Rheumatology Review. How to Approach Arthritis DURATION ACUTECHRONIC INFLAMMATION? YESNO Crystal...
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Transcript of Rheumatology Review. How to Approach Arthritis DURATION ACUTECHRONIC INFLAMMATION? YESNO Crystal...
Rheumatology ReviewRheumatology Review
How to Approach ArthritisHow to Approach Arthritis
DURATION
ACUTE CHRONIC
INFLAMMATION?
YES NO
• Crystal Deposition• Infection• Early Chronic• Trauma• Hemarthrosis
• OA
JOINT INVOLVEMENT
MONO OLIGO POLY (symmetry)• Early Oligo/Poly• Chronic/Indolent Infection
• Seronegative disease• Sjögren’s
• RA• SLE• Seronegative • Chronic Tophaceous Gout
Any 4 of the following 11 criteria (simultaneously or Any 4 of the following 11 criteria (simultaneously or sequential) needed to help diagnose SLEsequential) needed to help diagnose SLE Serositis (pleuritis, pericarditis)Serositis (pleuritis, pericarditis) Oral UlcersOral Ulcers Non-deforming Arthritis Non-deforming Arthritis PhotosensitivityPhotosensitivity Blood disorders (such as hemolytic anemia or Blood disorders (such as hemolytic anemia or
pancytopenia in absence of offending drug/agent)pancytopenia in absence of offending drug/agent) ANA positiveANA positive Renal DiseaseRenal Disease Malar Rash (distinct from photosensitivity)Malar Rash (distinct from photosensitivity) Discoid RashDiscoid Rash Neurologic Disorders (seizures, psychosis, etc)Neurologic Disorders (seizures, psychosis, etc) Presence of Anti-Smith, anti-phospholipids, anti-Presence of Anti-Smith, anti-phospholipids, anti-
dsdna, false positive syphilis testdsdna, false positive syphilis test
Diagnostic Criteria for SLEDiagnostic Criteria for SLE
Any 4 of the following 7 criteria. Primarily used for Any 4 of the following 7 criteria. Primarily used for research purposes, made prior to discovery of research purposes, made prior to discovery of anti-ccpanti-ccp Morning stiffness > 1hour for at least 6 weeksMorning stiffness > 1hour for at least 6 weeks Arthritis and soft tissue swelling of at least 3 Arthritis and soft tissue swelling of at least 3
joints for > 6 weeksjoints for > 6 weeks Arthritis of hand joints > 6 weeksArthritis of hand joints > 6 weeks Symmetric arthritis for > 6 weeksSymmetric arthritis for > 6 weeks Rheumatoid factor above the 95Rheumatoid factor above the 95thth percentile percentile Erosive arthropathy on filmsErosive arthropathy on films Subcutaneous nodulesSubcutaneous nodules
Diagnostic Criteria for RADiagnostic Criteria for RA
SjSjöögren’s, Lupus, gren’s, Lupus, neonatal heart neonatal heart
blockblock
Lupus Lupus
CREST CREST
Scleroderma Scleroderma
RARA
Antiphospholipid Antiphospholipid Syndrome Syndrome
Name That AntibodyName That Antibody
Anti-Ro (SS-A), Anti-La (SS-B)Anti-Ro (SS-A), Anti-La (SS-B)
Anti-Smith, Anti-Double StrandedAnti-Smith, Anti-Double Stranded
Anti-CentromereAnti-Centromere
Anti-Scl70 (anti-topoisomerase)Anti-Scl70 (anti-topoisomerase)
Anti-CCP, RFAnti-CCP, RF
Lupus AnticoagulantLupus Anticoagulant
Mixed Connective Mixed Connective Tissue DiseaseTissue Disease
Stiff Man Syndrome Stiff Man Syndrome
CREST CREST
Scleroderma Scleroderma
Dermato/PolymyositisDermato/Polymyositis
Celiac Disease Celiac Disease
Name That AntibodyName That Antibody
Anti-RNPAnti-RNP
Anti-GADAnti-GAD
Anti-CentromereAnti-Centromere
Anti-Scl70 (anti-Anti-Scl70 (anti-topoisomerase)topoisomerase)
Anti-Mi-2, Anti-Jo1Anti-Mi-2, Anti-Jo1
Anti-TransglutaminaseAnti-Transglutaminase
Autoimmune HepatitisAutoimmune Hepatitis
Primary Biliary Primary Biliary CirrhosisCirrhosis
Churg-Strauss, Churg-Strauss, Microscopic Microscopic Polyangitis Polyangitis
Wegener’s Wegener’s
Drug Induced LupusDrug Induced Lupus
Seronegative ArthritisSeronegative Arthritis
Name That AntibodyName That Antibody
Anti-Smooth MuscleAnti-Smooth Muscle
Anti-Mitochondrial AntibodyAnti-Mitochondrial Antibody
p-ANCAp-ANCA
c-ANCAc-ANCA
Anti-Histone AbsAnti-Histone Abs
HLA-B27HLA-B27
Gratuitous photosGratuitous photos
SjSjöögren’s, Lupus, gren’s, Lupus, neonatal heart neonatal heart
blockblock
Anti-Ro (SS-A), Anti-Anti-Ro (SS-A), Anti-La (SS-B)La (SS-B)
Lupus Lupus Anti-Smith, Anti-Anti-Smith, Anti-Double Stranded AbsDouble Stranded Abs
CREST CREST Anti-CentromereAnti-Centromere
Scleroderma Scleroderma Anti-Scl70 (anti-Anti-Scl70 (anti-topoisomerase)topoisomerase)
RARA Anti-CCP, RFAnti-CCP, RF
Antiphospholipid Antiphospholipid Syndrome Syndrome
Lupus AnticoagulantLupus Anticoagulant
Name That AntibodyName That Antibody
Mixed Connective Mixed Connective Tissue DiseaseTissue Disease
Anti-RNPAnti-RNP
Stiff Man Syndrome Stiff Man Syndrome Anti-GADAnti-GAD
CREST CREST Anti-CentromereAnti-Centromere
Scleroderma Scleroderma Anti-Scl70 (anti-Anti-Scl70 (anti-topoisomerase)topoisomerase)
Dermato/PolymyositisDermato/Polymyositis Anti-Mi-2, Anti-Jo1Anti-Mi-2, Anti-Jo1
Celiac Disease Celiac Disease Anti-Anti-TransglutaminaseTransglutaminase
Name That AntibodyName That Antibody
Autoimmune HepatitisAutoimmune Hepatitis Anti-Smooth Muscle Anti-Smooth Muscle AbAb
Primary Biliary Primary Biliary CirrhosisCirrhosis
Anti-Mitochondrial Anti-Mitochondrial AntibodyAntibody
Churg-Strauss, Churg-Strauss, Microscopic Microscopic Polyangitis Polyangitis
p-ANCAp-ANCA
Wegener’s Wegener’s c-ANCAc-ANCA
Drug Induced LupusDrug Induced Lupus Anti-Histone AbsAnti-Histone Abs
Seronegative ArthritisSeronegative Arthritis No Ab. HLA-B27No Ab. HLA-B27
Name That AntibodyName That Antibody