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CLINICAL RHEUMATOLOGY FOR UNDERGRADUATES

CLINICAL RHEUMATOLOGY FOR UNDERGRADUATES. BY HATEM ELEISHI, MD. September 2002. THIS LECTURE INCLUDES:. 5 CASES WITH ARTHRITIS. RADIOGRAPHS OF RA. 4 ADVICES. Always remember that…. THE CASES. Case number 1. A 31-year old male with hyperacute arthritis of right knee. 31-year old male.

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CLINICAL RHEUMATOLOGY FOR UNDERGRADUATES

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  1. CLINICAL RHEUMATOLOGY FOR UNDERGRADUATES BY HATEM ELEISHI, MD September 2002

  2. THIS LECTURE INCLUDES: 5 CASES WITH ARTHRITIS RADIOGRAPHS OF RA 4 ADVICES Always remember that…

  3. THE CASES

  4. Case number 1 A 31-year old male with hyperacute arthritis of right knee

  5. 31-year old male 3-days: hyper-acute onset of pain in the right knee following a sudden twist of the right leg while playing a football match. Swelling of the knee occurred several hours following the trauma. Inability to weight bear and of giving way since then.

  6. Examination: Massive effusion of the right knee Rest of examination could not be conducted due to severe pain

  7. male monoarthritis hyper-acute onset So,

  8. Arthritis in a male 20-50 years of age Internal derangement Seronegative spondyloarthropathy Gouty arthritis Osteoarthritis

  9. Traumatic: Inflammatory: Infectious: Neoplastic: COMMONEST CAUSES OF MONOARTHRITIS Internal derangement, fracture Crystal-induced: gout Autoimmune: Early seronegative arthropathies Most bacterial agents, mycobacterial Benign: as osteoid osteoma Malignant: synovial sarcoma

  10. REMEMBER THAT ANY POLYARTICULAR ARTHRITIS MAY INITIALLY BEGIN AS A MONOARTICULAR DISEASE

  11. Arthritis according to mode of onset Three modes of onset

  12. Time seconds minutes hours days months weeks Hyper-acute Acute Insidious

  13. Hyper-acute onset seconds to minutes Fracture, internal derangement Trauma: Acute onset hours to a few days More virulent agents Infectious Crystal Autoimmune Less commonly several weeks to months Insidious onset More commonly Autoimmune Infectious Other Less virulent agents

  14. male monoarthritis hyper-acute onset INTERNAL DERANGEMENT

  15. Case number 2 A 26-year old female with: Fatigue Polyarthritis and a facial rash.

  16. A 26-year old female presented with generalized fatigue and pain and swelling of her hands, knees and feet with a MS of 60 minutes of 5 weeks duration. Examination: arthritis of small joints of hands, extensor tenosynovitis of the hands, facial rash. Labs: ESR 70; Hb 11.5; WBC 4.2; plat 221; urine: proteinuria with casts on microscopy.

  17. Summary, 26-y old female inflammatory polyarthritis malar rash proteinuria

  18. Arthritis in a female 25-50 years of age: Rheumatoid arthritis Systemic lupus erythematosus Other CT diseases: SS; DM; MCTD Osteoarthritis

  19. COMMONEST CAUSES OF POLYARTHRITIS Inflammatory: RA, SLE, DM/PM, SS, MCTD, seronegatives Infectious: Some bacterial agents: gonorrhea, brucellosis Neoplastic: Leukemia, metastasis

  20. Causes of erythematous rash over cheeks: Systemic lupus erythematosus Dermatomyositis Drugs: steroids

  21. 26-y old female inflammatory polyarthritis malar rash Systemic lupus erythematosus

  22. A technetium-99m phosphonate scan of the hands of a young woman with arthrlagia of uncertain cause. Case number 5 What abnormality is shown? To what are the abnormalities due? What is the probable diagnosis? What other conditions may cause a ‘hot’ scan?

  23. Other conditions that cause a hot scan: Any cause of increased bone metabolism such as: Repair of fractures Bone destruction: by primary or secondary tumor within bone Inflammation adjacent to bone

  24. CONCLUSION OF THE CASES In a patient with arthritis, consider: Age of patient Sex of patient Mode of onset Number of joints affected Symmetry of joint affection Which regions or joints are affected Factors that aggravate and ameliorate symptoms Associated manifestations

  25. Plain radiography of the hands in Rheumatoid Arthritis EARLY RHEUMATOID ARTHRITIS

  26. TWO YEARS LATER

  27. MODERATELY ADVANCED RHEUMATOID ARTHRITIS

  28. EGYPTIAN RHEUMATOID ARTHRITIS

  29. Four take-away advices

  30. Advice 1: Carefully read the instructions before you practice medicine

  31. Advice 2: Listen to your patients

  32. Advice 3: Believe not but A good history Your eyes Your hands

  33. Advice 4: Doctors are more than just tablets

  34. Lastly, Always remember that

  35. A competent physician is the one who has a firm grip of BASIC MEDICINE

  36. Thank you

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