••••••••••••••••••••••••••••••••••••••••••••••
✏️ SLE from A to Z 🎯 بوست 1️⃣ 💻
••••••••••••••••••••••••••••••••••••••••••••••
🔷Definition
💻Lupus is a chronic autoimmune disease characterized by production of Autoantibodies which deposit within the tissues and fix complement leading to TISSUE
INFLAMMATION
✅Manifestations can vary from Skin and joint disease to organ dysfunction such as Renal affection , cerebral affection , hematological affection ETC
💥 Prognosis can vary depending on the degree of organ involvement and damage
🔎 Gender affection !!
كما هو معروف ،، فإن هذا المرض هو مرض يصيب الإناث
غالبا ونادرا ما يصيب الذكور
✓Female ♀️to Male♂️ ratio ; 9 : 1 or 10 : 1
✓The typical patient is female of age range from 15 - 45 years in childbearing period
✓This suggests a strong relationship between Female Sex hormones and development of SLE
السؤال المهم ؟ 🌀
هل من الممكن أن يحدث مرض الذئبه الحمراء فى سن أقل من ١٥-١٦ ؟! وهل هناك إمكانية لحدوثه فى
الخمسينات ؟
الاجابه ؛ تقريبا 20% من الحالات بتحدث فى سن أقل من ١٦ سنه ،، مع بقاء النسبه الأكبر أيضا للإناث
ولكن الغريب أن مرض الذئبه الحمراء اكتشف مؤخرا كنتيجة للاحصائيات الاخيره حدوث نسبة ١٥ ٪ من الحالات بعد ال 55 سنه
ملحوظه : عندنا قاعده فى البراكتس وهيا استبعاد مرض الذئبه الحمراء بعد سن الخمسين ،، ولكن هذا غير دقيق ،، لابد من وضعها أيضا فى الاحتمالات ولكن ليست هيا الاحتمال الأول‼️
✏️ If you use a mindmap for mutlisystem Connective Tissue diseases ‼️
📈What are the organs affection in SLE ?!!
••••••••••••••••••••• ••••••••••••••••||••••••••••••••••
🟢SKIN ✔️
🟢MUCUS MEMBRANES ✔️
🟢JOINTS ✔️
🟢SEROSAL MEMBRANES
( pleura & pericardium ) ✔️
🟢BLOOD ✔️
🟢KIDNEYS ✔️
🟢CNS/PNS ✔️
🟢BLOOD VESSELS ( occasional )
🟢LUNGS ( rare)
🟢HEART ( rare)
🟢MUSCLES ( it is an association,but not a feature)
🟢EXOCRINE GLANDS ( it is an association but not a feature)
🟢EYES (it is an association but not a feature )
🟢CARTILAGES ( it is an association but not a feature)
🕵️Every affected tissue has immune deposits ( complexes ICs) which lead to certain Symptom , sign or even end organ failure
✏️Note 1️⃣
SLE is an autoantibody mediated disease
So , ANA must be positive , and in some cases Anti-dsDNA and Anti-smith Antibody might be positive
✏️Note 2️⃣
SLE has strong association with Anti-phospholipid syndrome
🚩 features of each organ بشكل مبسط !!
🟤Skin :
✏️Malar rash ( butterfly shaped erythematous rash on the cheeks sparing the nasolabial folds)
✏️Photosensitivity in sun- exposed areas
احمرار الوجه أو أى جزء من الجلد تم تعرضه للشمس
✏️Discoid lupus
(DLE) is a chronic scarring skin condition.
➡️DLE is a sub-type of chronic cutaneous lupus erythematosus.
➡️It is characterised by persistent scaly plaques on the scalp, face, and ears which subsequently can progress to scarring, atrophy,dyspigmentation, and permanent hair loss in affected hair-bearing areas.
👥Other skin lesions 👥
Specific cutaneous SLE
Cutaneous lupus (CLE) has specific acute, subacute and chronic manifestations.
Acute cutaneous lupus
~~~
- Central face malar or "butterfly" violaceous erythema with a sharp cutoff at lateral margins, resolves without scarring (may result in persistent telangiectasia)
- Bullous systemic lupus erythematosus: a blistering rash,less common
✏️maculopapular rash resembling morbilliform drug eruption; less common
✏️Mucosal erosions and ulcerations (lips, nose, mouth, genitals); less common
✏️Photosensitivity: lupus rashes are mainly on sun-exposed sites. Photosensitivity can be mild to very severe with the rash appearing after minimal light exposure.
