نقاط مهمة بمحاضرات الRheumato الي جايه بأسئلة الأعوام السابقة:
Juvenile Idiopathic Arthritis (JIA)
• Oligoarthritis: Most common form of JIA (60% of cases), affects large joints asymmetrically, associated with uveitis, and many patients are ANA-positive.
• Treatment: Methotrexate is often first-line.
• Ophthalmological complication: Iridocyclitis (uveitis).
Rheumatoid Arthritis (RA)
• Investigations: Check RF and ACPA (Anti-CCP is most specific/sensitive).
• Immune characteristic: Th1 and Th17 involvement (not Th2).
• RA Criteria: 6/10 points are needed for diagnosis.
• Bone erosion: Driven by osteoclasts.
• Extra-articular manifestation: Rheumatoid nodules (most common).
• F:M ratio: 3:1.
• Pulmonary fibrosis: Can cause bibasal fine inspiratory crackles.
• Treatment: DMARDs are first-line.
• Felty’s syndrome: RA + splenomegaly + neutropenia.
Osteoarthritis (OA)
• Management: Includes weight loss, quadriceps strengthening exercises, patient education, and NSAIDs.
• X-ray findings: Reduced joint space, subchondral sclerosis, bone cysts, osteophytes.
• Synovial joint cartilage: Contains type II collagen (not type I).
Ankylosing Spondylitis (AS)
• HLA-B27: Strongly associated (>95%).
• Treatment: NSAIDs and spinal exercises are first-line.
Reactive Arthritis (ReA)
• Triggers: Chlamydia, Campylobacter, Salmonella, Shigella, Yersinia.
• Skin manifestation: Keratoderma blennorrhagica.
• Alternate name: Reiter’s disease.
Psoriatic Arthritis (PsA)
• Characteristic signs:
• Pitting of nails + DIP swelling.
• Involves DIP joints more than first MTP joint.
Enteropathic Arthritis
• Associated condition: Inflammatory bowel disease (IBD).
• Clue: History of bloody diarrhea.
Systemic Lupus Erythematosus (SLE)
• Investigations:
• For disease activity: Anti-dsDNA and C3.
• Pregnancy-related issues: Anti-cardiolipin, anti-Ro, anti-La.
• Diagnosis: Anti-dsDNA is the most specific.
• Lupus nephritis: Class IV is diffuse proliferative GN.
Scleroderma
• Limited cutaneous scleroderma:
• Skin involvement is limited to the face, hands, and feet.
• Pulmonary hypertension is more common.
• Diffuse scleroderma:
• Interstitial lung disease (ILD) is more common.
• Renal disease is more common.
• Pulmonary hypertension: Seen more in limited scleroderma.
Raynaud’s Phenomenon
• Management: Avoid cold, use thermal socks, and consider calcium channel blockers (e.g., nifedipine), losartan, fluoxetine, or sildenafil.
Granulomatosis with Polyangiitis (GPA)
• Features: Granulomas affecting nasal passages, airways, and kidneys.
• Symptoms include epistaxis, nasal crusting, sinusitis, proptosis, and possibly deafness.
• Antibody: C-ANCA (PR3-ANCA) is usually positive.
Giant Cell Arteritis (GCA)
• Key symptoms: Headache, jaw claudication, visual disturbance.
• Treatment: Prompt steroids.
Myositis
• Investigations: Check CPK, aldolase, LDH, and AST.
Gout
• Diagnosis: Negatively birefringent, needle-shaped crystals on joint fluid analysis.
• Treatment: NSAIDs, colchicine, or corticosteroids for acute attacks.
Anti-Phospholipid Syndrome (APS)
• Diagnosis: Anti-cardiolipin antibodies or lupus anticoagulant.
Sjogren’s Syndrome
• Symptoms: Dry eyes, dry mouth, cold fingers.
Henoch-Schönlein Purpura (HSP)
• Features: Purpuric rash on buttocks and lower limbs, hematuria, joint pain.
Behcet’s Disease
• Key symptoms: Oral ulcers, genital ulcers, erythema nodosum, positive pathergy test.
Pulmonary Embolism (PE)
• Investigation: Do a CTPA (CT pulmonary angiography).
