Rheumatology scheme

Rheumatology scheme
DEFINITION
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it is aconnective tissue disorder ccc by articular & extra-articular
manif. most probably autoimmune
N.B...(...IN SLE........u should write extra before articular)
AETIOLOGY
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* Still questionable
*most probably autoimmune ( +ve autoantibodies )
* genetic factors play arole ( +ve family history & HLA association )
* environmental factors play some role.
N.B..(...IN....SLE ...ADD...)
* HORMONAL FACTORS PLAY AROLE
( ESTROGEN so itis common in females)
* drug induced lupus (HIP)
( Hydralazine...INH....PENICILLAMINE..PHENYTOIN
C/P
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TYPE OF PATENT
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* FEMALE ) MALE..
.EXCEPT IN (GPAN) GOUT / PAN /
ANKYLOSING
IN RA.......3:1
IN SLE.......9 :1
GENERAL manif.
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fever....fatigue.....sweating
+ morning stiffness in RA
ARTICULAR manif.
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( 3D)
Distribution
Discription
Deformity
Distribution (5)
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*mono / poly.....all are poly except ACUTE GOUT & SOME ATYPICAL
CASES
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*symmetrical / assymetrical.....all are A except SLE & RA
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*small / large joints.................SLE & RA affect small) large
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*peripheral / central................
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*erosive / non.
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. ...RA & CHRONIC GOUT ( CARTILAGE EROSION & DESTRUCTION)

DISCRIPTION (5)
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*REDNEES
*TENDERNESS
*HOTNESS
*SWELLING
* LIMITATION OF MOVEMENT
DEFORMITY
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IF EROSIVE....DEFORMITY (mention)
in RA.......(5) HANDS + CATS
IN CH.GOUT...WRITE deformity only
EX.ARTICULA.MANIF. ( 8)
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*SKIN
***** all...vasculitis...pallor...raynauds
RA..PALMAR ERYTHEMA &SC NODULES
SLE...3 RASH.. ... ی
SCLERODERMA...skin induration
*RENAL
RA.....AMYLOIDOSIS + drug induced GN
SLE...GLOMERULO.NEPHRITIS
SCL....SCL.RENAL CRISIS
*CVS
3 ITIS
s HTN & IHD
*CHEST
pleurisy
P.HTN
P.INFARCTION
IPF
+ CAPLAN syndrome.....in RA
ARDS..........................in sle
*CNS
psycosis & depression
chorea & eplipsy
myopathy & neuropathy
stroke
+ in RA
CARPAL TUNNEL & ATLANTO.AXIAL SL
* EYE
RED EYE d.t any ITIS
*GIT
ANVP + HSM + any itis
*BLOOD
anaemia ( autoimmune / FE deficiency )
pancytopenia...in SLE & FELTY
INVESTIGATIONS
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*X.RAY
*****
bone....osteoprosis+ in erosive (narrow joint space &
deformity)
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chest...pleural effusion &pericardial effusion
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*ASPIRATION
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of synovial fluid....+ve Ab
*blood
*****
Anaemia / pancytopenia ?
increased acute phase reactants
*leucocytosis>EXCEPT?
*ESR
*CRP
*SEROLOGICAL TESTS
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( non specific / specfic)
* non specific ( with any disease )
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(1) RF
+VE IN 80 % in RA & 20 % IN SLE
(2)LE

(2) ANA
+VE IN 95 - 100 % IN SLE
30 % IN RA
*SPECIFIC
(1) ANTI DNA..........SLE
(2) ANTI ی .....SLE
(3) ANTI ...drug induced lupus
(4)ANTI یʪ ..RO ANTI LA...SLE & SJORGAN
(5) SCL 70 AB.... SCLERODERMA
TTT
*CORTISONE
*NSAIDS
*IMMUNOSUPPRESSIVES
* PHYSIO THERAPY
N.B
VARIANTS & TTT.............CONCENTRATE ON