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14.02.19 Rheumatology revision

Rheumatoid Arthritis Associations
  • Eyes
    • Secondary Sjögren's syndrome
    • Scleritis
    • Episcleritis
  • Skin
    • Leg ulcers
    • Felty's syndrome
    • Rashes
    • Nail fold infarcts
  • Rheumatoid nodules
    • May occur in the eyes, may be subcutaneous, and may be in the lung, heart and occasionally the vocal cords
  • Neurological
    • Peripheral nerve entrapment
    • Atlanto-axial subluxation
    • Polyneuropathy
    • Mononeuritis multiplex
  • Respiratory
    • Pleural involvement
    • Pulmonary fibrosis
    • Bronchiolitis obliterans
    • Caplan's syndrome
  • Cardiovascular
    • Pericardial involvement
    • Valvulitis
    • Myocardial fibrosis
    • Vasculitis
    • MI
  • Kidneys
    • Analgesic nephropathy
    • Amyloidosis
  • Liver
    • Mild hepatomegaly
    • Abnormal transaminases
  • Other
    • Thyroid disorders
    • Osteoporosis
    • Depression
    • Splenomegaly


SICKFACES.COM Group
  • Sodium valproate
  • Isoniazid
  • Cimetidine
  • Ketoconazole
  • Fluconazole
  • Alcohol (acute)
  • Chloramphenicol
  • Erythromycin
  • Sulfonamides
  • Ciprofloxacin
  • Omeprazole
  • Metronidazole
  • Grapefruit juice


Seronegative arthropathies
  • Ankylosing spondylitis
    • Spinal movement reduced in all directions
    • Question-mark posture
    • Associations: All the A's:
      • Ankylosis of spine
      • Acute anterior uveitis
      • Amyloidosis
      • Aortic incompetence
      • Aortitis
      • AV Block
      • Apical fibrosis
      • Achilles tendonitis
      • Anti-TNF alpha therapy
  • Psoriatic arthritis
    • cf Arthritis mutilans
  • Reactive arthritis
    • Chlamydia is the most common trigger (50%)
      • Also Salmonella
    • Antibiotics don't help
  • Enteropathic arthritis


Felty's syndrome
  • Combination of rheumatoid arthritis, SPLENOMEGALY and neutropenia
  • Normally after a long time with RA
  • Manage by controlling the underlying RA
  • Pancytopenia with bone marrow hyperplasia
    • cf Hypoplasia as side-effect of medication


Notes
  • Eyes
    • Scleritis is PAINFUL
    • Episcleritis is PAINLESS
    • Keratitis is BILATERAL
  • Anti-TNF alpha
    • CHECK TB STATUS
    • Really good for ank. spond.
  • Steroids => Striae on trunk
  • Brick-shaped, positive birefringent crystals in pseudogout
  • SLE: ANA 95%, anti-dsDNA 80%
  • Schober's test

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