Browse the corpus

Rheumatology TESTYOURSEIF A 40-year old man has a 6 week history of dyspnea, dry cough, fever, decreased appetite, and weight loss. He has progressive difficulty climbing stairs and reaching up to shampoo his hair. He has deep fissures and thickened skin on the palms of his hands. ANSWER: For diagnosis, choose antisynthetase syndrome. Vasculitis Gottron Papules: Red patches and plaques over the knuckles (Gottron papules) characteristic of dermatomyositis. Diagnosis Vasculitis is an inflammation of blood vessels that causes stenosis or attenuation with subsequent tissue ischemia, aneurysms, or hemorrhage. This condition may be secondary to an underlying process or occur as a primary disease. Primary vasculitides may be categorized based on the size of the blood vessel that is predominantly involved, the pattern of organ involvement, and the histopathologz.

Vasculitis Gottron Papules: Red patches and plaques over the knuckles (Gottron papules) characteristic of dermatomyositis. Diagnosis Vasculitis is an inflammation of blood vessels that causes stenosis or attenuation with subsequent tissue ischemia, aneurysms, or hemorrhage. This condition may be secondary to an underlying process or occur as a primary disease. Primary vasculitides may be categorized based on the size of the blood vessel that is predominantly involved, the pattern of organ involvement, and the histopathologz. gTUDY TABLE: Vasculitis Diagnosis Type Presentation Testing Large-vessel vasculitis Giant cell arteritis Older adults with fever, headaches, scalp tenderness, ESR (>50 mm/h) and temporal artery jaw claudication, and visual symptoms biopsy Polymyalgia rheumatica Not a vasculitis, but commonly associated with giant ESR (usually >50 mm/h) cell arteritis or develops as a primary condition. Older adults with aching and morning stiffness in the proximal muscles of the shoulder and hip girdle Muscle strength and muscle enzymes are normal. Takayasu arteritis Young Asian women with {ever, malaise, weight loss, Aortography and arthralgia preceding arm/leg claudication, pulse deficits, vascular bruits, and asymmetric arm BP readings Medium-vessel vasculitis Polyarteritis nodosa Nonglomerular kidney disease, hypertension, HBV serologic studies, biopsy of involved mononeuritis multiplex, and skin lesions (nodules, tissue (usually skin, peripheral nerve, or livedo reticularis, palpable purpura) testicle), and mesenteric or renal angiography (aneurysms and stenoses) Primary angiitis of the CNS Recurrent headaches, stroke, TlA, and progressive angiography, and brain LP, MRl, cerebral encephalopathy biopsy (granulomatous vasculitis) Small-vessel vasculitis Granulomatosis with Recurrent middle ear infections, destructive rhinitis or C-ANCA and anti-PR3 antibody assay polyangiitis sinusitis, saddle-nose deformity, tracheal collapse, Biopsy skin or kidney pulmona ry infi ltrates/cavities/hemoptysis, and pauci- immune GN Microscopic polyangiitis Pulmonary infiltrates, palpable purpura, and rapidly P-ANCA and anti-MPO antibody assay progressive pauci-immune GN Biopsy skin, lung, or kidney Eosinophilic granulomatosis Asthma, eosinophilia, elevated lgE, and pulmonary P-ANCA and anti-MPO antibody assay with polyangiitis i nfi ltrates/hemoptysis and biopsy gA vasculitis (Henoch- I Palpable purpura; joint and gut involvement Skin biopsy (lgA immune complex Schonlein purpura) (abdominal pain); and GN deposition)or kidney biopsy (lgA nephropathy) (Continued on the next page)

gTUDY TABLE: Vasculitis Diagnosis Type Presentation Testing Large-vessel vasculitis Giant cell arteritis Older adults with fever, headaches, scalp tenderness, ESR (>50 mm/h) and temporal artery jaw claudication, and visual symptoms biopsy Polymyalgia rheumatica Not a vasculitis, but commonly associated with giant ESR (usually >50 mm/h) cell arteritis or develops as a primary condition. Older adults with aching and morning stiffness in the proximal muscles of the shoulder and hip girdle Muscle strength and muscle enzymes are normal. Takayasu arteritis Young Asian women with {ever, malaise, weight loss, Aortography and arthralgia preceding arm/leg claudication, pulse deficits, vascular bruits, and asymmetric arm BP readings Medium-vessel vasculitis Polyarteritis nodosa Nonglomerular kidney disease, hypertension, HBV serologic studies, biopsy of involved mononeuritis multiplex, and skin lesions (nodules, tissue (usually skin, peripheral nerve, or livedo reticularis, palpable purpura) testicle), and mesenteric or renal angiography (aneurysms and stenoses) Primary angiitis of the CNS Recurrent headaches, stroke, TlA, and progressive angiography, and brain LP, MRl, cerebral encephalopathy biopsy (granulomatous vasculitis) Small-vessel vasculitis Granulomatosis with Recurrent middle ear infections, destructive rhinitis or C-ANCA and anti-PR3 antibody assay polyangiitis sinusitis, saddle-nose deformity, tracheal collapse, Biopsy skin or kidney pulmona ry infi ltrates/cavities/hemoptysis, and pauci- immune GN Microscopic polyangiitis Pulmonary infiltrates, palpable purpura, and rapidly P-ANCA and anti-MPO antibody assay progressive pauci-immune GN Biopsy skin, lung, or kidney Eosinophilic granulomatosis Asthma, eosinophilia, elevated lgE, and pulmonary P-ANCA and anti-MPO antibody assay with polyangiitis i nfi ltrates/hemoptysis and biopsy gA vasculitis (Henoch- I Palpable purpura; joint and gut involvement Skin biopsy (lgA immune complex Schonlein purpura) (abdominal pain); and GN deposition)or kidney biopsy (lgA nephropathy) (Continued on the next page) 389