Rheumatology PDF

RHEUMATOLOGY Note : misnomer in OA Topic Outline I. Introduction -...

RHEUMATOLOGY Note : misnomer in OA Topic Outline I. Introduction - a. Nomenclatures arthro joint I.Introduction A = a. Nomenclatures  Arthritis - It inflammation b. Classification of Arthritis II. Inflammatory Arthritis  Arthralgia - It pain a. Autoimmune i. RA  Arthropathy - jt dse ii. JIA iii. Mixed Connective Tissue  Seropositive - It) RF and /or (f) AUPA Disease 1. SLE  Seronegative - D-) RF , (-) ALPA RF : Rheumatoid Factor 2. Scleroderma ALPA : Anti-citminated Protein Antibody  ESR and CRP - birmarkers inflammation 3. Polymyositis/Dermat Sedimentation of Rate ESR : Erythrocyte omyositis Crp : C-Reactive Protein 4. Sjogren’s  ANA - autoimmune indicator ANA : an tinuclear antibody iv. Seronegative b. Classification of Arthritis 1. Spondyloarthropath y ↑ a. Psoriatic Arthritis - b. Ankylosing Spondylitis c. Reactive Arthritis d. Inflammator y Bowel Disease · · 2. Polymyalgia ↑· Rheumatica = b. Crystal-Induced Synovitis i. Gout L- · # ii. Pseudogout III. Non-Inflammatory Arthritis a. Osteoarthritis b. Fibromyalgia Syndrome - - - E J 1  II. Inflammatory Arthritis Articular manifestations: "Tith Flora" A a. Autoimmune i. RHEUMATOID ARTHRITIS (RA) Human definition: RA is PIC AGS AND FINGER /10 poyarthritis : 5 or more its hyper , must 5 cardinal pain # heat inflammatory : gredness ⑤ loss OF FYM signs tumor Chronic : 16 was duration of X bursitis antimentary : systemic : multi-organ d ulnar drift Msunarlydeviaa. a > - symmetrical : bilat. affectation. e (f) Piano key sign > - wristinstability (Rujt) 3 down > - ulnar styloid moves up : RA STAGES OF s/sx: - ·mirage A STAGE It STAGE I RA has small , peripher synovial , articular : age X DIP jt Normal e it , extra-articular : "boy" Extraarticular manifestations: Tita Flora ① eyes ⑳ (Magda by Gloc 9) o Si Tita Flora ay may problema landto conjunctiviti Alam mo ba ang edad niya ay kwarenta 40 y10 & Sica Dati rati siyaý isang piyanista · st) piano key sign Na panadera na ngayon baker's Si Tita Flora ay may yst problema rheumatoid modedes Sa kanyang pagnga-nga TM ay hirap siya Kanyang hinlalaki ay baliko na I then y Anong nangyari saýo? ⑤ heart pericarditis Ito ay kwento ng isang babaeng May sakit sa umaga, wala sa gabi FELTY' SYNDRomE morning stiffness Baluktot ang kanyang mga daliri Sphenomegaly remice Ang galaw ng leeg ay puro hindi Neutropenia At it subluxation 2 a Thrombocytopen Classifications: Ii. JUVENILE IDIOPATHIC "RF Rises" ARTHRITIS (JIA) R RF 1987 ACR CLASSIFICATION elevation # PTS. Aka JUVENILE akd RHEUMATULY ARTHRITS (SRA) F Finger/hand involvement definition: in 1 its for persistent pain at last or more Ce uks R Rheumatoid nodules commonly been in 16 %10 guls I Involvement of 3 or more its types: S Stiffness (morning 1. POLYARTICULAR : < 5 Its E Erosions/decalcification 2. OLIGOARTICULAR : 2-4 its S symmetric aka PANCIARTICULAR 3. STILL'S BSE) : joints & internal organs SYSTEMIL 2010 ACR CLASSIFICATION Ce pts Joint pain (arthralgia TRIAD Arthritis (it involvements A S a. I large jt O It Z Rashes (pink salmon , i : , Tlarge:PT A fever 4-10 smalljts : 3 pts < 10 jt : 5 pts A. b Auto-antibodies (RFEAPA) 1. both negative : 0 pt tests: is low (H) : 2 pts 4 2. any one is high (t) : 3 pts any 1. 3 one. CRD + ESR A c Acute phase reactants (ESRYCRP 2. (f) HLA-B27. normal : 0 1. both is abnormal : 1 one 2. any 3. CHANA 6 d. C weeks duration 1. < wks : 0 4. (t) RF / 2. 