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| =Systemic Lupus Erythematosus= | | =Systemic Lupus Erythematosus= |
| + | Autoimmune inflammatory condition caused by antibody-antigen deposition in various tissues. |
| + | *H&P: Young women, blacks, hispanics, asians, HLA-DR4 serotype |
| + | *Dx: DOPAMINe RASH 4 of 11 criteria, rule out 2° causes (drug-induced lupus SHIPP: sulfonamides, hydralazine, isoniazid, phenytoin, procainamide). Best screening test is ANA (98% sensitivity), most specific are anti ds-DNA, anti-Sm. Complement C3 and C4 levels can also be low, especially during acute flares. |
| + | *Tx: NSAIDs for arthritis and mild serositis; hydroxychloroquine for skin and renal disease; for moderate to severe disease, use corticosteroids or anti B cell biologics; for acute flares, use steroid tapers. Test for anti-SSA in patients thinking about getting pregnant, as this antibody can cross the placenta and cause neonatal lupus and complete heart block. If patient has anti-phospholipid antibody syndrome, they need lifelong warfarin. |
| + | |
| =Rheumatoid Arthritis= | | =Rheumatoid Arthritis= |
| + | *H&P: middle aged women, morning stiffness that lasts > 30 min and improves with activity |
| + | *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; Sulfasalazine, Hydroxychloroquine, or Glucocorticoids for milds disease; Methotrexate, anti-TNF biologics, or 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. |
| + | |
| =Osteoarthritis= | | =Osteoarthritis= |
| + | *H&P |
| + | *Dx |
| + | *Tx |
| + | |
| =Gout= | | =Gout= |
| + | *H&P |
| + | *Dx |
| + | *Tx |
| + | |
| =Low Back Pain= | | =Low Back Pain= |
| + | *H&P |
| + | *Dx |
| + | *Tx |
| + | |
| =Spondyloarthropathies= | | =Spondyloarthropathies= |
| ==Ankylosing Spondylitis== | | ==Ankylosing Spondylitis== |