RHEUMATOLOGY SECTION INTERNAL MEDICNE BOARD REVIEW COURSE.

RHEUMATOLOGY SECTIONINTERNAL MEDICNE

BOARD REVIEW COURSE

ANATOMY REVIEW

SERONEGATIVE SPONDYLOARTHROPATHIES

SNSA’s

SNSA UNIFYING FEATURES• sacroiliac joint involvement (axial disease) with inflammatory back pain• peripheral joint involvement (non-axial disease)• no RF• extra-articular features:

• HLA-B27• enthesopathy• dactylitis• mucocutaneous disease• conjunctivitis/uveitis• cardiac disease (valvular / conduction)

SNSA’s

SNSA’s

SNSA’s

SNSA’s

HLA-B27

HLA-B27

ANKYLOSING SPONDYLITIS

AS / PULMONARY DISEASE

AS / CARDIAC DISEASE

SACROILIITIS

SACROILIITIS

SPONDYLITIS

REITER’S / REACTIVE ARTHRITIS

PSORIATIC ARTHRITIS

PSORIATIC ARTHRITIS

PSORIATIC ARTHRITIS

IBD-Related Arthritis

• Peripheral (parallels IBD activity)

• Axial (does not parellel, more HLA B27+)

• Other extraintestinal features– Uveitis– Sclerosing Cholangitis– E. nodosum– Pyoderma gangrenosum

RHEUMATOID ARTHRITIS

RA - PANNUS

RA

RA & C-SPINE

RA & C-SPINE

RA & C-SPINE

FELTY’S SYNDROME

FS & LGL

RAEXTRAARTICULAR

RA - EYE

RA - PULMONARY

RA & RHEUMATOID NODULE

INFECTIOUS ARTHRITIS

DISSEMINATED GC

NONGONOCOCCAL BACTERIAL ARTHRITIS

NONGONOCOCCAL ARTHRITIS

INFECTIOUS BURSITIS

TUBERCULOUS ARTHRITIS

POTT’S DISEASE

PARVOVIRUS

LYME

LYME - ECM

ACUTE RHEUMATIC FEVER

ACUTE RHEUMATIC FEVER

ACUTE RHEUMATIC FEVERE. MARGINATUM

CRYSTALLINE ARTHRITIS

CRYSTALLINE ARTHRITIS

GOUT

GOUT

GOUT

GOUT

CRYSTALLINE ARTHRITIS

CPPD

HADDHYDROXYAPATITE DEPOSITION

DISEASE

CALCIUM OXALATE

FIBROMYALGIA

FIBROMYALGIA

HIV-ASSOCIATED ARTHROPATHIES

HIV

• Incomplete Reiter’s

• PsA

• RA goes away..

• Myopathies

• “DILS”

OSTEOARTHRITIS

OSTEOARTHRITIS

NODAL OSTEOARTHRITIS

OSTEOARTHRITISHIP

EROSIVE OA

OSTEOARTHRITISDISH

OSTEOARTHRITISOCHRONOSIS

OSTEOARTHRITISHEMOCHROMATOSIS

OSTEOARTHRITISNEUROPATHIC

OSTEOARTHRITISAVN

OSTEOARTHRITISAVN

AMYLOIDOSIS

AMYLOIDOSIS

AMYLOIDOSISPRIMARY

AMYLOIDOSISABDOMINAL / RECTAL BX

SARCOIDOSIS

SARCOIDOSIS

REFLEX SYMPATHETIC DYSTROPHY

REFLEX SYMPATHETIC DYSTROPHY

REFLEX SYMPATHETIC DYSTROPHY

OFFICE ORTHOPEDICS

OFFICE ORTHOPEDICS

1. Shoulder

2. Elbow

3. Hip

4. Knee

5. Back

6. Hand

ENDOCRINE ASSOCIATED ARTHROPATHIES

HYPERPARATHYROIDISM

HEMOCHROMATOSIS

DIABETIC ARTHROPATHY

TUMOR ASSOCIATED ARTHROPATHIES

TUMOR ASSOCIATED ARTHROPATHEIS

• DM / PM• HPO• Palmar fasciitis• Raynaud’s• Vasculitis• MDS• PMR• Sweet’s• Erythromelalgia

SLE

SLE

SLE

SLE

SLE

SLE

SLE

SLE

SLE

SLE

Drug-Induced SLE

• Clinically the same except no renal or kidney disease

• Anti-histone antibody• No anti-Smith or anti-ds dna aby• Complements normal• Drugs: INH, procainamide, hydralazine• Treatment. Short course of NSAIDs or

steroids and DC offending drug

SLE

LIVEDO RETICULARIS

SLE

SLE

SLE

NEONATAL CUTANEOUS LUPUS

MCTD

Sjogren’s Syndrome

• Sicca complex– Keratoconjunctivitis (lacrimal gland)– Oral sicca (parotid)– Lymphocytic infiltrate (CD4)– SSA (Ro), SSB (La), RF, ANA, polyclonal

gammopathy– Woman age 30-50– Extraglandular

• ILD, PBC, vasculitis, neuropathy, arthritis, Raynaud’s, fever, fatigue, adenopathy/lymphoma, Hashimoto’s, myositis

– Primary vs secondary (RA)

VASCULITIS

Cholesterol Emboli Syndrome

-blue toes after an intervention- TIA- ARF- microhematuria- fever- ischemic bowel- eosinophilia- ESR increased- heparinization may worsen by releasing clefts from plaques

HYPERSENSITIVITY VASCULITIS / HSP

CRYOGLOBULINEMIA

CRYOGLOBULINEMIA

CRYOGLOBULINEMIA

BEHCET’S

BEHCET’S

ANCAC-ANCA (PR3)-Wegener’sP-ANCA (MPO)-CSS/MPA

WEGENER’S

POLYARTERITIS NODOSA

POLYARTERITIS NODOSA

POLYARTERITIS NODOSA

KAWASAKI

KAWASAKI

GIANT CELL ARTERITIS

PMR

PMR

GIANT CELLARTERITIS

TAKAYASU’S

SCLERODERMA

MORPHEA & LINEAR SCLERODERMA

CREST

PSS SKIN

SCLERODERMA GI

SCLERODERMA GI

SCLERODERMA ANTIBODIES

SCLERODERMA LUNG

SCLERODERMA KIDNEY

EOSINOPHILIC FASCIITIS

POLYMYOSITIS / DERMATOMYOSITIS

PM /DM

DM

GOTTRON’S (DM)

IBM

PM /DM

DM