Rheumatology ReviewRheumatology Review

How to Approach ArthritisHow to Approach Arthritis

DURATION

ACUTE CHRONIC

INFLAMMATION?

YES NO

• Crystal Deposition• Infection• Early Chronic• Trauma• Hemarthrosis

• OA

JOINT INVOLVEMENT

MONO OLIGO POLY (symmetry)• Early Oligo/Poly• Chronic/Indolent Infection

• Seronegative disease• Sjögren’s

• RA• SLE• Seronegative • Chronic Tophaceous Gout

Any 4 of the following 11 criteria (simultaneously or Any 4 of the following 11 criteria (simultaneously or sequential) needed to help diagnose SLEsequential) needed to help diagnose SLE Serositis (pleuritis, pericarditis)Serositis (pleuritis, pericarditis) Oral UlcersOral Ulcers Non-deforming Arthritis Non-deforming Arthritis PhotosensitivityPhotosensitivity Blood disorders (such as hemolytic anemia or Blood disorders (such as hemolytic anemia or

pancytopenia in absence of offending drug/agent)pancytopenia in absence of offending drug/agent) ANA positiveANA positive Renal DiseaseRenal Disease Malar Rash (distinct from photosensitivity)Malar Rash (distinct from photosensitivity) Discoid RashDiscoid Rash Neurologic Disorders (seizures, psychosis, etc)Neurologic Disorders (seizures, psychosis, etc) Presence of Anti-Smith, anti-phospholipids, anti-Presence of Anti-Smith, anti-phospholipids, anti-

dsdna, false positive syphilis testdsdna, false positive syphilis test

Diagnostic Criteria for SLEDiagnostic Criteria for SLE

Any 4 of the following 7 criteria. Primarily used for Any 4 of the following 7 criteria. Primarily used for research purposes, made prior to discovery of research purposes, made prior to discovery of anti-ccpanti-ccp Morning stiffness > 1hour for at least 6 weeksMorning stiffness > 1hour for at least 6 weeks Arthritis and soft tissue swelling of at least 3 Arthritis and soft tissue swelling of at least 3

joints for > 6 weeksjoints for > 6 weeks Arthritis of hand joints > 6 weeksArthritis of hand joints > 6 weeks Symmetric arthritis for > 6 weeksSymmetric arthritis for > 6 weeks Rheumatoid factor above the 95Rheumatoid factor above the 95thth percentile percentile Erosive arthropathy on filmsErosive arthropathy on films Subcutaneous nodulesSubcutaneous nodules

Diagnostic Criteria for RADiagnostic Criteria for RA

SjSjöögren’s, Lupus, gren’s, Lupus, neonatal heart neonatal heart

blockblock

Lupus    Lupus   

CREST CREST

Scleroderma  Scleroderma 

RARA

Antiphospholipid Antiphospholipid Syndrome Syndrome 

Name That AntibodyName That Antibody

Anti-Ro (SS-A), Anti-La (SS-B)Anti-Ro (SS-A), Anti-La (SS-B)

Anti-Smith, Anti-Double StrandedAnti-Smith, Anti-Double Stranded

Anti-CentromereAnti-Centromere

Anti-Scl70 (anti-topoisomerase)Anti-Scl70 (anti-topoisomerase)

Anti-CCP, RFAnti-CCP, RF

Lupus AnticoagulantLupus Anticoagulant

Mixed Connective Mixed Connective Tissue DiseaseTissue Disease

Stiff Man Syndrome    Stiff Man Syndrome   

CREST CREST

Scleroderma  Scleroderma 

Dermato/PolymyositisDermato/Polymyositis

Celiac Disease Celiac Disease 

Name That AntibodyName That Antibody

Anti-RNPAnti-RNP

Anti-GADAnti-GAD

Anti-CentromereAnti-Centromere

Anti-Scl70 (anti-Anti-Scl70 (anti-topoisomerase)topoisomerase)

Anti-Mi-2, Anti-Jo1Anti-Mi-2, Anti-Jo1

Anti-TransglutaminaseAnti-Transglutaminase

Autoimmune HepatitisAutoimmune Hepatitis

Primary Biliary Primary Biliary CirrhosisCirrhosis

Churg-Strauss, Churg-Strauss, Microscopic Microscopic Polyangitis Polyangitis

Wegener’s  Wegener’s 

Drug Induced LupusDrug Induced Lupus

Seronegative ArthritisSeronegative Arthritis

Name That AntibodyName That Antibody

Anti-Smooth MuscleAnti-Smooth Muscle

Anti-Mitochondrial AntibodyAnti-Mitochondrial Antibody

p-ANCAp-ANCA

c-ANCAc-ANCA

Anti-Histone AbsAnti-Histone Abs

HLA-B27HLA-B27

Gratuitous photosGratuitous photos

SjSjöögren’s, Lupus, gren’s, Lupus, neonatal heart neonatal heart

blockblock

Anti-Ro (SS-A), Anti-Anti-Ro (SS-A), Anti-La (SS-B)La (SS-B)

Lupus    Lupus    Anti-Smith, Anti-Anti-Smith, Anti-Double Stranded AbsDouble Stranded Abs

CREST CREST Anti-CentromereAnti-Centromere

Scleroderma  Scleroderma  Anti-Scl70 (anti-Anti-Scl70 (anti-topoisomerase)topoisomerase)

RARA Anti-CCP, RFAnti-CCP, RF

Antiphospholipid Antiphospholipid Syndrome Syndrome 

Lupus AnticoagulantLupus Anticoagulant

Name That AntibodyName That Antibody

Mixed Connective Mixed Connective Tissue DiseaseTissue Disease

Anti-RNPAnti-RNP

Stiff Man Syndrome    Stiff Man Syndrome    Anti-GADAnti-GAD

CREST CREST Anti-CentromereAnti-Centromere

Scleroderma  Scleroderma  Anti-Scl70 (anti-Anti-Scl70 (anti-topoisomerase)topoisomerase)

Dermato/PolymyositisDermato/Polymyositis Anti-Mi-2, Anti-Jo1Anti-Mi-2, Anti-Jo1

Celiac Disease Celiac Disease  Anti-Anti-TransglutaminaseTransglutaminase

Name That AntibodyName That Antibody

Autoimmune HepatitisAutoimmune Hepatitis Anti-Smooth Muscle Anti-Smooth Muscle AbAb

Primary Biliary Primary Biliary CirrhosisCirrhosis

Anti-Mitochondrial Anti-Mitochondrial AntibodyAntibody

Churg-Strauss, Churg-Strauss, Microscopic Microscopic Polyangitis Polyangitis

p-ANCAp-ANCA

Wegener’s  Wegener’s  c-ANCAc-ANCA

Drug Induced LupusDrug Induced Lupus Anti-Histone AbsAnti-Histone Abs

Seronegative ArthritisSeronegative Arthritis No Ab. HLA-B27No Ab. HLA-B27

Name That AntibodyName That Antibody