Ankylosing spondylitis: extra-articular manifestations
6 A's:
- Atlanto-axial subluxation
- Anterior uveitis
- Apical lung fibrosis
- Aortic incompetence
- Amyloidosis (kidneys)
- Autoimmune bowel disease (UC)
Antirheumatic agents (disease modifying): members
CHAMP:
- Cyclophosphamide
- Hydroxycloroquine and choloroquinine
- Auranofin and other gold compounds
- Methotrexate
- Penicillamine
Arthritis: juvenile idiopathic differential
ARTHRITIS:
- Anxiety
- Rickets and metabolic
- Tumor
- Hematological
- Reactive arthritis
- Immunological (SLE)
- Trauma
- Injury
- Sepsis
Arthritis: seronegative spondyloarthropathies
PEAR:
- Psoriatic arthritis
- Enteropathic arthritis
- Ankylosing sponylitis
- Reiter's/ Reactive
Asprin: side effects
ASPRIN
- Aplastic anemia
- Salt & water retention
- Peptic ulcer
- Rash (skin Rash)
- Induce bronchial asthma
- Nephrotoxicity
Back pain: causes
DISK MASS (since near vertebral disc):
- Degeneration (DJD, osteoporosis, spondylosis)
- Infection (UTI, PID, Pott's disease, osteomyelitis, prostatitis)/ Injury, fracture or compression fracture
- Spondylitis (ankylosing spondyloarthropathies such as rheumatoid arthritis, Reiters, SLE)
- Kidney (stones, infarction, infection)
- Multiple myeloma/ Metastasis (from cancers of breast, kidney, lung, prostate, thyroid)
- Abdominal pain (referred to the back)/ Aneurysm
- Skin (herpes zoster)/ Strain/ Scoliosis and lordosis
- Slipped disk/ Spondylolisthesis
Behcet's syndrome: diagnostic criteria
PROSE:
- Pathergy test (i/d saline injection)
- Recurrent genital ulceration
- Oral ulceration (recurrent)
- Skin lesions
- Eye lesions
*Oral ulceration is central criteria, plus any 2 others.
Carpal tunnel syndrome
TINel's sign:
- TINgling sensation after
- Tapping on
- Traumatized nerve in carpal
- Tunnel syndrome
Chrug-Strauss syndrome: symptoms and signs
PAVE:
- P-ANCA
- Asthma
- Vasculitis
- Eosinophilia
CREST sydrome: components
CREST:
- Calcinosis
- Raynaud's phenomena
- Esophageal dysmotility
- Sclerodactyly
- Telangectasia
Dermatomyositis or polymyositis: risk of underlying malignancy
Risk is 30% at age 30.
Risk is 40% at age 40, and so on.
Felty's syndrome: components
SANTA:
- Splenomegaly
- Anaemia
- Neutropenia
- Thrombocytopenia
- Arthritis (rheumatoid)
- Antibiotics
Gout: drugs and foods raising uric acid levels
Drugs are FACT:
- Frusemide
- Aspirin/ Alcohol
- Cytotoxic drugs
- Thiazide diuretics
Foods are SALTS:
- Shellfish
- Anchovies
- Liver and kidney
- Turkey
- Sardines
Gout: factors that can precipitate an attack of acute gouty arthritis
DARK:
- Diuretics
- Alcohol
- Renal disease
- Kicked (trauma)
*And, the attack occurs most often at night [thus "dark"].
Gout: major features
GOUT:
- Great toe
- One joint (75% monoarticular)
- Uric acid increased (hence urolithiasis)
- Tophi
Gout vs. pseudogout: crystal lab findings
- Pseduogout crystals are:
- Positive birefringent
- Polygon shaped
*Gout therefore is the negative needle shaped crystals.
* Also, gout classically strikes great Toe, and its hallmark is Tophi.
Henoch schonlein purpura: signs and symptoms
NAPA:
- Nephritis
- Arthritis, arthralgias
- Purpura, palpable (especially on buttocks and lower extremities)
- Abdominal pain (need to rule out intussusception)
HLA-B27: associated diseases
PAIR:
- Psoriasis
- Ankylosing spondylitis
- Inflammatory bowel disease
- Reiter's syndrome
HLA-DR: genetic predisposition immune disease examples
HLA-DR:
- Hashimoto's disease
- Leukemia/ Lupus
- Autoimmune adrenalitis/ Anemia (pernicious)
- Diabetes insipidous
- Rheumatoid arthritis
Joint pain: causes
SOFTER TISSUE:
- Sepsis
- Osteoarthritis
- Fractures
- Tendon/muscle
- Epiphyseal
- Referred
- Tumor
- Ischaemia
- Seropositive arthritides
- Seronegative arthritides
- Urate
- Extra-articular rheumatism (such as polymylagia)
Kawasaki disease: diagnostic criteria
CHILD:
5 letters=5 days, >5 years old, 5 out 6 criteria for diagnosis:
- Conjuctivitis (bilateral)
- Hyperthermia (fever) >5 days
- Idiopathic polymorphic rash
- Lymphoadenopathy (cervical)
- Dryness & redness of (i)lips & month (ii)palms & soles [2 separate criteria]
Kawasaki's disease: features
FEAR ME:
- Fever
- Eye: perilimbic sparing conjunctival injection
- Adenopathy: usually cervical
- Rash
- Mouth: red lips
- Extremities: red hands and feet
*Disease to be feared because of risk of coronary aneurysms.
