<aside> 💡 WHEN TO CALL RHEUM

• Inflammatory arthritis (atraumatic joint swelling ‘soft mushy swelling’, synovitis, morning predominent symptoms)
  • Gout
  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Reactive Arthritis
• Connective tissue disease
  • scleroderma: endothelial instability. Reynauds often first manifestation
  • SLE: concern for kidneys.
  • sjrogrens
  • polymyositis: painless, proximal weakness, cant: get off toilet/bed, go up stairs. raised CK
• vasculitis
  • large vessel:
    • Giant Cell Arteritis: any branch of aorta, anyone >50 in anglosaxon/swedish, new onset headache, raised inflamm, poly rheumatica, jaw pain/claudication. most concerned for blindness.
    • Polymyalgia Rheumatica
  • small vessel: ‘ANCA diseases’
    • (Wegner’s) Granulomatosis with polyangiitis (GPA): ENT, renal and lung involvement
    • Eosinophilic granulomatosis with polyangiitis (eGPA): new onset asthma, eosinophilia, mononeuritis multiplex
    • microscopic polyangiitis (MPO): renal, sometimes pulmonary </aside>

<aside> 💡 inflammatory arthritis joint aspirate: WCC>2000 x10^6

RA/Gout/Pseudogout/septic/SLE/sarcoidosis/rheumatic fever

50,000x10^6 consider septic, crystalline, RA

</aside>

non blanching, palpably purpuric rash=vasculitic

rheum in a nutshell:

• often atraumatic joint swelling, with prolonged morning stiffness (of joints)
• monoarthritis with fever is infection until proven otherwise
• most autoimmune arthritis are relapsing/remitting, requiring DMARDs
• short course steroids (Prednisolone) for acute attacks

<aside> 💡 physiological prednisolone = 5mg daily = 20mg cortisone

</aside>

Crystal Induced Arthritis

Rheumatoid Arthritis (RA)

Osteoarthritis (OA)

OA vs RA

Juvenile Idiopathic Arthritis