in RA and SLE

however,

in SLE, it is possible for the digets to be straightened, in RA they cannot

boutonniere= PIP up, DIP down

swan neck = PIP down, DIP up

for intra-articular, there is pain with ACTIVE and PASSIVE motion

for extra-articular, there is only pain with ACTIVE

cross leg and put the heel of that leg on the opposite knee

put slight pressure down on crossed leg's knee

pain= hip involvement

looks for meniscal injury (click or pain)

the MCMURRAY manuever

patient supine, elevation of knee

what does front to back pressure evaluate?

what does side to side pressure evaluate?

front/back= cruciate ligaments

side/side= collateral ligaments

make a mark @ L5/S1 and another mark 10 cm about it with patient standing

when they flex, there should be 5+ cm migration of the marks. less means limited motion

it is the earliest way to detect any kidney disease.

patients with SLE often have proteinuria, hematuria, and cylindruria

 something in blood that is the main stimulator of immune response in all tissues

most useful in gauging degree of immune complex disease like SLE.  in RA, its prob normal unless vasculatitis is occuring

cells are constantly breaking down into "cellular dust".  [dust is characteristic of vasculitis] the body can view this dust as foreign and make Abs against it

Immunoglobulins can be made that complex with these free floating Abs.  The risk of this is that these complexes can lodge in certain tissues of the body and begin to propogate an immune response. 

and ANA test detects these complexes

You will see these complexes especially in SLE

Radiograph of the knee showing moderate to severe osteoarthritis.  Note the marked joint space narrowing of the medial compartment.

an IgM Ab produced against altered IgG.

present in about 80% of RA cases

Distribution of disease activity in rheumatoid arthritis.  Delayed image of the hands from 99mTc-MDP scintigraphy showing distribution of active disease in a patient with rheumatoid arthritis.

rim pattern is specific for lupus bc it is specific for dsDNA, while complete nuclear fluorescence is indicitive, but non-specific

speckled= sjogrens

rash on palm

or on feet

shit aint right

tongue ulcers, lung opacity by xray, granulomatoisis

PIC of sinus errosion

what do you do if you see a pt with ecruciating headaches.

btw, they have an ^ ESR

steroids, probably a temporal arthrisitis

close presentation to a takaysau arthritiis s (this occludes arteries)

hand peel, sore throat, strawberry tongue

looks like streptococcus , but is a miscellaneous vasculititis syndrome

SIMON

runny nost, sinusitis? (first response?)

skin lesions, asthma?

wegners (steroids, cytotoxics) [serious granulomatous disease]

churg-strauss

symptoms of reactive (reiters) arthritis

penile lesions

severe conjuctivitis

sacroiliitis

DERMOMYOSTITIS skin marker?

GOTTRON PATCHES!!!

scalous patches over knuckles!!