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