✏️Diffuse hair loss (nonscarring alopecia) with brittle hair shafts
🟤Subacute cutaneous lupus
•••••||•••••|••••••|••••• ||•••••
✏️Flat, scaly patches resembling psoriasis, often in a network pattern
✏️ SLE from A to Z 🎯 بوست 1️⃣ 💻
••••••••••••••••••••••••••••••••••••••••••••••
🔷Definition
💻Lupus is a chronic autoimmune disease characterized by production of Autoantibodies which deposit within the tissues and fix complement leading to TISSUE
INFLAMMATION
✅Manifestations can vary from Skin and joint disease to organ dysfunction such as Renal affection , cerebral affection , hematological affection ETC
💥 Prognosis can vary depending on the degree of organ involvement and damage
🔎 Gender affection !!
كما هو معروف ،، فإن هذا المرض هو مرض يصيب الإناث
غالبا ونادرا ما يصيب الذكور
✓Female ♀️to Male♂️ ratio ; 9 : 1 or 10 : 1
✓The typical patient is female of age range from 15 - 45 years in childbearing period
✓This suggests a strong relationship between Female Sex hormones and development of SLE
السؤال المهم ؟ 🌀
هل من الممكن أن يحدث مرض الذئبه الحمراء فى سن أقل من ١٥-١٦ ؟! وهل هناك إمكانية لحدوثه فى
الخمسينات ؟
الاجابه ؛ تقريبا 20% من الحالات بتحدث فى سن أقل من ١٦ سنه ،، مع بقاء النسبه الأكبر أيضا للإناث
ولكن الغريب أن مرض الذئبه الحمراء اكتشف مؤخرا كنتيجة للاحصائيات الاخيره حدوث نسبة ١٥ ٪ من الحالات بعد ال 55 سنه
ملحوظه : عندنا قاعده فى البراكتس وهيا استبعاد مرض الذئبه الحمراء بعد سن الخمسين ،، ولكن هذا غير دقيق ،، لابد من وضعها أيضا فى الاحتمالات ولكن ليست هيا الاحتمال الأول‼️
✏️ If you use a mindmap for mutlisystem Connective Tissue diseases ‼️
📈What are the organs affection in SLE ?!!
•••
🟢SKIN ✔️
🟢MUCUS MEMBRANES ✔️
🟢JOINTS ✔️
🟢SEROSAL MEMBRANES
( pleura & pericardium ) ✔️
🟢BLOOD ✔️
🟢KIDNEYS ✔️
🟢CNS/PNS ✔️
🟢BLOOD VESSELS ( occasional )
🟢LUNGS ( rare)
🟢HEART ( rare)
🟢MUSCLES ( it is an association,but not a feature)
🟢EXOCRINE GLANDS ( it is an association but not a feature)
🟢EYES (it is an association but not a feature )
🟢CARTILAGES ( it is an association but not a feature)
🕵️Every affected tissue has immune deposits ( complexes ICs) which lead to certain Symptom , sign or even end organ failure
✏️Note 1️⃣
SLE is an autoantibody mediated disease
So , ANA must be positive , and in some cases Anti-dsDNA and Anti-smith Antibody might be positive
✏️Note 2️⃣
SLE has strong association with Anti-phospholipid syndrome
🚩 features of each organ بشكل مبسط !!
🟤Skin :
✏️Malar rash ( butterfly shaped erythematous rash on the cheeks sparing the nasolabial folds)
✏️Photosensitivity in sun- exposed areas
احمرار الوجه أو أى جزء من الجلد تم تعرضه للشمس
✏️Discoid lupus
```````````````````````(DLE) is a chronic scarring skin condition.
➡️DLE is a sub-type of chronic cutaneous lupus erythematosus.
➡️It is characterised by persistent scaly plaques on the scalp, face, and ears which subsequently can progress to scarring, atrophy,dyspigmentation, and permanent hair loss in affected hair-bearing areas.
👥Other skin lesions 👥
Specific cutaneous SLE
Cutaneous lupus (CLE) has specific acute, subacute and chronic manifestations.
