SLE + preg. >> steroid + HCQ + SSZ + ASA
Bleomycine may cause SCL-like syn. Non-SLE >> APA causes 1st trimester abortions
Most common Sx in sys.SCL is reflux SLE >> APA causes 2nd and 3rd trimester abortions
Eosinophilic fasciitis may mimic SCL but no raynaud and responde to Rx-induced SLE >> Tx: NSAID and HCQ may be used
steroid ANA is very high 1:20,000 in MCTD
Skin in SCL >> D-pencillamine APA >> spleen infarction
Diffuse idiopathic skeletal hyperostosis >> no SI involvement , non- CREST = Limited SYSTEMIC sclerosis
marginal , syndesmophytes Limited SSc >> watermelon stomach
AS + minimal trauma >> Spine Fx Diffuse SSc >> large diverticula
Reiter may benefit from 3 weeks of tetracycline Bacterial overgrowth >> intermittent ciproz
HIV >> severe form of AS D-pen >> nephrotic syn
Sausage shaped digits >> psoriasis , reiter Cyclosporine >> achillis tendon rupture ( tendonitis >> FQ)
Most common joint in DJD >> knee then base of the thumb Eosinophillic fasciitis occurs after physical activity , often require steroid ,
Acute Gout >> NSAID , Colchicine , STEROID if RENAL IMPAIRMENT sparing hand , no raynaud , nl capillaroscopy
PseudoGout >> hypoMg , HypoPh , hyperPTH , Hch , hypoT4 PBC >> AMA , PSC >> p-ANCA
pseudoGout >> elderly , subacute , large joint , inflammatory , knee wrist , Medstudy >> polymayalgia rheumatic >> pain and stiffness while
poly (gout = mono) Polymyositis >> weakness
PAN , Churg-strauss , wegner >> all steroid + cyclophosph Polymyositis >> cytotoxic T cells >> EMG: decreased amplitude with
PAN >> medium , no pulm , no GN , 10% hep.B , (-)p-ANCA increased spike amplitude!!)
mPAN >> small/medium , alveolar hemorrhage , GN , no hep.B , p-ANCA(+) PM >> CD8 , DM >> CD4childhood PM or DM occur without cancers.
Anti-Jo >> mechanic hands + ILD
Anti-Mi2 >> DM OA >> acetaminophen >> NSAID >> Tramadol >> steroid injection
Anti-SRP >> PM MKSAP 4 >> evaluate ptn with DM with proper-age screening tests for ca
Malignancy assoc. with DM >> PM and some experts even recommend testing every 6 to 12 months if (-)
IVIG may be helpful in ptn dont responde to other medication Avascular necrosis of the hip >> occurs w/o restriction of joint motion
Inclusion body myositis is the most common myopathy in age over 50 yrs Whipplii >> gram (+)
IBM >> CPK maybe mildely elevated HIV + MAI >> may cause PAS (+) intestinal Bx but it is acidfast not G+
IBM assoc. with statins , colchicine , cocaine Carpal tunnel syn:
FIBROMYALGIA >> related to neurotransmitter dysFx HypoT4 >> accumulation of matrix substances
Non-restorative sleep RA >> tenosynovial inflammation
Tx: FDA 1st Rx = pregabaline Acromegaly >> synovial tendon hyperplasia
Can use TCAs coz it will prolonge stage 4 sleep Pregnancy 3rd T. >> accumulation of fluid in carpal tunnel
Myogacial pain syn >> occurs after trauma (whiplash ) Subachromial bursitis >> active motion >> pain
Tx: excersise , sleep , local anesthetic injection Most sever pain when passively flexed + internally rotated
Chronic regional pain syn >> reflex sympathetic Paget >> nl Ca/PH high AP
Dx: tri-phase bone scans Milk-alkali >> high ca + nl AP
Vasculitis >> thrombocytosis Epidural abscess >> MRI of spine
Ptn recall the day of onset >> PMR RA and SLE doesnt resolve in less than 4 w
PMR >> low dose steroid , TA >> high dose steroid If it does >> this is not RA (probably VIRAL)
Eos. Fasciitis + PMR >> assoc. with paraneoplastic syn. DJD >> no pain with palpation (unlike inflammatory)
TAKAYASU >> Tx: CCB to prevent vasospasm and Anti-coag. And steroid Vertebral Fx >> pain over vertebra
PAN >> if obvious site >> Bx it , if no >> ABD. Angio >> if (-) >> blind Bx Sprain >> paraspinal pain
Wegner >> 1st Bx the east ones (nose , sinuses , mouth) Hyperthyroid myopathy >> proximal myopathy
OA aggravates by weather changes Apophyseal joint arthritis >> AS
to reduce gi bbbleed from nsaid >> ppi better tolerance than mesoprostol Tenderness of the spinous process with gentle percussion is the most
if comadin + wanna give nsaid >> u should give him ppx of ppi important sign of vertebral Osteomyelitis.
