The document provides an overview of various rheumatological diseases, including their common causes and clinical features, such as rheumatoid arthritis, osteoarthritis, gout, and systemic lupus erythematosus. It presents symptomatology, differential diagnoses for polyarthritis, and explains the causes of false positives for rheumatoid factor tests. Additionally, it touches on classification criteria for rheumatoid arthritis based on joint distribution and serology.

1. Rheumatology
A BRIEF REVISION OF RHEUMATOLOGY TOPIC
Dr. Sami Ur Rehman
Final Year MBBS
Quaid-e-Azam Medical College, Bahawalpur

2. #1:-Most common causes:-
 Rheumatoid Arthritis
 Osteoarthritis
 Ankylosing spondylitis
 Gout
 Rheumatic fever
 Psoriatic arthritis
 SLE
 Septic Arthritis
 Reactive Arthritis
 Enteropathic Arthropathy
 Pseudo-gout
 Reactive Arthritis

3. #2:-Five Clinical Features of each of the
above disease:-

4. Rheumatoid Arthritis:-
 Chronic inflammatory multisystemic disease with the main target
being the synovium.
Clinical Presentation:-
 Morning stiffness(>1hr) for 6 weeks
 Swelling of wrists , MCPs , PIPs for 6 weeks
 Swelling of 3 joints for 6 weeks
 RF +ve or anti-CCP
 CRP or ESR
 Some joints never involved in RA: DIPs ,, Joints of lower back

5. Osteoarthritis:-
 Most common joint disease
 Target tissue is articular cartilage
 Commonly affected joints : DIP’s, Knee, Thumb carpo-metacarpal joints.
Clinical Presentation:-
 Localized disease(knee or hip usually):pain on movement
 Joint gelling: pain after rest up to 30 minutes
 Joints are affected in oligo-articular asymmetric pattern.
 Morning stiffness <20-30 min
 ESR and C-reactive proteins normal.
 Osteophytes formation(Bouchard’s nodes->PIP’S ,, Heberden’s nodes->DIP’S)

6. Ankylosing Spondylitis:-
 Inflammatory disorder that primarily affects the axial skeleton and peripheral joints
 More common in young men
 90% are positive for HLAB27
Clinical Presentation:-
• Pain and stiffness in the lower back and buttocks
• Pain and stiffness that is worse in the mornings and during the night, but may be
improved by light exercise.
• Mild fever.
• Loss of appetite.
• Pain and tenderness in the ribs, shoulder blades, hips, thighs and heels.
• Fatigue.
• Mild to moderate anemia, which can make people pale, tired and short of breath.
• Inflammation of the bowel.
• Iritis or uveitis

7. Gout:-
 Inflammatory arthritis which develop as a result of high level of uric acid in
the blood.
Clinical Presentation:-
 Commonly acute mono-arthritis
 Metatarsophalangeal joints of the first toe is commonly affected(podagra)
 Severe pain and extreme tenderness
 Joint is red hot swollen with shiny overlying skin and dilated veins.
 First episode occurs at night with severe joint pain and looks exactly like
cellulitis

8. SLE:-
 Systemic disease in which tissues and multiple organs are damaged by pathogenic
autoantibodies and immune complexes.
Clinical Presentation:-
 Malar Rash
 Discoid rash
 Photosensitivity
 Oral ulcers
 Arthritis
 Serositis
 Renal involvement
 Neurological disorder(seizures or psychosis)
 Hematological disorder(hemolytic anemia,leukopenia,thrombocytopenia)
 Immunological disorder(anti-dsDNA , anti-SM, and other ANA’s

9. Septic Arthritis:-
 Most rapid and destructive joint disease
 Most common cause of it is Gonorrhea.
 Women at greater risk during menses and pregnancy
Clinical Presentation:-
 Acute or subacute monoarthritis
 Fever
 Joint usually swollen and red
 Pain at rest and movement both
 Lower limb joints esp. knee and hip commonly affected.

