Rheumatology Images

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Dr Pushkar Kumar

Rhemotology pathologies images

Health & Medicine

Homogenous Pattern
Corresponds to both :
Anti-dsDNA & Anti-Histone Ab
Most common pattern in SLE

Centromere Pattern
Corresponds to :
Anti-Centromere antibody
Probable Diagnosis :
CREST syn/Limited SSc

Nucleolar Pattern
Corresponds to Anti-SCL-70
(Anti-topoisomerase 1 antibody)
Probable Diagnosis :
Diffuse SSC
(Systemic Sclerosis)

Speckled Pattern
Corresponds to :
SSA/SSB(Anti-Ro/La)/Anti-U1-
RNP
Probable Diagnosis :
Sicca syndrome/MCTD

Inflammatory Polyarthritis
RHEUMATOID ARTHRITIS
• RA Factor Positive
(Seropositive)
• HLA-DR4/DRB1 (Sporadic)
• Axial involvement : Rare
• Predominant feature : Articular
• 1st line Rx : DMARDS
SPONDYLOARTHROPATHY
• RA Factor Negative
(Seronegative)
• HLA-B27 (Strong Family H/O)
• Axial : Relatively common
• Extra-articular predominant
• 1st line Rx : NSAIDS

Focus : Articular features in RA
Rheumatoid Arthritis
• Symmetrical,
• Appendicular dominant
• Small joints of the hands
(Wrist, MCP, PIP involvement)

SpA : Appendicular dominant
Psoariatic Arthropathy
• Joint involvement can mimic RA
• Skin/Nail changes Preceded the
joint involvement in majority
• In 5-10%, arthritis precedes. Early
DIP involvement differentiates
from RA.
MC : Oncholysis (Nail-Peeling)

SpA : Appendicular dominant
Enteropathic arthropathy
• Asymmetrical Large Joints.
• May affect UL joints
(Shoulders, Elbow)
• Most commonly preceded by
diarrhea. Associated with :
• UC >> CD
Specific : Pyoderma gangrenosum

SpA : Appendicular dominant
REACTIVE ARTHRITIS
• Asymmetrical Large Joints.
Predominantly affects weight
bearing joints i.e. LL joints.
• Most commonly preceded by
febrile illness.
Specific : Keratoderma Blenorrhagia

Biologicals
• Anti-TNF Alpha agents : Etarnacept, Infliximab,
(Most Preferred) Adalimumab, Golimumab and
Pegylated form of Certolizumab.
• IL-1 Antagonist : Anakinra
• IL-6 Antagonist : Tocilizumab, SARILUMAB
• T-Cell Modulator : Abatacept
• B-cell Antagonist : Rituximab

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