Musculoskeletal - Revision history

Aesetholephews: /* Missed Concepts */

2023-01-17T01:09:41Z

Missed Concepts

Aesetholephews: /* Rheumatoid Arthritis */

2023-01-16T23:03:26Z

Rheumatoid Arthritis

Aesetholephews: /* Missed Concepts */

2023-01-16T18:03:28Z

Missed Concepts

Aesetholephews: /* Polymyositis */

2023-01-16T16:37:42Z

Polymyositis

Aesetholephews at 06:14, 15 January 2023

2023-01-15T06:14:21Z

Aesetholephews: /* Polymyositis and Dermatomyositis */

2023-01-15T06:10:18Z

Polymyositis and Dermatomyositis

Aesetholephews: /* Missed Concepts */

2023-01-15T01:34:19Z

Missed Concepts

Aesetholephews: /* Kawasaki Disease */

2023-01-15T01:28:43Z

Kawasaki Disease

Aesetholephews: /* Scleroderma */

2023-01-14T03:43:49Z

Scleroderma

Aesetholephews: /* Polymyositis and Dermatomyositis */

2023-01-14T02:05:34Z

Polymyositis and Dermatomyositis

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 *'''Lateral''' shoulder pain is the most common symptom in torn rotator cuff.
 *Scoliosis that '''causes back pain, is rapidly progressive, or associated with neurological symptoms''' may be pathologic (e.g. spinal tumor). Most cases are idiopathic.
 =Systemic Lupus Erythematosus=

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 *H&P: middle aged women, HLA-DR4 serotype; morning stiffness that lasts > 30 min and improves with activity; Swan Neck deformity (PIP extension, DIP flexion), Boutonniere deformity (PIP flexion, DIP extension), ulnar deviation of MCP.
 *Dx: 4 criteria for 6+ weeks. 3 or more joints (PIP, MCP, wrist, elbow, knee, ankle); symmetrical joint synovial hypertrophy with cartilage loss and osteoporosis on xray; elevated CRP, ESR (sensitive, not specific), rheumatoid factor (75% sensitive), or anti-CCP (most specific); inflammatory synovial fluid on joint aspiration; rheumatoid skin nodules (elbow most common).
-*Tx: NSAIDs and PT; DMARDS (Sulfasalazine, Hydroxychloroquine, Azathioprine) ± Glucocorticoids for mild disease; Methotrexate (1st line), anti-TNF biologics (2nd line) ± corticosteroids for moderate-severe disease; anti-TNF biologics AND corticosteroids for severe disease. Avoid methotrexate in patients with HIV, liver disease, ILD, renal disease, pregnancy, or bone marrow suppression; avoid anti-TNF in patients with TB. '''Patients taking methotrexate should also get folate supplementation.'''
+*Tx: NSAIDs and PT; DMARDS (Sulfasalazine, Hydroxychloroquine, Azathioprine) ± Glucocorticoids for mild disease; Methotrexate (1st line), anti-TNF biologics (2nd line) ± corticosteroids for moderate-severe disease; anti-TNF biologics AND corticosteroids for severe disease. Avoid methotrexate in patients with HIV, liver disease, ILD, renal disease, pregnancy, or bone marrow suppression; avoid anti-TNF in patients with TB. Patients taking methotrexate should also get '''folate supplementation.'''
 =Osteoarthritis=