76 WRS : 6 RA e. 6/10 points = Cheat Sheet CHIKA! Si JIA, wala pa ngang 16 y/o, POSitive na! Paano ba naman, more than 1 ang jowa! Ayan tuloy, 6 weeks nang in pain. CHAR ! CLASSIFICATION OF FUNCTIONAL CAPACITY IN RA III. MIXED CONNECTIVE Class I able to perform usual ADI TISSUE DISEASES (MCTDs) USVA (self-care ,vocational ,avocationals usual self-care and vocational , definition: able to perform Class II in AVOCATIONAL Acts : LIMITED conditions features but #Sv of characterized able to usual suF-can activities, perform I SLE Class III but LIMITED to Vocational SANORAMNA As is Sclewderma ⑪go D PM /DM i Class IV LIMITED In ability to perform usual ADY overlapping *SVA Sjogren's is 3  III. MIXED CONNECTIVE III. MIXED CONNECTIVE TISSUE DISEASES (MCTDs) TISSUE DISEASES (MCTDs) 1. SYSTEMIC LUPUS 2. SCLERODERMA (Scl) ERYTHEMATOSUS (SLE) Aka PROCRESSIVE SYSTEMIL SCLEROSIS definition: (PSS) B-cell hyperactivity commonly multi-systemic attectation of definition: (15-45y10) bearing child production causing in age seen characterized by fo much collagen (Fibrosis > tissues - scaring and thickening of s/sx: DOPAMINRASH types: D discoid rash 1. LOCALIZED > - mainly involves skin O oral ulcer P photosensitivity DIFFUSED CUTANEOUS S S. 2.. risk of multi-organ involvement higher A > - CAN t sensitive test M malar rash/ &B Butterfly rash I Immunologic ase (anti-Smith , anti-dsDNA) SX Neurologic : N 3. CUTANEOUS S. S and psychosis LIMITED. seizure > - wher risk of multi-organ involvement rephritis proteinuria Calcinosis R Renal affectation : , Raynaud's phenomenon Esophageal dysFXn A Arthropathy : ACOUD'sbuynonens end to 5th fines & mu subluxation Sclerodactyly Telangiectasia S Serositis : phritis pericarditis , tests: anti-centrimete Hematologic FELTU's · H : syndrome anti-sc170/anti-topoise merase condition - 1. autoantibodies : · 2. 4  III. MIXED CONNECTIVE III. MIXED CONNECTIVE TISSUE DISEASES (MCTDs) TISSUE DISEASES (MCTDs) 3. POLYMYOSITIS (PM) & 4. SJÖGREN’S SYNDROME F> M DERMATOMYOSITIS (DM) definition: > exocrine gland destruction 20 to lymphocytic definition: - infiltration idiopathic myositis characterized by SUMMETRICAL PROXIMAL IS WEARNESS s/sx: s/sx: Dry Eyes : Xeropthalmia TRIAD Dry month : Xerostomia PM ens against ENDomysium Arthritis pathognomonic Finding : SKIN DM · Gottron's papules My roads Other s/sx: rash eyelid 1. MIKULICI Syndrome · Heliotrope > - bilat- partid gland affectation CD4 alls against PERmysium 2. Raynaud's Phenomenon types: 3. Dysparennia 1. 1 IDIOPATHIC PM > - painful intercourse dif dry vagine DM types: 2. 1 IDIOPATHIC 1. PRIMARY : C) underlying rheumatologic condition 3. pm/ DM I malignancy 2. SECONDARY : I underlying rheumatologic 4. pm / DM in childhood condition associated : other vascular also 5. PM/DM tests: 6. INCLUSION Body myosins 1. Schirmer Test production Caistal ear affectations > - 2. Lip / parotid biopsy tests: 3. anti-Ro/antiSSA anti-la/antiSSB anti-soz PM 1. DM 2. anti-mil Cheat Sheet CHIKA! French flay sign For the party (parotid) ang French show girl Sjogren's kaya nag RoLa-on to keep her eyes, mouth, and kips dry!!! 5  IV. SERONEGATIVE IV. SERONEGATIVE 1. SPONDYLOARTHROPATHIES 1. SPONDYLOARTHROPATHIES c. ANKYLOSING definition: SPONDYLITIS (AS) condition associated i HLA-B27 symmetric affectation - rheumatologic (strongest in AS) firding definition: c and ke pathognomonic i 3-6 mos Of ENTHESITIS > - Chronic LBP that persists for ation of sites where tendon and ligament its hallmark - inflamm BIL SACROILMI as bone insert into a > - Enset : < 40 y10 (men) > - PARI-priest-lalaki