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