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