Rheumatology

Review
Baher Krayem
 Arthritis
– Distribution of involvement
• Symmetric
• Asymmetric

– Acute Vs Chronic
• 1-2 weeks = acute
• more than 6 weeks = chronic
– Joint inflammation
• Always aspirate
– Systemic Symptoms
• Every system can be involved
 Joint Aspiration

Osteoarthritis
What is the diagnosis?
 SLE

– Etiology unknown
– 90% Females
– Criteria
– Systems involved

ANA is 90 sensitive !
Anti dsDNA is specific
Autoantibodies
 Drug Induced Lupus
– Usually dermatitis and arthritis
– Nephritis is very rare
– ANA is positive
– Stop the offending agent

Offending agents
Hydralazine Procainamide
Minocycline Isoniazide
Propythiouracil Methyldopa
 Of note..
HUS TTP
– High prevalence in SLE patients
– HUS → associated with E.Coli
– TTP → ADAMTS-13 deficiency

Microangiopathic hemolytic anemia

HUS TTP
Hemolytic anemia Hemolytic anemia
Thrombocytopenia Thrombocytopenia
Acute renal failure Acute renal failure
Fever
Neurologic symptoms
 APLA Syndrome
– One third of SLE patients
• Arterial embolic, venous thrombosis, pregnancy morbidity
– Lab Antibodies:
• Lupus anticoagulant
• Anticardiolipin
• Beta2 glycoprotein
– Clinical Criteria:
– Treatment:
• Treat the complication, if arterial emboli then aspirin +
warfarin, if venous thrombosis → warfarin alone
 Rheumatoid Arthritis?

– Pro RA?
– Against RA?
Not just the Joints..
 Treatment of RA
– NSAIDs → Only for symptomatic relief
– DMARDs
• Methotrexate = the cornerstone of therapy
• Anti TNF = newer therapies, for more severe patients
– Role of steroids = no role for long term use
– Approach to therapy
• First MTX
• If no improvement after 6 months → anti TNF
What is the diagnosis?
Scleroderma
 Treatment
– Mainly Symptomatic because there
is no effective therapy

– Complications:
• Blue toe syndrome
• Interstitial lung disease
• Scleroderma Renal Crisis
– Treat with ACE-I
– What exacerbate?
– Clinical Story
What is the diagnosis?
Sjogren
Sero (-) Arthritis
 Ankylosing Spondylitis

– Diagnosis
• MRI for bone
– Rx
• Anti TNF
Reactive arthritis
What is the diagnosis?
Osteoarthritis
 Treatment
– Non pharmacologic
What is the diagnosis?
 Gout and Pseudo Gout
– Presentation
– Causes
• Drugs: Diuretics
• Alimentation
– Diagnosis
• Clinical
• LAB → Uric acid levels are _____ during attack.
• Joint aspiration → Needle like crystals
– Treatment
• NSAIDS
• GCSs: Systemic and Local
• Allopurinol
Cough and dyspnea
Sarcoidosis
Behcet Disease
 ANCA vasculitis

• Granulomatosis with polyangiitis → Sinusitis, Lung consolidation and

nephritis [Hematuria]
• Microscopic polyangiitis → Not very important
• Eosinophilic granulomatosis with polyangiitis → Asthma, Lung
consolidation and nephritis [Hematuria]
– Clinical suspicion
– LAB diagnosis: Measure c-ANCA and p-ANCA
– Biopsy → Always tissue diagnosis
– Mortality → High mortality rates, mainly cardiac
Temporal Arteritis =
Giant Cell Arteritis

– Clinical Polymyalgia Rheumatica:

• Headache
• Jaw claudication
– Clinical
• Fever
• Shoulder pain
• Age 60+
• Without signs of TA
– Lab:
• Anemia
– Lab:
• Very high ESR and CRP • Anemia
– Complication: • Very high ESR and CRP
• Can lead to blindness
– Treatment: – Treatment:
• Steroids for long periods • Steroids for long periods
[Shorter than TA]
Takayasu