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DU PA Misc Rheum

Duke PA Miscellaneous Rheumatologic Disease

new onset of headaches, or history of headaches with new patter--be suspicious for Giant Cell Arteritis
White, over the age of 50, female to male 2:1, are demographics for Giant Cell Arteritis
Headache – new or different from before, Scalp tenderness, especially over the, temporal artery, Jaw claudication, Systemic illness – weight loss, fevers, malaise Giant Cell Arteritis
Giant Cell Arteritis immediately treated with __ high dose prednisone
labs – very high ESR/CRP, anemia, low albumin Giant Cell Arteritis
if you *suspect* GCA __ treat it!
Sudden, irreversible blindness if left untreated Giant Cell Arteritis
White, over the age of 50, female to male 2:1, are demographics for Polymyalgia Rheumatica
Pain and stiffness of the pelvic and shoulder girdles, Weakness is not a feature, Morning stiffness is severe and protracted, Patients typically complain of difficulty fastening bra and getting up from seated position Polymyalgia Rheumatica
PMR Polymyalgia Rheumatica
GCA Giant Cell Arteritis
treatment of PMR moderate to low dose prednisone
Vasculitis of small vessels and capillaries lead to rupture/bleeding around them, Lower extremities, Redness does not blanch with pressure Palpable Purpura
A SMALL vessel vasculitis Wegener’s Granulomatosis
Signs/symptomsUpper Airway severe sinus disease (suspect in patients with refractory sinus symptoms)epiglottic changesLungsnodules and/or hemorrhageKidneysacute glomerulonephritisprotein, blood, and casts in the urine Wegener’s Granulomatosis
Saddle nose deformity Wegener’s Granulomatosis
treatment of Wegener’s Granulomatosis, corticosteroids – high dose initially, cyclophosphamide
dry eyes (keratoconjunctivitis) and dry mouth (xerostomia) sicca syndrome
An inflammatory disorder of the exocrine glands Sjögren's Syndrome
Symptoms:Sicca Syndrome: Dry eyes (keratoconjunctivitis sicca)Dry mouth (xerostomia) parotid gland enlargementsome patients may also have fatigue/myalgiasrare: internal organ involvement (lungs, kidneys, etc Sjögren's Syndrome
Testing:Eyes: Schirmer’s test: measures tear production on a paperRose-Bengal staining: shows corneal damageMouth:salivary Gland biopsyLabs:antibodies to Ro and L Sjögren's Syndrome
treatment of keratoconjunctivitis ocular lubricants, artificial tears
treatment for xerostomia liberal fluids; specially-formulated mouthwash, toothpaste and chewing gum (Biotene ®),oral moisturizers
treatment for systemic symptoms of Sjögren's Syndrome steroidsNSAIDsDMAARDs (usually hydroxychloroquine)
reddish-cyantotic, lacey pattern of the skin livido reticularis
if you see livido reticularis be suspicious for Antiphospholipid Syndrome
APS Antiphospholipid Syndrome
Recently described syndrome of antibody-mediated hypercoagulabilitySymptoms:recurrent thrombosis – arterial and/or venouspregnancy loss – early or latePatients with this disorder have lupus-like symptoms but fail to meet diagnostic criteria Antiphospholipid Syndrome
Testing:Anti-cardiolipin antibodiesLupus anticoagulantFalse positive RPR (Syphilis test) Antiphospholipid Syndrome
Treatment:If thrombosis: life-long anticoagulation with warfarin plus ASA 81mg qdIf pregnancy loss: heparin and ASA 81mg during future pregnanciesEchocardiography to rule out vegetations Antiphospholipid Syndrome
Chronic pain syndrome of unknown etiologyNot autoimmune or inflammatorySymptoms:“I hurt all over.” “I feel like I was hit by a truck in the morning.” muscle tenderness to palpationfatigue and disturbed sleep, women, ages 20-50 fibromyalgia
Testing: Physical ExamNo joint swelling or inflammationTender points: press until your thumb nail blanches, Laboratory evaluation is within normal limits fibromyalgia
Testing for fibromyalgiatender points: press until your thumb nail blanches Back of headChest – upper & lowerUpper back – medial & lateralLow backButtockGreater trochanterMedial kneeLateral epicondyle
Treatment: Not very effective and very frustratingFollowed by primary care physicianSelf-careExercise, yoga, meditationSleep improvementTreat sleep apnea, restless legsPharmacotherapy: hypnotics, tricyclics, cyclobenzaprine (Flexeril®) fibromyalgia
Anti-depressants: SSRIs, duloxetine (Cymbalta®)Analgesics: tramadol, gabapentin, pregabalin (Lyrica®)SSRIs, duloxetine, cyclobenzaprine also helpful with painNSAIDs, prednisone not helpfulavoid “trap” of chronic narcotics fibromyalgia
Overlap Syndrome of Lupus and Sclerodermamany rheumatologists don’t consider this a unique disease – just the gray between these diseases Mixed Connective Tissue Disease (MCTD)
Symptoms:severe Raynaud’s phenomenonswollen (“puffy”) hands, arthritismay have any/many symptoms of SLE and scleroderm Mixed Connective Tissue Disease (MCTD)
Created by: bwyche