RHEUMATOLOGY NOTES

FOR MEDICAL STUDENTS

by

J.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

Lulu Edition License Notes

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GENETIC DISORDERS

Mucopolysaccharidoses

11 diseases: Morquio’s sy, Sanfilippo sy, Hunter sy, Hurler sy, Scheie sy. etc.

Clinical: mental retardation, enlarged liver/spleen, stiff joints

Dx: ↑mucopolysaccharides in urine

Osteogenesis Imperfecta

4 types

Blue sclera, fragile bones

Dissection of ascending aorta

Ehlers-Danlos Synfrome

8 types

Skin hyperextensible, fragile, cigarette paper scars, bruising, arteries prone to rupture

Marfan’s Syndrome

Long, slender extremities, arachnodactyly, dislocated lens

Aortic valve dilatation/regurgitation, ascending aorta dissection, mitral valve prolapse

EYES & SALIVARY GLANDS

Sjogren's Syndrome

Xerostomia (dry mouth), Keratoconjuctivitis sicca (dry eyes, constant sensation of foreign body in eye), dental caries, parotid enlargement

Cause: idiopathic/autoimmune

Pathology: lymphocytic infiltration and destruction of exocrine glands

Assn: Hodgkin’s Lymphoma (B-cell lymphoma)

Dx: Lip / salivary gland biopsy (most specific), Ab’s à anti-Ro (SS-A), Anti-La (SS-B), positive Rheumatoid factor, abnormal Schirmer test

Tx: Artificial tears/saliva, sugar-free gum, good oral hygiene, steroids

BONES

Osteoporosis

Dx: Bone densitometry (T score > -2.5 à osteoporosis, -1.5 to -2.5 à osteopenia)

Tx: Calcium, Vit D (best initial drugs), Bisphosphonates (have been shown to reduce incidence of hip fractures), Calcitonin, Estrogen

JOINTS

Rheumatoid Arthritis

Symmetrical, polyarticular (three or more joints), inflammatory, erosive arthritis

Pannus à articular cartilage resembling granulation tissue because of chronic inflammation, subcutaneous nodules over extensor surfaces

MCP & PIP joints

Swan-neck deformity, Boutonniere deformity, radial deviation of the wrist with ulnar deviation of the digits

Subcutaneous rheumatoid nodule over elbow

Subluxation of atlanto-axial joint

Morning stiffness, lassitude, low-grade fever, anemia, weight loss

Extraarticular manifestations

Caplan Syndrome: Fibrosing alveolitis

Felty Syndrome: Splenomegaly, neutropenia, infections

Pericarditis, pleural effusion

Dx: Positive rheumatoid factor (IgM or IgG, although children with RA are often RF-(-) and titer levels may take several months), ↑ESR, ↑CRP

Tx: Physical therapy

Mild disease (negative RF, no X-ray findings) à NSAID (best initial) +

Hydroxychloroquine (causes retinopathy, patients require frequent eye exams) or Sulfasalazine

Moderate-severe disease (positive RF + bony erosion on X-ray) àNSAID + Methotraxate (best initial DMARD)

Other DMARDs à, Etanercept, Infliximab, Gold, Sulfasalazine

Steroids (low dose PO and intra-articular for bad flar-ups)

Surgery à synovectomy, joint replacement

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