Rheum PPT 2018
Rheum PPT 2018
Rheum PPT 2018
Carmelita J. Colbert, MD
Assistant Professor of Medicine
Division of Rheumatology
Loyola University Medical Center
What is Rheumatology?
• Laboratory abnormalities
Differential Diagnosis for Different Joint Patterns
• Monoarticular
– Trauma, hemarthrosis, spondyloarthropathy
– Septic arthritis, crystal-induced
• Oligoarticular
– Spondyloarthropathy, crystal-induced, infection
related
• Polyarticular
– RA, SLE, crystal-induced, infectious
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Rheum Diseases You Will Encounter
• Osteoarthritis
• Rheumatoid Arthritis
• Seronegative spondyloarthropathy
• Crystal-induced arthritis
• Systemic lupus erythematosus
• Vasculitis
• Other important rheumatologic diseases
– Scleroderma, Inflammatory Myopathy
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OSTEOARTHRITIS
• Most common form of arthritis
– Extra-articular manifestations
• Rheumatoid nodules, interstitial lung disease, vasculitis
Diagnostic Criteria: Rheumatoid Arthritis
• Target population
– At least 1 joint with definite synovitis
– Synovitis not better explained by another disease
• Seronegative
• Oligoarticular, asymmetric
• Chronic, inflammatory
• Sacroiliac involvement
• Enthesopathy
• Spinal involvement (inflammatory)
• HLA B27
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Seronegative Spondyloarthropathies
• Ankylosing spondylitis
• IBD associated arthropathy
• Psoriatic arthritis
• Reactive arthritis
• Undifferentiated spondyloarthropathy
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Treatment
• Similar to treatment for rheumatoid
arthritis
• 3 differences
– Hydroxychloroquine can worsen psoriasis
– Axial involvement
• Biologic therapy recommended
– TNF alpha inhibitors are mainstay for
biologics (the other biologics not shown to be
as effective)
• Chronic inflammatory disorder
• Prevalence 0.5%
• Etiology unknown
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SYSTEMIC LUPUS ERYTHEMATOUS
(MALAR RASH)
Discoid Lupus
Treatment
• Short term: prednisone
• Mild or cutaneous disease
– Hydroxychloroquine
• Moderate to severe disease
– Azathioprine, Mycophenolate mofetil
• Severe disease
– Mycophenolate mofetil
– Rituximab
– Cyclophosphamide
Scleroderma
• Localized vs Systemic
• Systemic : Diffuse or Limited
– Limited = CREST (Calcinosis, Raynaud’s, Esophageal
dysmotility, Sclerodactyly, Telangiectasias)
– Limited
• Skin involvement distal to MCPs
• Lung complication: Primary pulmonary hypertension
• More esophageal involvement, less colon involvement, telangiectasias
• Anti-Centromere antibodies
– Diffuse
• Lung complication: Interstitial lung disease/fibrosis
• Diffuse Scl GI complications ie) colon involvement more common
• Scl 70 Antibodies
– Scleroderma renal crisis can occur in both
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SCLERODERMA
SCLERODERMA
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Vasculitis
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Idiopathic Inflammatory Myopathy
• Polymyositis
• Dermatomyositis
• PM and DM
– Proximal muscle weakness
– Muscle pain not a typical symptom if chronic
– Elevated muscle enzymes: CK, Aldolase, LDH
– Myositis Panel
• Diagnosis: biopsy
• Lung involvement: interstitial lung disease
• Increased risk for malignancy: breast cancer, ovarian cancer,
adenocarcinoma
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DERMATOMYOSITIS
DERMATOMYOSITIS