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 *Chronic exertional compartment syndrome (worse with exertion) vs. tibial stress fracture (pain with standing) vs. shin splints
 *Septic arthritis of the hip in an infant can lack fever, but presents with pseudo paralysis (due to pain), elevated WBCs, elevated CRP, and effusion. *Legg-Calvé-Perthes disease (idiopathic avascular necrosis of the hip) occurs in children aged 3-8, is insidious in onset, and does not have elevated inflammatory markers.
-*Myotonic dystrophy is autosomal dominant, caused by CTG repeats with genetic anticipation. Classic form presents in adulthood with muscle weakness and myotonia (impaired muscular relaxation). Infantile presentation includes respiratory failure, hypotonia, inverted V upper lip, cataracts, poor feeding, and clubbed foot. Diagnosis is via genetic testing.
+*Myotonic dystrophy (most common form of '''adult onset muscular dystrophy''') is autosomal dominant, caused by CTG repeats with genetic anticipation. Classic form presents in adulthood with muscle weakness and myotonia (impaired muscular relaxation). Infantile presentation includes respiratory failure, hypotonia, inverted V upper lip, cataracts, poor feeding, and clubbed foot. Diagnosis is via genetic testing.
 *FOOSH with "sail sign" (fat pad visible on xray), should be immobilized in a splint.
 *Osteoporosis can lead to vertebral compression fractures after minimal trauma in elderly patients, manage with '''Tylenol/NSAIDs and PT.'''

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 *H&P: Proximal muscle weakness
 *Dx: Elevated CK; Differential includes fibromyalgia and PMR.
-*Tx: Can be complicated by ILD.
+*Tx: Can be complicated by '''ILD.'''
 =Dermatomyositis=
 *H&P: Symmetric proximal muscle weakness. Gottron papules, heliotrope rash

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 =Systemic Lupus Erythematosus=
 Autoimmune inflammatory condition caused by antibody-antigen deposition in various tissues.
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 *Dx: CREST syndrome—Calcinosis, Raynaud's phenomenon, Esophageal dysmotility (GERD), Sclerodactly, and Telangiectasias. It involves the distal extremities and face only, is slowly progressive, has positive anti-centromere antibodies, a fair prognosis, and is associated with pulmonary hypertension. Diffuse scleroderma has generalized skin involvement, is rapidly progressive, has anti Scl-70 (topoisomerase I) antibodies, a poor prognosis, weaker association with calcinosis and telangiectasias, is associated with pulmonary interstitial fibrosis, and is more likely to trigger renal failure. '''Both can cause scleroderma renal crisis, which presents as acute malignant hypertension'''
 *Tx: '''ACEI (captopril is preferred) is 1st line for scleroderma renal crisis, even though ACEI are generally avoided in acute renal failure. Also give IV nitroprusside if there is concomitant malignant HTN'''

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 *Tx: TCAs, SSRIs, Gabapentin, Pregabalin, exercise, PT, hydrotherapy, heat, pain psych
-=Polymyositis and Dermatomyositis=
+=Polymyositis=
-*H&P: Proximal muscle weakness, elevated CK.
+*H&P: Proximal muscle weakness
-*Dx: Differential includes fibromyalgia and PMR
+*Dx: Elevated CK; Differential includes fibromyalgia and PMR.
 *Tx: Can be complicated by ILD.
 =Scleroderma=

← Older revision		Revision as of 01:34, 15 January 2023
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	*Raynaud is treated with '''dhp-CCBs like nifedipine'''.		*Raynaud is treated with '''dhp-CCBs like nifedipine'''.
	*'''Lateral''' shoulder pain is the most common symptom in torn rotator cuff.		*'''Lateral''' shoulder pain is the most common symptom in torn rotator cuff.
		+	*Scoliosis that '''causes back pain, is rapidly progressive, or associated with neurological symptoms''' may be pathologic (e.g. spinal tumor). Most cases are idiopathic.

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 ==Kawasaki Disease==
 *H&P: Medium vessel vasculitis; ≥ 5 days fever with at least 4 of 5 other criteria in a child; often Asian
-*Dx: CRASH and Burn; differential includes acute rheumatic fever from S. pyogenes (no uveitis); CRP is elevated but not required
+*Dx: CRASH and Burn criteria for Kawasaki—'''Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/feet swelling, AND fever ≥ 5 days'''; differential includes acute rheumatic fever from S. pyogenes (no uveitis); CRP is elevated but not required
 *Tx: IVIG; Hold off on live vaccines for 12 months after IVIG therapy; get a TTE to eval for coronary artery aneurysm