5. Long case : SLE
• History of presenting complaint
• Chronology of illness
• When it first started/ how it was diagnosed/ organ involved
• Frequencies of flares : Which organ flares
• What was the steroid dose
• Complication of steroid
• Compliance
6. Cont…
• Obs and Gynae history :
• Miscarriages
• At what weeks
• Social history
• Occupation
• How much the illness have affected the patient
17. Management..
• Management of flares : based on which organ involved
• Hydrocycloroquine
• Azathoprine
• Methotrexate
• Cyclophosphomide
• Biologics
18. RHEUMATOID ARTHRITIS
• Chronic, systemic inflammatory
disease
• Autoimmune
• Characterized by symmetrical
inflammation of joints
• Arthritis : red swollen tender
23. Management
• Methotrexate – anchor drug
• Short course of prednisolone
• Hydroxycloroquine
• Sulphasalazine
• Leflunomide
• Biologics
24. Q :
• A 42 – year –old lady presented with fever, joint pain and rash.
• Further questions?
• Further investigations?
Editor's Notes
White /ischemic .. Blue.. Red
nflamed and scaly skin on the face of a 30 year old woman with seborrheic dermatitis. This is an inflammatory disorder where the skin becomes flaky, itchy and red. It occurs especially in areas rich in oil-producing sebaceous glands, such as the scalp and round the nose
White patches particularly around the macula.
The 1987 ACR classification criteria has been criticized for its lack of sensitivity in early disease. Joint damage and bony erosions that occur 2/2 to RA are irreversible and can occur early in the course of disease (30% of patients have bony erosions on imaging at the time of diagnosis). Additionally, initiation of DMARDs within 3 months of diagnosis is essential for improving clinical outcomes and reducing radiographic evidence of damage. In 2010, the ACR and European League Against Rheumatism developed a new approach for classifying RA in order to identify patients who are at risk for developing persistent and/or erosive disease. The new classification criteria focuses on early diagnosis in order to facilitate early initiation of DMARDs to prevent progression to erosive disease.
The tests for rheumatoid factor routinely detect IgM RF, which are present in 60-70% of patients with RA (do not IgG or IgA which may be present in some patients but not detected)
May be present due to other disease states like SLE, mononucleosis, syphilis, TB, bacterial endocarditis, acute hepatitis, cirrhosis, pulmonary fibrosis
The presence of antibodies to CCP has high specificity of RA, > 90% (but lower sensitivity)
30% of patients will have bony erosions on radiographic imaging at the time of diagnosis
