Rheum

Autoimmune/Inflammatory/Rheum #

SLE #

  • Arthralgias are always polyarticular
  • Check ANA
    • if positive check C3/C4 levels
    • if ↓ => SLE

Polymyalgia Rheumatica #

  • Proximal myalgia of the hip and shoulder with morning stiffness > 1 hour.
  • Associated with giant cell arteritis.
    • Ask about scalp tenderness
    • Claudication: pain after/while chewing

Usually seen in 50+yo, with positive CRP/ESR.

Rapid response to low dose corticosteroids pathognomonic.

Ankylosing Spondylitis #

Low back pain in young (<45) patient lasting >3 months. Oft missed/underdiagnosed (prevalence 0.5-2%).

  • M:F 2-3:1
  • age 20-30 (>80% pts with sx before 30)
  • inflammatory characteristics
    • better w/ exercise
    • worse in monring (not improved with rest)
    • lasting >30 minutes
    • morning stiffness
  • Ask about associated stuff
    • Anterior uvitis
      • unilateral eye pain, photophobia, redness/watering
    • sleep disturbances/daytime fatigue
    • Swelling (diffuse) of fingers/toes (dactylitis)
    • arthirits of large joints (knee, hip, ankle, shoulder)
  • Assocaited with other imflammatory conditions
    • Chrons/UC
    • psoriasis

Workup #

  • Pelvic XR
  • HLA-B27 positive (LR+ 9)
  • CRP usually elevated
  • RF negative

Consider #

  • psoriatic arthritis
  • reactive arthritis
  • enteropathic arthritis

Treatment #

  • PT/exercise
  • NSAIDs
  • TNF inhibitors