Please make sure you know how to examine the hands for rheumatological problems.
Questions
What is the difference between arthralgia,arthritis and arthropathy?
Causes of arthralgia
Rheumatoid Arthritis
Explain the pathogenesis of Rheumatoid arthritis(RA)
Who is more prone to develope RA?Why?
How is RA different from other types of arthritis e.g. osteoarthritis?
Explain something on Still's disease(Juvenile RA)
Differential diagnosis for symmetrical arthritis? What investigations would you do to confirm?
What are the criterias used to diagnose RA?
How do you define morning stiffness?
What complications can arise from RA?
How to manage RA?
Gouty Arthritis
What is the cause? Briefly describe the pathogenesis.
What are the risk factors?
Why is it that the most common site for crystal deposition is the 1st metatarsophalangeal joint?
Describe the pattern of joint involvement.
How can you classify the attacks?
Define pseudogout. How do you differentiate it from gouty arthritis.
How would diagnosis be confirmed?
What is a tophy? Does it happen in every gout case? If not, when does it happen?
What are the complications of prolonged hyperuricaemia?
How would you treat an acute attack of gouty arthritis?
What advice would you give the patient to reduce attack rates.
Systemic Lupus Erythematosus
What is it?
What are the causes?
If there are joints involvement, what would be the pattern?
What criteria is used currently to diagnose SLE?Explain
What blood test should be done to confirm SLE?
Are there any correlation between complement level and disease activity? Explain.
Explain the complications of lupus.
Prognosis. Patient usually die of?
Management & advice to the patient
Systemic Sclerosis a.k.a Scleroderma
Epidemiology
A bit of pathogenesis
Types of scleroderma, how to differentiate them in PE.
What is CREST syndrome?
How do you differentiate a rheumatoid nodule, a calcinosis and a gouty arthritis clinically?
Which complication of scleroderma is the most common?
What are the autoantibodies looked for to confirm scleroderma? Can they be used to differentiate between the types? How?
Prognosis? What is the most common cause of death?
Management.
Psoriasis
What is it?Briefly describe the pathogenesis.
Explain the possible pattern of skin lesions. Which one is most common?
Explain the types of joint involvements of psoriasis.
How to differentiate RA and psoriatic arthropathy?
Management
Seronegative spondylytis(SS)
Explain what is meant by this term.
Give examples of SS and explain.
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11 comments:
Psoriasis:
It is a genetically- determined inflammatory and proliferative disorder of skin charac by increased epidermal turnover resulting in thickening of epidermis with thick keratin deposition.
Possible patterns of skin lesions:
1. Pustular psoriasis
2. Guttate psoriasis
3. Flexural psoriasis
4. Erythrodermic psoriasis
5. Plaque psoriases- most common
Types of joint involvement:
1. Asymmetrical DIP arthropathy
2. RA like hands
3. Asymmetrical large joint mono or oligoarthropathy
4. Spondyloarthropathy and sacroilitis
5. Arthritis mutilans
For psoriatic arthropathy- there would be presence of nail pitting, onycholysis with or without plaques on the skin esp on the extensor surface and the arthropathy mainly involves DIP while in case of RA, DIP joint as a rule is not involved.
Treatment :
1) Topical: emollients, coal tar ointments, dithranol, calipotriol
2) Systemic: steroids, MTX( in severe refractory disease)
Seronegative spondylitis:
1) rheumatoid factor seronegative
2) usually larger joints are involved such as knees, ankles and sacro-iliac joints
3) if peripheral joints are involved, they are usually asymmetrical
4) characteristic articular features include enthesitis ( inflammation at sites of tendon insertion),dactylitis and sacroilitis.
5) strong association with HLA-B27
Examples are:
1. Ankylosing Spondylitis
2. Reactive arthritis
3. Psoriatic arthritis
4. Enteropathis arthritis
Systemic Sclerosis:
More common in female 4 to 1 ratio.
Disease patterns:
1. Limited scleroderma
Scleroderma limited to face, neck and limbs distal to elbow and knee
Usually begins with Raynaud phenomenon
CREST( Calcinosis, Raynaud’s, Esophageal dysmotility, sclerodactylyl, Telangiectasia)
Anticentromere Ab
Renal crisis rare while pulmonary hypertension more common.
Better prognosis.
