RHEUMATOLOGY NOTES

FOR MEDICAL STUDENTS

byJ.R. Phillip MD, PhD

LULU EDITION

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PUBLISHED BY:J.R. Phillip MD, PhD on Lulu

Rheumatology Notes

For Medical Students

Copyright © 2016 by J.R. Phillip MD, PhD

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GENETIC DISORDERS

Mucopolysaccharidoses11 diseases: Morquio’s sy, Sanfilippo sy, Hunter sy, Hurler sy, Scheie sy. etc.Clinical: mental retardation, enlarged liver/spleen, stiff jointsDx: ↑mucopolysaccharides in urine

Osteogenesis Imperfecta4 typesBlue sclera, fragile bonesDissection of ascending aorta

Ehlers-Danlos Synfrome8 typesSkin hyperextensible, fragile, cigarette paper scars, bruising, arteries prone to rupture

Marfan’s SyndromeLong, slender extremities, arachnodactyly, dislocated lensAortic valve dilatation/regurgitation, ascending aorta dissection, mitral valve prolapse

EYES & SALIVARY GLANDS

Sjogren's SyndromeXerostomia (dry mouth), Keratoconjuctivitis sicca (dry eyes, constant sensation of foreign body in eye), dental caries, parotid enlargementCause: idiopathic/autoimmunePathology: lymphocytic infiltration and destruction of exocrine glandsAssn: Hodgkin’s Lymphoma (B-cell lymphoma)Dx: Lip / salivary gland biopsy (most specific), Ab’s anti-Ro (SS-A), Anti-La (SS-B), positive Rheumatoid factor, abnormal Schirmer testTx: Artificial tears/saliva, sugar-free gum, good oral hygiene, steroids

BONES

Osteoporosis

Dx: Bone densitometry (T score > -2.5 osteoporosis, -1.5 to -2.5 osteopenia)Tx: Calcium, Vit D (best initial drugs), Bisphosphonates (have been shown to reduce incidence of hip fractures), Calcitonin, Estrogen

JOINTS

Rheumatoid ArthritisSymmetrical, polyarticular (three or more joints), inflammatory, erosive arthritisPannus articular cartilage resembling granulation tissue because of chronic inflammation, subcutaneous nodules over extensor surfacesMCP & PIP jointsSwan-neck deformity, Boutonniere deformity, radial deviation of the wrist with ulnar deviation of the digitsSubcutaneous rheumatoid nodule over elbowSubluxation of atlanto-axial jointMorning stiffness, lassitude, low-grade fever, anemia, weight loss

Extraarticular manifestationsCaplan Syndrome: Fibrosing alveolitisFelty Syndrome: Splenomegaly, neutropenia, infectionsPericarditis, pleural effusion

Dx: Positive rheumatoid factor (IgM or IgG, although children with RA are often RF-(-) and titer levels may take several months), ↑ESR, ↑CRPTx: Physical therapyMild disease (negative RF, no X-ray findings) NSAID (best initial) +Hydroxychloroquine (causes retinopathy, patients require frequent eye exams) or Sulfasalazine Moderate-severe disease (positive RF + bony erosion on X-ray) NSAID + Methotraxate (best initial DMARD)

Other DMARDs , Etanercept, Infliximab, Gold, SulfasalazineSteroids (low dose PO and intra-articular for bad flar-ups) Surgery synovectomy, joint replacement

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