Felty's Syndrome

Rheumatoid Arthritis, Hypersplenism, Leucopenia, Thrombocytopenia

Anemia and Rheumatoid Arthritis

The causes of anemia in Rheumatoid arthritis :

1. Iron utilization is impaired- microcytic anaemia

2. Reduced erythropoietin levels- normochromic

3. Decreased folate due to chronic disease- macrocytic

4. Hemolytic phenomenon: felty syndrome and sulphasalazine

5. Drug associated anemia :
NSAID induced bleeding and secondary iron deficiency.
Bone marrow suppression from drug therapy i.e.
gold / penicillamine / Methotrexate.

6. Intercurrent infection

Criteria for Rheumatoid Arthritis Diagnosis

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis.

Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al.

American Rheumatism Association, Atlanta, GA 30329.

The new criteria are as follows:
1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement;
2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician;
3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints;
4) symmetric swelling (arthritis);
5) rheumatoid nodules;
6) the presence of rheumatoid factor; and
7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints.

Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria

PMID: 3358796 [PubMed - indexed for MEDLINE]

from pubmed

Osteoarthritis

Important Points


Hereditory Haemochromatosis: Osteoarthritis, DM, Liver Diseases


Nodes: Herbenden Node (distal IP Joint), Bouchard's Node (proximal IP Joint)

Laryngeal Oedema/ Spasm

Important Causes : Anaphylaxis, Anaphylactoid reaction, Infection (erysipelas)
C1 Inhibitor Def., Drug Hypersensitivity

Differentiation is by symptoms and investigation.
Anaphylaxis is associated with bronchial spasm and hypotension and is due to IgE triggered mast cell degranulation while anaphylactoid is associated with Non IgE triggered Mast Cell Degranulation.
C1 inhibitor def does not cause urticaria while above two causes usually do.also it doesnt responce to epinephrine.

Imp: Dont forget C1 inhibitor def, drug history, resuscitation, allergy test and epinephrine self administration teaching.

High Yield topics in Rheumatology for MRCP amd USMLE

Ever wanted to read less and score high? I always did. This is the place where i will be posting all High yield topics i prepared while my MRCP exam. This blog is for only Rheumatology.
Other blogs with other specialities will be published soon.

You are most welcome to take part in preparing this topics and share here or just discuss the topic below in comments.

Best of Luck for your exam and future!!!