10. Rheumatic Fever:-
 Affect the big joints(knee-ankle-elbow)
 One or more joints(polyarthritis)
 Migratory with signs of inflammation
 Asymmetric
 Respond quickly to salicylates
 Resolves within 1-3 weeks
 Leaves no permanent damage.

11. Psoriatic Arthritis:-
 Most commonly involves the DIP joints when associated with
psoriatic nail disease
 Patterns: symmetrical polyarthritis, DIP’s, oligoarticular,
Arthritis mutilans, spinal involvement
 “Pencil in-cup” deformity in severe cases on radiology.
 Swan-neck deformity
 Dactylitis
 RA-factor -ve

12. Reactive Arthritis:-
 A seronegative arthropathy that occurs as a complication
from an infection somewhere in the body.
 Typically affecting lower limb
 1-4 weeks after:
urethritis or dysentery or Reiter’s syndrome

13. Pseudo-gout:-
 CPPD crystals deposition within articular hyaline cartilage
 Knee is the most common site
Clinical Presentation:-
 Warm, tender, erythematous joints with signs of large effusion
 Fever
 Pt appears confused and ill

14. Enteropathic Arthropathy:-
 a form of chronic, inflammatory arthritis associated with the
occurrence of an inflammatory bowel disease (IBD)=Ulcerative
colitis and Crohn’s disease.

15. Systemic Sclerosis:-
 Chronic multisysytem disease characterized by the thickening of the skin caused
by accumulation of the conn tissue and by involvement of the visceral
organs(lungs,git,kidneys)
Clinical Presentation:-
 Skin Thickening
 Raynaud’s phenomenon
 GIT: esophageal dysmotility, hypomotility of small intestine, dilation of large
intestine
 Lungs: Pulmonary fibrosis an Cor-pulmonale
 Kidneys: scleroderma renal crisis in which malignant HT develops and is
associated with acute renal failure.

16. Behcet Disease:-

17. #3:-Symptomatology of Rheumatology:-
 Pain
 Stiffness
 Swelling
 Erythema (redness) and warmth
 Weakness
 Locking and triggering
 Extra-articular features(like uveitis,3rd degree heart block,
aortic insufficiencies, rash, Raynaud phenomenon, etc.)

18. #4:-D/D of Polyarthritis with nodules:-
TYPE EXAMPLE
INFECTIVE
Bacterial: Lyme disease, subacute bacterial
endocarditis
Viral: rubella, mumps, glandular fever, chickenpox,
hepatitis B and C, human immunodeficiency virus
(HIV)
Post-infective Rheumatic fever
Degenerative Osteoarthritis: nodal with Heberden’s/Bouchard’s
nodes
Metabolic Haemochromatosis, gout
Inflammatory Rheumatoid arthritis, SLE, psoriatic arthritis
Other Hypertrophic pulmonary osteoarthropathy

19. #5:-Causes of false +ve RA factor:-
 SLE(Associated with positive Coomb's test)
 Sjogren syndrome
 Chronic liver disease
 Sarcoidosis
 Interstitial pulmonary fibrosis
 Infectious mononucleosis
 Hep B(Associated with HBsAg)
 TB
 Leprosy
 Syphilis(associated with +ve VDRL)
 Subacute bacterial endocarditis
 Visceral leishmaniasis
 Schistosomiasis
 malaria

20. Joint distribution (0–5) Score
1 large joint 0
2–10 large joints 1
1–3 small joints (large joints not counted) 2
4–10 small joints (large joints not counted) 3
>10 joints (at least one small joint) 5
Serology (0–3)
Negative RF and negative ACPA 0
Low positive RF or low positive ACPA 2
High positive RF or high positive ACPA 3
Acute-phase reactants
Normal CRP and normal ESR 0
Abnormal CRP or abnormal ESR 1
A score of ≥6 classifies the
patient as having definite
rheumatoid arthritis.
This should be distinguished
from a definite diagnosis as a
patient may clinically have
rheumatoid arthritis but not
fulfill criteria.
American College of Rheumatology/European League Against
Rheumatism classification criteria for rheumatoid arthritis:-