male s/sx: > - IV. SERONEGATIVE tests: 1. SPONDYLOARTHROPATHIES 1. HLA-B27 a. PSORIATIC ARTHRITIS Patrick Test 2. STX modified (PsA) m F = schober 3. X- Ray definition: a. squarring vertebral bodies condition associated i psoriasis of > - chronic inflammatory > - commonly affecting bit. b. Syndesmophyte formation - calcification of annulus Fibrosis s/sx: c. bamboo spire (late stage) rail P Psoriasis (skin and changes) Pain jts sausage digits IV. SERONEGATIVE S (dactylitis 1. SPONDYLOARTHROPATHIES A xial involvement b. REACTIVE ARTHRITIS (back pain which inprous [ activity) (ReA) types: Aka RHTER'S DSE 1. DISTAL PSA > - predominantly Dip It definition: dif autoimmune ryn > - inflammatory arthritis 2. ARTHRITIS MUTILANS to genito-urinary infection hard s/sx: > Onset zoy 10 (MLF) - : 22 telescoping Finger/opera - (f) glass paerdimakapu Si ReA , di makakita , masakit ans , a Arthritis TRIAD tests: Conjunctivitis 1. X-ray : pencil-in-up deformity Urethritis - MC bacteria guituls in : mydia * RA is Hir common patients. in ① PSA bowel : campylobacter. Salmonella 6  IV. SERONEGATIVE II. Inflammatory Arthritis 1. SPONDYLOARTHROPATHIES A b. Crystal-induced Synovitis d. INFLAMMATORY c. definition: BOWEL DISEASE (IBD) > - inflammatory arthritis resulting from definition: intra-articular deposition cy al infection > - inflammatory GI Tract s/sx: s/sx: Extraintestinal manifestation GOUT PSEUDOGOUT ENTEROPATHIC ARTHRITIS middle- - arthritis 5 erosions and deformities affecting Epidemiology elderly peripheral and axial jts aged mer men 1. 1st mip types: (podagra) 1. Knee Joint 2. Knee DULCERATIVE in rectur COLHIS ② CHRON's 3 colon affectation (gonagra, 2. Shoulder , > - ileum - 3. Wrist wrist , map (heiragra) calcium monosodium Crystal. aka urate Pyrophosphate IV. SERONEGATIVE unir and dihydrate 2. POLYMYALGIA RHEUMATICA (PMR) Hallmark TOPHI CHONDROCALGNOSIS uni-acid rich food : definition: alcohol , guer, Trigger condition meat seafood inflammatory rheumatologic > - red , characterized by SUMMETRICAL PAIN and Cholchine oute attacks STIFFNESS around neck , shoulder, hipits : commonly in >50 chronic y10 (women) attack Aupurinol > - seem : s/sx: AUNTIEPOLY A Auntie : F > m U Uber ↑Crp Topay (Jopay by Mayonnaise) Sero N Negative Topay, kumusta na ba? GIANT T TEMPORAL CELL ARTERITIES/ CELL ANTERITIES Monosdium urate lalo lang lumalala Topay, kwarenta ka na. I IN THE MORNING SAFFNESS Tuhod go, first MTP podagra - Paano mawawala? E Entry Magcolchi-allo ka na P PROXIMAL > - ML : SHOULDER Ngayon AFFECTATION C O RTILOSTEROD L LOW DOSE Y yung hall mark 7 III. Non-Inflammatory Arthritis B. FIBROMYALGIA A SYNDROME (FMS) A. OSTEOARTHRITIS (OA) mono-articles definition: definition: > - widespread pain - and ase > - complex d/o of > - me joint condition other affecting fedetness -non-inflammatory age-related assoc i x weight-bearingjts common adult females young > - : s/sx: FIBRO s/sx: pain, stiffness, LOM F Fatigue I Insomnia Knee MC B Blues : anxietyo Hip depression PID : Bouchard's R Rigidity Hands DIP : Heberden's (HeberDIP) O uch ! Spine cervical : C5- le tests: types: 1. 1. PRIMARY "near lear - idiopathic women old , obse/overnight a. IF : , > - assoc. 2. SECONDARY > - underlying conditions b. tests: c. 1. X-ray : ball mark FORTHAT isOSOPHY 2. mc clinical : CREPHUS Finding 3. classification: Kellgren-Lawrence Classification of Osteoarthritis Grade 1 doubtful OA minimal OA Grade 2 * definite ostrophyte formation Grade 3 OA moderate - alformities Grade 4 Sovere -A 8