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Rheum Labs

Rheumatology

QuestionAnswer
Giant Cell Arteritis labs High ESR, CRP & IL-6 ; mild norm/norm anemia w/ thrombocytosis; temporal art bx is diagnostic
Elevated ESR, Leukopenia, Elevated ACE levels (40-80% prevalence) sarcoidosis
Schirmer test: to confirm dx of: Sjogren dz
needle-like morphology and strong negative birefringence, under polarized light= gout
Birefringence: Urate crystals strongly negatively birefringent, needle shaped
Birefringence: CPPD crystals positively birefringent, rhomboid crystals
Gout: Not useful in dx: serum uric acid, plain films
Gold standard in dx of gout joint aspirate demonstrating uric acid crystals
CPPD dx demo crystals in jt fluid; chondrocalcinosis on plain film; CT, MRI and U/S all detect CPPD; do serum Ca, Mg, PO4, alk phos, ferritin, Fe, TIBC
Spondylo labs inc acute phase reactants (ESR, CRP); hi plts; N/N anemia; hi serum IgA; (rare: hi AlkPhos); hi CPK; mild hi CSF protein & complement
Sarcoid: Dx Bx; Bronchoscopy; PFT; serum ACE; CXR; Gallium Scan; MRI / CT; Vit D sensitivity; Mediastinoscopy
Most common Ab’s assoc with SLE ANA (best screening test); dsDNA (hi titer diagnostic); anti-Smith to confirm; anti-RNP (not spec for SLE); Ro, La
Gono arthritis: labs syn fluid, blood cx not too helpful; cx likely infected mucosal surfaces (cervix, anus, oropharynx); WBC usually normal
Essential for dx / tx of infxs arthritis: synovial fluid (usu pos as are cx) (Blood cx pos in 50%)
TB arthritis: labs Syn fluid cell counts may be lower (than other infxs arth); AFB found in syn fluid in <20%
Fungal arthritis: Labs cx joint fluid may be neg; Complement fixation, antigen assays, synovial bx: all dx important
RA: Labs no single dx test confirms RA; acute phase reactants (ESR, CRP, thrombocytosis); autoAbs (CCP more specific than RF; ANA); anemia of chronic dz; synovial fluid analysis; inc WBCs, mostly PMNs
RA labs: CCP vs RF 30% RA pts are RF neg; 60% RA pts CCP pos (RF for severe dz)
Dx gold std for PM/DM bx (open bx preferred; can do needle)
Inflam myopathies: ANA Ab 50% prev; High titers usually indicate presence of another CTD
Inflam myopathies: Anti-Jo Ab 25% prev; PM or DM & ILD, arthritis, Raynaud’s
Inflam myopathies: Anti-PM-Scl low prev; Ab to nucleolar protein complex; assoc with PM/SSc
Inflam myopathies: Anti-Mi-2 low prev; DM with V sign, shawl sign
Scleroderma: ANA prev 95%; both lcSSc & dcSSc
Scleroderma: anti-topoisomerase (Scl-70) more assoc w/diffuse dz; assoc w/ tendon rubs, pulmo fibrosis, inc mortality
Scleroderma: anti-centromere more in LcSSc; assoc w/ CREST, pulmonary HTN, Raynaud
2 autoAbs unique to scleroderma: anti-topoisomerase (Scl-70); anti-centromere
Giant cell arteritis Labs very high ESR/CRP, anemia, low albumin
Wegener: dx bx involved tissue (gold std)
Wegener: Labs: c-ANCA (anti-neutrophil cytoplasmic antibody) (AKA PR3-ANCA, reacts w/ proteinase-3); inflammation: high ESR, CRP, anemia
Wegener: bx of most available tissue (esp lung or kidney)
Sjogren: Testing: Eyes: Schirmer test: measures tear production on paper (+ if <5mm); Rose-Bengal staining: shows corneal damage
Sjogren: Testing: Mouth: salivary gland bx; lower lip bx = lymphocyte infiltrate & gland fibrosis
Sjogren: Testing: Labs: 70% +RF; 60% +ANA; 60% Ro Ab; 40% La Ab
Anti-phospholipid syndrome dx / testing: Anti-cardiolipin Ab; Lupus anticoag; False pos RPR
Fibromyalgia: Labs within normal limits
Mixed Connective Tissue Dz Testing: pos anti-RNP Ab
Polymyositis labs high CPK & aldolase
PMR labs Elevated CRP & ESR (>50), not so high as in giant cell arteritis
polyarteritis nodosa dx studies vessel bx or angiogram; high ESR, CRP, urine pro, ANCA; HBsAg
Psoriasis labs high ESR; N/N anemia; hyperuricemia; normal RF
Temporal bone fx: dx CT Temporal Bone, non-contrasted; ENT Consult
Shoulder x-rays AP Grashey (30 deg), scap Y, axillary
Painless bony mass. Plain films = stalky or broad-based projection from bone surface Osteochondroma
MRI sensitive/not sensitive for: sensitive for meniscus; not good for chondral injury (effusion, nonlocal, nontender)
Rhabdomyolysis: Labs Myoglobinuria; CK elevated 5-10x normal (37-200)
Plain Films: Consider: Consider joint above & below injury
CT scan: defines: Defines bony anatomy
MRI: defines: Defines soft tissues
Nuclear medicine studies: Help define tumors, etc
EMG: Evaluates: Evaluates denervation of muscle units
NCS: Evaluates: Evaluate conduction velocities
Hemodynamically Unstable Fx imaging/look for: AP lateral xray: Inspect inner/ outer main ring cortices; 2 small rings; SI joint spaces (equal); symphysis pubis should align, < 5mm joint space; acetabulum
Hemodynamically Unstable Fx: if fx identified or suspected: CT (+/- MRI)
Septic joint/osteo: Dx tests Bone scans localize osteomyelitis; Joint aspiration to identify organism
MS Imaging Plain films (at least 2 views); consider joints above/below injury; CT (bony); MRI (ST); nuc med (tumors); EMG/NCS
Trauma x-ray series Lateral C-Spine; PA Chest; AP Pelvis
MS injuries: plain films At least 2 views; Check entire film; Consider joint above & below injury
Nuclear med studies to: define tumors, etc
Posterior fat pad is always: pathologic
Bucket-handle or corner fracture on x-ray = Metaphyseal Corner fx; less common, more specific for abuse than diaphyseal fx; represent planar fx through primary spongiosa
test that should be ordered to rule out DVT in the case of shoulder pain doppler ultrasound
initial test to be ordered to evaluate post-operative pain x-ray to evaluate for hardware failure
Antibodies in DM & PM Anti-Jo, ANA
Created by: Abarnard