2. Diffuse scleroderma
Scleroderma involving trunk and proximal limbs as well as face and distal limbs
Usually begins with dactylitis and arthritis
AntiScl 70 Ab
Renal crisis more common than pulmonary hypertension
Most common cause of death: renal failure
Management:
a) Supportive: NSAIDs, PPI, vasodilators
b) Specific: D-penicillamine
Difference RA-Psoriasis
clinically your answer is correct. Confirm by doing blood test where Psoriasis will often show normal ESR and no rheumatoid factor.
Local treatment by intra articular injection of steroids can also be employed in joint disease.
As for SS, one more example is infective,e.g. salmonella arthritis.
In scleroderma, pulmonary fibrosis is second only to dysphagia as a complication. SOme authorities said dysphagia is not a complication, its a manifestation of the disease. However the new term used "limited cutaneous scleroderma" refers to skin manifestation, therefore any internal disease is considered complication. This makes Dysphagia as the most common complication of scleroderma.
In diffuse scleroderma, besides anti topoisomerase(Scl70), anti RNA polymerase I and III is also frequently used and is highly specific.
I'm not sure bout this, but in Malaysia the most common cause of death in scleroderma patient is cor pulmonale due to pulmonary hypertension as a result of fibrosis. Maybe what you read is different, being in a different country.
Good one....most of your answers are the same as mine, perhaps we're using the same book? hahaha..
btw you can add me to your facebook account at jeffsylee@yahoo.com if you please...
Have a nice day:)
thx... reali lucky to bump into u as i learn so many things. lol
for the differentiation i think gouty arthritis would presents with all signs of inflammation with or without tophi overlying but for rheumatoid nodule it is local swelling mainly over area of pressure e.g olecranon. for sclerodactylyl the overlying skin would be smooth, shiny, tight..
to be honest, i hav no ideas...lol
is it possible to explain why gout is common in MTP joint( podagra)?
Rheumatoid nodules are firm and most of the time its non tender compared to Gouty tophy...the common sites as you said is the olecranon, etc while tophy often appear at the places where temperature is lower,e.g. MTP joints and even earlobes
As for calcinosis, it is hard and non tender, as compared to RN and tophy.
To recap
RN-firm,non tender
Calcinosis-hard,non tender with shiny tight skin etc
Tophy-hard,tender to touch
Why is the podagra most affected? It is not proven yet but 1 hypothesis states that uric acid calcify better at area with lower temperature and higher pressure. This makes the podagra and the joints of the lower limbs ideal for calcification. Haha i forget the chemical equation, because I saw it in 1st year where i know nothing about gout~ I think its in the new england journal of medicine,but i forget what volume..
thx once again... i think u can be a lecturer as well in the future
Gouty arthritis- crystal arthritis characterized by deposition of MSUM in the joints due to overproduction of uric acid or under-excretion.
Risk factors: regarding to the pathogenesis
e.g if overproduction- maybe genetic e.g lesch nyhan syndrome or env- lifestyle.
if underexcretion- maybe due to drugs such as thiazide, low dose ASA; insulin resistance and aging
Pattern of joint involvement: small e.g finger and toes joints and large joints e.g knee, ankle, elbow and wrist usually mono-to pauciarticular involvement.
Regarding the attack, there r mainly 3 periods with acute, intercritical and chronic tophaceous arthropathy.
Pseudogout- crystal arthritis characterized by deposition of calcium pyrophosphate dehydrate.
Differences from the gout:
The pattern of joint involvement is different from gout, tending to affect the wrists, knees, shoulders and elbows
Attacks are generally more prolonged (2–3 weeks).
Pseudogout tends to affect more elderly patients, usually on a background of nodal osteoarthritis.
To confirm the diagnosis- joint aspiration to see negatively birefringent crystal.
Tophi- chalky deposits of monosodium urate
In my opinion, I dun think it happens in gout case and I think it happens with prolonged hyperuricemia.
Complication of prolonged hyperuricemia-uropathy??
For the acute attack- mainly analgesics like NSAIDs or if CI or not effective- colchicines or again intolerant or CI- intra-articular injection of steroids.
To reduce the attack rates- advice mainly non-pharmacological e.g weight reduction, diet control esp red meat, beans, alcohol, seafood or pharmacological if indicated.
Lately I have aroused the curiosity to know the difference between arthralgia, arthritis and arthropathy? I have read many blogs but until now I find one that actually clarify that doubt me, impress me and see I am concerned the causes of arthralgia, because I read that I own a symptom Rheumatoid Arthritis, two months ago and I visit the doctor prescribe generic viagra This helped me to minimize the impact of the disease
I think you should explore the articles on your website, You should also cover different different categories for articles as you writes awesome. Thanks for sharing this great article with us.
rheumatology
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