Osteoarthritis: x-ray signs
LOSS:
- Loss of joint space
- Osteopyhtes
- Subcondral sclerosis
- Subchondral cysts
Osteoporosis: risk factors
ACCESS:
- Alcohol
- Corticosteroid
- Calcium low
- Estrogen low
- Smoking
- Sedentary lifestyle
Psoriasis: pathophysiology
PSORIASIS:
- Pink Papules/ Plaques/ Pinpoint bleeding (Auspitz sign)/ Physical injury (Koebner phenomenon)/ Pain
- Silver Scale/ Sharp margins
- Onycholysis/ Oil spots
- Rete Ridges with Regular elongation
- Itching
- Arthritis/ Abscess (Munro)
- Stratum corneum with nuclei, neutrophils
- Immunologic
- Stratum granulosum absent/ Stratum Spinosum thickening
Raynaud's phenomenon: causes
COLD HAND:
- Cryoglobulins/ Cryofibrinogens
- Obstruction/ Occupational
- Lupus erythematosus, other connective tissue disease
- Diabetes mellitus/ Drugs
- Hematologic problems (polycythemia, leukemia, etc)
- Arterial problems (atherosclerosis)
- Neurologic problems (vascular tone)
- Disease of unknown origin (idiopathic)
Rheumatoid arthritis: features
RHEUMATOID:
- Ragocytes/ Rheumatoid factor (anti-IgG)
- HLA-DR4/ HLA-Dw4
- ESR increase/ Extra-articular features (restrictive lung disease, subcutaneous nodules)
- Ulnar deviation
- Morning stiffness/ MCP joint
- Ankylosis/ Atlantoaxial joint subluxation/ Autoimmune/ ANA
- T-cells (CD4)/ TNF
- Osteopenia
- Inflammatory synovial tissue/ Idiopathic/ IL-1
- Deformities (swan-neck, boutonniere)
Sarcoidosis: summary
SARCOIDOISIS:
- Schaumann calcifications
- Asteroid bodies/ [ACE] increase/ Anergy
- Respiratory complications/ Renal calculi/ Restrictive lung disease/ Restrictive cardiomyopathy
- Calcium increase in serum and urine/ CD4 helper cells
- Ocular lesions
- Immune mediated noncaseating granulomas/ [Ig] increase
- Diabetes insipidus/ [D vit.] increase/ Dyspnea
- Osteopathy
- Skin (Subcutaneous nodules, erythema nodosum)
- Interstitial lung fibrosis/ IL-1
- Seventh CN palsy
Seronegative spondyloarthopathy: diseases
RAPE:
- Reiter's syndrome
- Ankylosing spondylitis
- Psoriatic arthitis
- Enteropathic arthitis (IBD)
Sjogren syndrome: morphology
"Jog through the MAPLES":
*Sjogren is:
- Mouth dry
- Arthritis
- Parotid enlarged
- Lymphoma
- Eyes dry
- Sicca (primary) or Secondary
SLE (Systemic Lupus Erythematosus): diagnosis (ARA criteria)
DAMP AS RHINO:
- Discoid rash
- ANA (+)
- Malar rash
- Photosensitivity
- Arthritis
- Serositis (pleural, pericardial)
- Renal involvement
- Hematologic abnormality
- Immunologic abnormality
- Neurologic abnormality (seizures, psychosis)
- Oral / nasal ulcer, Observed
SLE (Systemic Lupus Erythematosus): diagnosis
"MD SOAP 'N HAIR":
- Malar rash
- Discoid rash
- Serositis
- Oral ulcer
- Arthritis
- Photosensitivity
- Neurologic abnormality
- Hematologic abnormality
- ANA (+)
- Immunologic abnormality
- Renal involvement
SLE: drugs inducing it
SHIPPP:
- Sulfonamides
- Hydralazine
- INH
- Procanimide
- Penicillamine
- Phenytoin
SLE: factors that make SLE active
UV PRISM:
- UV (sunshine)
- Pregnancy
- Reduced drug (eg steroid)
- Infection
- Stress
- More drug
SLE: signs and symptoms
SOAP BRAIN:
- Serositis [pleuritis, pericarditis]
- Oral ulcers
- Arthritis
- Photosensitivity
- Blood [all are low - anemia, leukopenia, thrombocytopenia]
- Renal [protein]
- ANA
- Immunologic [DS DNA, etc.]
- Neurologic [psych, seizures]
Takayasu's disease is Pulseless disease
- "Can't Tak'a ya pulse" (Can't take your pulse):
- Takayasu's disease known as Pulseless disease, since pulse is weakened in the upper extremities.
Whipple's disease: full features
WHIPPLES:
- Weight loss
- Hyperpigmentation of skin
- Infection with tropheryma whippelii
- PAS positive granules in macrophage
- Polyarthritis
- Lymphadenopathy
- Enteric involvement
- Steatorrhea