What is rheumatoid nodule? Where is it found?
A. These are painless, firm, subcutaneous nodule, invariably associated with positive rheumatoid factor. It is present in 20 to 30% cases of rheumatoid arthritis.
Sites: Pressure points, such as elbow,
extensor surface of forearm and hands (fingers), scapula, scalp, sacrum, shin, Achilles tendon, toes, sclera, pleura, lungs and pericardium.
Significance of rheumatoid nodule:
1-It is one of the diagnostic criteria
2-Associated with high titer of; rheumatoid factor (positive RA test)
3-Associated with active and aggressive RA
4-A bad prognostic sign.
Histologically 3 zones:
1-Central zone of necrotic material including collagen fibril, noncollagen filament and cellular debris
2-Mid zone of palisading macrophages
3-Outer zone of granulation tissue.
Nodules may ulcerate and become infected.
Treatment with methotrexate may increase the number of rheumatoid nodule in some patients.
Nodules resolve when the disease is under control. If it causes problem, it may be removed surgically or by local injection of corticosteroid.
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A. These are painless, firm, subcutaneous nodule, invariably associated with positive rheumatoid factor. It is present in 20 to 30% cases of rheumatoid arthritis.
Sites: Pressure points, such as elbow,
extensor surface of forearm and hands (fingers), scapula, scalp, sacrum, shin, Achilles tendon, toes, sclera, pleura, lungs and pericardium.
Significance of rheumatoid nodule:
1-It is one of the diagnostic criteria
2-Associated with high titer of; rheumatoid factor (positive RA test)
3-Associated with active and aggressive RA
4-A bad prognostic sign.
Histologically 3 zones:
1-Central zone of necrotic material including collagen fibril, noncollagen filament and cellular debris
2-Mid zone of palisading macrophages
3-Outer zone of granulation tissue.
Nodules may ulcerate and become infected.
Treatment with methotrexate may increase the number of rheumatoid nodule in some patients.
Nodules resolve when the disease is under control. If it causes problem, it may be removed surgically or by local injection of corticosteroid.
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Raynaud’s syndrome" Primary":
This common disorder affects 5–10% of young women aged 15–30 years in temperate climates. It does not progress to ulceration or infarction, and significant pain is unusual. The
underlying cause is unclear and no investigation is necessary.
The patient should be reassured and advised to avoid exposure to cold. Usually, no other treatment is required, although vasodilators such as nifedipine can may be helpful if symptoms are troublesome. More severe Raynaud’s syndrome can also occur in association with digital ulceration in patients with connective
tissue disease.
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This common disorder affects 5–10% of young women aged 15–30 years in temperate climates. It does not progress to ulceration or infarction, and significant pain is unusual. The
underlying cause is unclear and no investigation is necessary.
The patient should be reassured and advised to avoid exposure to cold. Usually, no other treatment is required, although vasodilators such as nifedipine can may be helpful if symptoms are troublesome. More severe Raynaud’s syndrome can also occur in association with digital ulceration in patients with connective
tissue disease.
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Pregnancy should be avoided if there is neurological, renal and cardiac abnormality in SLE.
If the mother has “anti-Ro antibody” (SSA), there may be congenital complete heart block of the baby, due to transplacental transfer of antibody. With anti Ro or anti La antibodies in mother, there is 2% risk of giving birth to a baby with neonatal lupus syndrome.
This is characterized by skin rash, hepatitis and fetal heart block.
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If the mother has “anti-Ro antibody” (SSA), there may be congenital complete heart block of the baby, due to transplacental transfer of antibody. With anti Ro or anti La antibodies in mother, there is 2% risk of giving birth to a baby with neonatal lupus syndrome.
This is characterized by skin rash, hepatitis and fetal heart block.
