13.03.12 Rheumatology clinic notes

History questions

    • Joint pain

    • Change in hair

    • ELBOWS

    • Rash

    • Raynauds

    • Visual changes

    • Dry mouth or eyes

Seronegative RA

    • RF negative

    • ANA, ESR, CRP may still be abnormal

    • Anti-CCP may be raised

    • Common variant - 30% of patients

    • Need to rely on clinical assessment - Disease activity score


    • Safe drugs

      • Sulfasalazine

      • Tramadol

      • NSAIDs except in 3rd trimester

    • Sjogren's/SLE

      • Ro antibodies can cross placenta => Heart block

        • => In utero scans + surgery

      • Clotting in placenta => Growth retardation

        • => Anticoagulation

Causes of raised ESR

    • Myeloma

    • Cancer

    • Sjogren's

    • TB

    • Helminths (along with eosinophils)

    • Lupus (do urine dip)

Adult-Onset Still's Disease (AOSD)

    • Adult version of juvenile idiopathic arthritis

    • Systemic inflammatory disease

    • Classic triad:

      • Persistent high spiking fever

      • Joint pain

      • Salmon-colored rash

    • Raised ferritin, but no other abnormalities

    • Prognosis is usually favorable but pulmonary, cardiovascular, and kidney manifestations may occasionally cause severe life-threatening complications

    • Treated first with steroids such as prednisone

    • Diagnosis requires 5 features, with 2 major:

McMurray test

    • Rotation test for demonstrating torn cartilage of the knee

      • A tear in the meniscus may cause a pedunculated tag of the meniscus which may become jammed between the joint surfaces

    • Procedure:

      • Knee is held by one hand, which is placed along the joint line

      • Flex to complete flexion while the foot is held by the sole with the other hand

      • Place one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress in order to identify a valgus deformity

      • The other hand rotates the leg externally while extending the knee

      • If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the medial meniscus

      • Likewise the medial knee can be stabilized in a fully flexed position and the leg internally rotated as the leg is extended


    • Psoriatic arthritis is typically asymetrical

      • Swelling and tenderness of individual joints

      • Frequently presents in a pattern of monoarticular or oligoarticular joint involvement

      • In patients with multiple joints involved, the pattern lacks the symmetry of rheumatoid arthritis

      • Early psoriatic arthritis may involve just a few lower extremity joints, such as the knees

    • PET scan for lymphoma/vasculitis

    • Rheumatoid factor (RF) is found commonly in patients with systemic lupus erythematosus (SLE), and has been associated with a more benign disease course

    • Enthesitis is inflammation of the entheses (sites where tendons or ligaments insert into the bone)

    • 1st generation cephalosporins are great against Gram +ves but rubbish against Gram -ves