CLINICAL RHEUMATOLOGY FOR UNDERGRADUATES
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Transcript of CLINICAL RHEUMATOLOGY FOR UNDERGRADUATES
CLINICAL RHEUMATOLOGYFOR UNDERGRADUATES
BYHATEM ELEISHI, MD
September 2002
5 CASES WITH ARTHRITIS
RADIOGRAPHS OF RA
4 ADVICES
Always remember that…
THIS LECTURE INCLUDES:
THE CASES
Case number 1
A 31-year old male with hyperacute arthritis of right knee
31-year old male
3-days: hyper-acute onset of pain in the right knee following a sudden twist of the right leg while playing a football match.
Swelling of the knee occurred several hours following the trauma.
Inability to weight bear and of giving way since then.
Examination: Massive effusion of the right kneeRest of examination could not be conducted due to severe pain
male
hyper-acute onset
monoarthritis
So,
Arthritis in a male 20-50 years of age
Internal derangementSeronegative spondyloarthropathyGouty arthritisOsteoarthritis
COMMONEST CAUSES OF MONOARTHRITIS
Internal derangement, fracture
Crystal-induced: goutAutoimmune: Early seronegative arthropathiesMost bacterial agents, mycobacterial
Traumatic:
Inflammatory:
Infectious:
Neoplastic: Benign: as osteoid osteomaMalignant: synovial sarcoma
ANY POLYARTICULAR ARTHRITIS MAY INITIALLY BEGIN
AS A MONOARTICULAR DISEASE
REMEMBER THAT
Arthritis according tomode of onset
Three modes of onset
secondsminuteshoursdaysweeksmonths
Hyper-acute
Acute Insidious
Time
Hyper-acute onset
Acute onset
Insidious onset
Trauma:
Infectious CrystalAutoimmune
AutoimmuneInfectiousOther
seconds to minutes
hours to a few days
several weeks to months
Fracture, internal derangement
More virulent agents
Less commonly
More commonly Less virulent agents
male
hyper-acute onset
monoarthritis
INTERNAL DERANGEMENT
Case number 2
A 26-year old female with:
Fatigue
Polyarthritis
and a facial rash.
A 26-year old female presented with generalized fatigue and pain and swelling of her hands, knees and feet with a MS of 60 minutes of 5 weeks duration.
Examination: arthritis of small joints of hands, extensor tenosynovitis of the hands, facial rash.
Labs: ESR 70; Hb 11.5; WBC 4.2; plat 221; urine: proteinuria with casts on microscopy.
26-y old femaleinflammatory polyarthritis
malar rash proteinuria
Summary,
Arthritis in a female 25-50 years of age:
Rheumatoid arthritisSystemic lupus erythematosusOther CT diseases: SS; DM; MCTDOsteoarthritis
Inflammatory:
RA, SLE, DM/PM, SS, MCTD, seronegativesInfectious: Some bacterial agents: gonorrhea, brucellosisNeoplastic:
Leukemia, metastasis
COMMONEST CAUSES OF POLYARTHRITIS
Causes of erythematous rash over cheeks:
Systemic lupus erythematosus
Dermatomyositis
Drugs: steroids
26-y old femaleinflammatory polyarthritis
malar rash
Systemic lupus erythematosus
A technetium-99m phosphonate scan of the hands of a young woman with arthrlagia of uncertain cause.
What abnormality is shown? To what are the abnormalities due? What is the probable diagnosis? What other conditions may cause a ‘hot’ scan?
Case number
5
Any cause of increased bone metabolism such as:
Other conditions that cause a hot scan:
Repair of fractures
Bone destruction: by primary or secondary tumor
Inflammation within bone
adjacent to bone
Mode of onset
In a patient with arthritis, consider:
Number of joints affectedSymmetry of joint affection Which regions or joints are affected
Factors that aggravate and ameliorate symptomsAssociated manifestations
Age of patientSex of patient
CONCLUSION OF THE CASES
Plain radiography of the hands
in Rheumatoid
Arthritis
EARLY RHEUMATOID
ARTHRITIS
TWO YEARS LATER
MODERATELY ADVANCED
RHEUMATOID ARTHRITIS
EGYPTIAN RHEUMATOID
ARTHRITIS
Fourtake-away
advices
Advice 1:Carefully read the instructions before you practice medicine
Advice 2:
Listen toyour patients
Advice 3: Believe not but
A good history
Your eyes
Your hands
Advice 4:Doctors are more than just tablets
Lastly,
Always remember that
A competent physician is the one who has a firm grip of
Thank you