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Sulfasalazine
Side effects:
-GIT upset (anorexia, nausea, vomiting, diarrhea)
-Skin rash
-Stevens Johnson syndrome
-Reversible sterility in males
-Blood dyscrasias (agranulocytosis,megaloblastic anemia and hemolytic anemia)
-Hemolysis in patients with G6PD deficiency.
Periodic check up:
-CBC
-LFT
-RFT
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Side effects:
-GIT upset (anorexia, nausea, vomiting, diarrhea)
-Skin rash
-Stevens Johnson syndrome
-Reversible sterility in males
-Blood dyscrasias (agranulocytosis,megaloblastic anemia and hemolytic anemia)
-Hemolysis in patients with G6PD deficiency.
Periodic check up:
-CBC
-LFT
-RFT
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Rituximab
In RA, also lymphoma, vasculitis
MOA: is an antibody directed against the CD20 receptor
•Adverse effects include
-Hypogammaglobulinaemia
-Infusion reactions
-Increased risk of infections
-Progressive multifocal leucoencephalopathy a serious and potentially fatal infection of the CNS caused by reactivation of JC virus.Rare.
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In RA, also lymphoma, vasculitis
MOA: is an antibody directed against the CD20 receptor
•Adverse effects include
-Hypogammaglobulinaemia
-Infusion reactions
-Increased risk of infections
-Progressive multifocal leucoencephalopathy a serious and potentially fatal infection of the CNS caused by reactivation of JC virus.Rare.
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Differences between primary and secondary Raynaud’s syndrome.
1-Age
P- 15-30 years, less than 30 years
S- More than 30 years
2-Gender
P- Female >male
S- F: M, 4:1
3-Family history
P- Present
S- Absent
4-Symmetry
P- Symmetrical
S- Asymmetrical
5-Gangrane&Ulceration
P-Absent
S-Present
6-ANA
P- negative
S- positive
7-Capillary nail-fold loops test
P- negative
S- positive "fallout".
P-Primary
S-Secondary
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1-Age
P- 15-30 years, less than 30 years
S- More than 30 years
2-Gender
P- Female >male
S- F: M, 4:1
3-Family history
P- Present
S- Absent
4-Symmetry
P- Symmetrical
S- Asymmetrical
5-Gangrane&Ulceration
P-Absent
S-Present
6-ANA
P- negative
S- positive
7-Capillary nail-fold loops test
P- negative
S- positive "fallout".
P-Primary
S-Secondary
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In Raynaud’s syndrome
Drugs to be avoided:
-Beta-blocker
Non-selective agents
•Alprenolol
•Bucindolol
•Carteolol
•Carvedilol
•Labetalol
•Nadolol
•Penbutolol
•Pindolol
•Propranolol
•Sotalol
•Timolol
-Ergotamine
-Oral contraceptive
-Sympathomimetic:
-Alpha and beta agonists
Salbutamol, phenylephrine, isoproterenol, and dobutamine.
Drugs may be given:
-Calcium antagonist (diltiazem and nifedipine)
-ACE inhibitor
-Angiotensin II receptor blocker
(valsartan)
-Aspirin
-Epoprostenol"prostacyclin analog"
-Sympatholytic" alpha blocker not beta "Prazosin (α1 inverse agonist).
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Drugs to be avoided:
-Beta-blocker
Non-selective agents
•Alprenolol
•Bucindolol
•Carteolol
•Carvedilol
•Labetalol
•Nadolol
•Penbutolol
•Pindolol
•Propranolol
•Sotalol
•Timolol
-Ergotamine
-Oral contraceptive
-Sympathomimetic:
-Alpha and beta agonists
Salbutamol, phenylephrine, isoproterenol, and dobutamine.
Drugs may be given:
-Calcium antagonist (diltiazem and nifedipine)
-ACE inhibitor
-Angiotensin II receptor blocker
(valsartan)
-Aspirin
-Epoprostenol"prostacyclin analog"
-Sympatholytic" alpha blocker not beta "Prazosin (α1 inverse agonist).
#MCQ
#Medicine