only elendorate reduces hip Fx in women .. the only one .. once weekly .. Rotator cuff tendonitis improves with lidocaine , tear doesnt
the others reduce vertebral ( but not hip ) Fractures .. RA >> osteopenia + osteoporosis
estrogen : no evidence that est reduces cardiovascular events .. don't be Cant grip cup or pen in the morning but functional in the evening >> RA
fooled .. Parvo B19 is recognized by the lack of inflammatory markers
-1.5 - -2.5 >> osteopenia Paget >> osteocalst DysFx
best initial blood test for sjogren >> SSA-SSB Spinal stenosis > Dx=MRI
most sensetive test >> minor salivary gland Biopsy PMR >> elevated ESR
dmard >> leflunamide Suspect vertebral osteomyelitis >> MRI 1st
if she wants to become pregnant >> cholestyramine will help excrete it AS >> chest wall motion restriction
from the hepatobillaiary circulation Serum sickness >> lymphadenopathy after Rx like pen.
SLE >> OCP is safe except APA and activr renal disease. Mesna for cyclophosph.
Bursitis >> rest >> aspiration >> steroid injection (students elbow , Allopurinol more important then hydration for preventing tumor lysis syn.
housemaid knee ) TA >> Aortic aneurysm
Adhesive capsulitis ( frozen shoulder ) unknown cause >> self-limited Most important thing of inf. Joint >> swelling
(Tx:exercise) Bursitis + tendonitis >> pain wit active movements
Night pain = buzz word for shoulder bursitis pain while lying on the PMR has ESR>50 !! (averg. Of TA 107)
affected shoulder
Most common cause of shoulder pain = rotator cuff injury
Pain with resisted abd of the shoulder >> rotator cuff tendonitis
Phalen test >> forced flextion of wrist USMLE WORLD:
Tinel = tappimh on volar aspect of median nerve 4-6-7-12-15-21-25-33(^_!)-36-38-41-43
Lying on shoulder >> pain >> bursitis 33/44
Lying on hip >> pain >> bursitis 6/6
Outside on the thigh over trochantric >> bursitis 39/50
On the groin >> hip joint pain 2-9-12-16-26
Pes anserine bursitis : medial aspect of tibia 39/44
Look for evidence of spondyloarthropathy in ptn with plantar fasciitis 78/94
Acute back pain >> Xray of low yield
Activities as tolerated better than bed rest 82.97 % (^_x)
Cyclophosph >> acrolin >> bladder ca screen with UA
PTU >> p-ANCA (+) SLE-Like syn
Ptn > 5mg steroid >> ca+D+biphosph
Reiter > recurrences are not related to reinfection
Maximally flexing the hip and knee and applying abduction (valgus) force
to the knee while externally rotating the foot and passively extending the
knee (McMurray's test) result in some tenderness >> menescial tear
Swelling occurs in menescial tear over several hours, in contrast to
ligamentous injuries, in which swelling is immediate
The Ottawa Knee Rules suggest obtaining a knee radiograph in patients
who meet any of the following criteria: 1) age older than 55 years, 2)
tenderness at the head of the fibula or patella, or 3) an inability to flex to
90 degrees or to bear weight both immediately after the injury and during
evaluation.