Rheumatic diseases

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Rheumatic diseases

  1. 1. Rheumatoid Arthritis By Dr.Aseel Nuseirat 29/6/2013
  2. 2. Overview  F > M 2.5: 1.  Rheumatoid arthritis usually has a slow, insidious onset over weeks to months  Typical age of onset 30-50.  RF +ve in 80-85 % / not specific.  May 2 years before +ve.  Accp / earlier / greater specificity for diagnosis of RA.  HLD-DR4 antigen  aggressive RA
  3. 3.  Rheumatoid arthritis is an autoimmune disease in which the normal immune response is directed against an individual's own tissue, including the joints, tendons, and bones, resulting in inflammation and destruction of these tissues.
  4. 4. Functional Presentation and Disability of RA  In the initial stages of each joint involvement, there is warmth, pain, and redness, with corresponding decrease of range of motion of the affected joint.  Progression of the disease results in reducible and later fixed deformities.  Muscle weakness and atrophy develop early in the course of the disease in many people.
  5. 5. 1. High RF. 2. Constitutional symptoms. 3. Insidious onset. 4. Early appearance of Rheumatoid nodule. 5. Early radiographic evidence of erossive disease. Severe cause probably with :
  6. 6. Signs & Symptoms  Morning stiffness several hours  fatigue  low grade fever  anorexia weight loss  Symmetric involvement of Joints , hands , MCPs , PIPs  Boutonniere deformity  advanced RA Flexion  PIP Extension  DIP
  7. 7.  Hoarseness  Sore throat + or.  Neck pain  involvement of cricoarytenoid C.  Knee  most common single joint initially involved RA.
  8. 8.  Carpal tunnel , tarsal funnel  RA.  Pt with inflammatory Knee arthritis present with swollen calf  ruptured backer cyst causing pseudo phlebitis.  Spine  C1-2 sublaxation separation of atlanto- odontoid process by ≤ 3mm.
  9. 9.  Surgical fusion not needed for asymptomatic c1-2 sublaxation.  Pt with c1-2 sublaxation are susceptible to trauma ass. With endo tracheal intubations and present post surgery : 1- syncope 2- lightheadedness 3- nystagmus  Therefore pt. with RA should do neck – x ray before surgery.  Lumber spine , SI joints spared
  10. 10. Diagnostic Criteria for RA  ≤ 4 diagnosis of RA.  Morning stiffness  Arthritis of 3 or more joints  Arthritis of hand joints  Symmetric arthritis  Rheumatoid nodules  Serum rheumatoid factor  Radiographic changes
  11. 11. Extra Articular Manifestation  Cardiac :- - Pericardities + Myocardities - Rheumatoid nodules on the valves - atherosclerosis – 3x risk ( sudden death, MI).  Renal :- ( very rare ) - Drug related renal disease. - amyloid renal disease.
  12. 12.  Lung :- - pleurisy with effusion exudate [ Glucose] ( low 20-30 ) LDH elevated. - Diffuse interstitial fibrosis. - intra pulmonary rheumatoid nodule.  BLD :- - anemia of chronic disease. - neutropenia.
  13. 13.  Nerve :- - mono neuritis multiplex foot or wrist drop.  Skin :- - nodules  on extensor, 25%  Vasculities :- - May resemble pan. - Necrosis & ulceration mostly on malleoli.
  14. 14.  Felly Syndrome :- - RA + splenomegaly + Neutropenia ( can do splenectomy )  LGL Syndrome :- - Neutropenia - Splenomegaly - Susceptibility to infection: 1- tend to LGL leukemia. 2- do not do splenectomy ( cause an exacerbation ).

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