Arthropathies and Myopathies
Patient presenting with MCP, PIP and MTP joint inflammation with elevated ESR and CRP with associated morning stiffness for >30mins.
What is RA?
This antibody is the most specific for rheumatoid arthritis when elevated.
What is anti-CCP?
A 30-year-old woman is seen in follow-up. She was diagnosed with systemic lupus erythematosus 12 years ago. Clinical and laboratory findings have been stable for 5 years, with no disease flares. Health risks of this organ system should be assessed.
What is cardiovascular system?
Referral for 47-year-old woman with 3-year history of pain in all of her muscles and joints. Her sleep is poor, and she awakens unrefreshed. She has anxiety and depression, with a history of opioid use disorder. "I must have rheumatoid arthritis!"
What is fibromyalgia?
48 year-old woman presenting to emergency department for visual changes in her right eye. On exam, she has scalp tenderness and jaw claudication. Labs show an ESR of 56. Definitive diagnosis is achieved by this intervention.
What is temporal artery biopsy?
28-year-old male with increased pain and mobility that worsens at night and is relieved with physical activity or heat.
What is AS?
Elevation of this antibody suggests polymyositis and/or antisynthetase syndrome.
What is anti–Jo-1 antibody?
36-year-old woman with history of Raynaud's is evaluated in the emergency department. Vitals with temperature is 37.0 °C (98.6 °F), blood pressure is 240/120 mm Hg, pulse rate is 90/min. PE shows skin over the hands, forearms, trunk, lower legs, and feet is tight and appears thickened. The fingers on both hands show cyanosis. This medication class is given to treat.
What is ACE-i?
Referral for 57-year-old woman for fatigue, generalized achiness, and oral dryness. Current medications are levothyroxine, amitriptyline, citalopram, intranasal glucocorticoids, and cetirizine. Antibody work-up is negative. "I need more meds to help me!"
What is medication adverse effects?
38 year-old patient with history of asthma presenting to emergency department with complaint of hemoptysis. Has been experiencing fatigue and diffuse muscle and joint pain. They have multiple nodules and papules along their lower extremity. CXR shows pulmonary infiltrates. CBC with diff shows elevated eosinophils. Further testing shows elevated P-ANCA. This disease is most suspected.
What is eosinophilic granulomatosis with polyangiitis?
A 33-year-old man has a 3-month history of left shoulder and right ankle pain and a left inflamed second toe. He had 4 days of bloody diarrhea 3 months ago.
What is reactive arthritis?
Elevation of this antibody is the most specific for SLE.
What is Anti-Sm?
A 39-year-old woman is evaluated for newly discovered neutropenia. She has a 10-year history of severe, difficult-to-control rheumatoid arthritis. The spleen tip is palpable on physical exam. This diagnosis is suspected.
What is Felty Syndrome?
Referral for treatment plan 72-year-old man with a 15-year history of pain and stiffness in the knees. He has tried exercises and PT without relief. Intra-articular glucocorticoids provide minimal relief. The medial joint line of each knee is tender to palpation. "Just chop them off already!"
What is TKA?
A 35-year-old woman is evaluated in the emergency department for sudden vision loss in the left eye. She reports recent postprandial abdominal pain and effort-related left arm pain. Radial pulse in the left arm is absent; left-sided subclavian bruit is present. MRA of the chest and abdomen shows luminal narrowing in several areas, including the ascending aorta, left subclavian artery, superior mesenteric artery, and right renal artery.
What is Takayasu arteritis?
55-year-old man is evaluated for urate-lowering therapy. He has experienced three gout flares over the past year. He is of Han Chinese descent. Testing for this must be done before initiating therapy.
What is HLA-B*58:01 allele testing?
Elevation of this antibody is most suggestive of drug-induced lupus erythematosus.
What is antihistone antibody?
51-year-old woman is evaluated for an immigration physical examination. She has a 2-year history of rheumatoid arthritis. She has no recollection or record of her immunizations. Current medications are oral methotrexate, tofacitinib, and folic acid. This vaccine is contraindicated in this patient.
What are live vaccines (MMR, influenza, varicella)?
Referral for 65-year-old man for “pain everywhere.” Two months ago, he developed neck and upper back pain, fatigue, and malaise. Over the next few weeks, stiffness and achiness developed in the shoulders and upper arms. Discomfort limits range of shoulder motion bilaterally and causes difficulty with standing from a seated position. This diagnosis is most likely.
What is polymyalgia rheumatica?
58 year-old male presenting with complaints of rash that began 3 days ago. Rash is palpable and consists of bright red macules and papules and occasionally hemorrhagic bullae confined to the lower leg and foot. He has a history of recurrent ear infections and sinusitis. This disease is most likely.
What is granulomatosis with polyangiitis?
56-year-old man is evaluated for a 2-year history of mid to lower back pain and stiffness. He has tried home-based exercises, with minimal benefit. There is no sacroiliac joint tenderness. XR shows flowing linear calcification and ossification along the anterolateral aspects of the vertebral bodies.
What is diffuse idiopathic skeletal hyperostosis (DISH)?
Elevation of this antibody suggests limited-cutaneous systemic sclerosis/CREST syndrome.
What is anticentromere pattern of ANA?
65-year-old man is evaluated for a 4-month history of a rash over the face and hands and a 3-month history of progressive proximal muscle weakness. A thickened, red rash is seen on the cheeks, forehead, and upper chest. This screening test should be preformed.
What is colonoscopy?
Referral for worsening 3 month duration of symptoms, which involve asymmetric distribution of proximal and distal muscles without any muscle pain. "I'm wasting away!"
What is inclusion body myositis?
53-year-old man is evaluated in the emergency department for abdominal pain. Four weeks ago, fatigue and malaise developed, followed 1 week later by a rash. Two weeks ago, he began tripping over his left foot. Three days ago, he developed abdominal pain after a meal; abdominal pain is now constant. He is slightly febrile but hemodynamically stable. Labs are remarkable for elevated creatinine and CRP. CXR is unremarkable. This disease is suspected most.
What is polyarteritis nodosa?