Rheumatology | Master Of Medicine

Category Archives: Rheumatology

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis is a frequently repeated question in AIPGME. The features essential for diagnosis of JRA are:

Athritis

  1. Non migratory
  2. Mono/Polyarticular
  3. Tendency to involve large joints or proximal interphalangeal joints
  4. Lasting more than 3 months

Systemic features

  1. Fever
  2. Erythematous rashes
  3. Rheumatoid nodules
  4. Leucocytosis

And occassionally:

  1. Iridocyclitis(Uveitis)
  2. Pleuritis
  3. Pericarditis
  4. Anemia
  5. Fatigue
  6. Growth failure

 

Joint involvements in diseases

Osteoarthritis

  • MC joint involved-Knee Joint
  • Primary OA(idiopathic)
  • Secondary OA(Trauma,metabolic etc)
  • Joint mice,subchondral sclerosis,osteophyte formation,Joint space narrowing
  • Heberdens nodes and Bouchards nodes.
  • Bouchards——->PIP
  • Heberdens——>DIP
  • Mnemonic:bOuchards—>O for Osteoarthritis
  • B Comes before H so B for PIP and H for DIP

Rheumatoid arthritis

  • HLA DR4 association
  • MC in women
  • Synovial hypertrophy and granulation tissue formation over cartilage(Pannus)
  • Symmetrical small Joint pains
  • MCP and PIP involvement
  • DIP never involved
  • Swan neck deformity-Flexion at DIP and hyperextended PIP
  • Boutonniere deformity-Flexed PIP
  • Atlantoaxial subluxation

Psoriatic Arthritis

  • DIP involvement
  • Sausage digits
  • Pencil in cup appearance

Gout

  • MC in MEN
  • Assymetric joint involvement
  • Joint swollen,red,painful.
  • Painful MTP joint of big toe-podagra
  • Due to precipitation of monosodium urate crystals due to hyperuricemia.
  • Gouty tophus
  • Needle shaped negatively birefringent crystals

Pseudogout

  • Calcium pyrophosphate crystals
  • Basophilic rhomboid crystals
  • Weakly positive birefringent
  • Affects large joints,classically knee

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