Acute cutaneous lupus
- Central face malar or "butterfly" violaceous erythema with a sharp cutoff at lateral margins, resolves without scarring (may result in persistent telangiectasia)
- Bullous systemic lupus erythematosus: a blistering rash,less common
✏️maculopapular rash resembling morbilliform drug eruption; less common
✏️Mucosal erosions and ulcerations (lips, nose, mouth, genitals); less common
✏️Photosensitivity: lupus rashes are mainly on sun-exposed sites. Photosensitivity can be mild to very severe with the rash appearing after minimal light exposure.
✏️Diffuse hair loss (nonscarring alopecia) with brittle hair shafts
🟤Subacute cutaneous lupus
•••••
✏️Flat, scaly patches resembling psoriasis, often in a network pattern
✏️Annular (ring-shaped) polycyclic (overlapping circular) lesions
Lesions resolve with minimal scarring
Affects trunk and arms
Flares on exposure to the sun, but usually spares face and hands
🟤Chronic cutaneous lupus
||````|````|```` ||````|```|````|``
Classic discoid lupus is most common: indurated hyperpigmented plaques
Localised (above the neck in 80%) or generalised (above and below the neck in 20%)
🟤Joint pain
===========
✅Arthralgia is more common than Arthritis
Often, there is pain in joints ( small hands joints , large joints of arms like Elbows, shouders and large joints of legs ( knees)
✏️Note 👥
🔷The pain is of Inflammatory nature !!
(↓with movemens of the joints ➕ morning stiffness)
🔷If arthritis occurs ( true synovitis ) with joints swellings , hotness , redness , tenderness and limitations in movements --> it is non erosive Arthritis , unlike Rheumatoid arthritis!!
🕵️Quiz !!
Are there any deformities that could occur due to Arthritis of SLE ?!
✏️Answer
Arthritis related to SLE often doesn't lead to deformities except in special form called Jaccoud's arthropathy
🕵️Jaccoud's Arthropathy is a deforming, non-erosive arthritis, occurring in 10 % of SLE patients. It is correctable with physical manipulation
🚩While Jaccoud's Arthropathy can involve all joints, it most commonly manifests as severe deformations of the hands, including ulnar deviation, swan neck and boutonniere deformities, and Z-deformity of the thumb, with multiple non-erosive subluxations.
🔎Ulnar drift with subluxation of the MCP joint is often the first sign, whereas swan neck, boutonniere, and Z-deformities may occur at later stages.
🟤Oral ulcers
===========
They are often painless and commonly affecting the palate !!
🟤Serosal membrane affection { Serositis }
°°°°°|°°°°°°°°°°°°°°°°°°°|°°°°°°°°°°°°°°°°°°°|°°°°°°
👥Pleural affection ;
✅Pleurisy = pleuritic localized stitching chest pain ↑ é inspiration
Or
✅Pleural effusion ; dyspnea preceded by chest pain
👥Pericardial affection
✅Pericarditis ; pleuritic type chest pain which ↑ with inspiration and ↓ on leaning forwards { rub may be heard on the heart
Or
✅Pericardial effusion ; often manifested by Tamponade { Beck's triad : hypotension + high JVP and distant Heart sounds )
N .B : both Pleural effusion and pericardial effusion are exudative ( high protein & ↑LDH )
🟤Blood affection
==|====|=====|==
🕵️Hematological affection might be in the form of ⤵️
✅ Thrombocytopenia
~~~~~
( either isolated or in association with anemia )
Features : purpura ( petechiae & echymosis & orificial bleeding like vaginal bleeding , epistaxis , etc )
🟤Anemia
~~~
Either caused by autoimmune destruction ( warm type of Autoimmune hemolytic anemia ; AIHA)
Or
Anemia of chronic disease ( active collagen disease .
- Leucopenia , mainly due to lymphopenia ( note that isolated lymphopenia is a common lab sign in SLE , also it indicates activity
- Pancytopenia ( the least common feature )
🟤Kidney Affection
==============
SLE causes Glomerulonephritis ( immune complexes mediated ; immune deposits )
Renal affection can occur in some patients but not all patients
🟤Features of renal affection
°°°°°|°°°°°°°°°°°|°°°°°°°°°°|°°°°°°°
-Isolated Proteinuria > 0.5 gm
It might be heavy ≥ 3.5 gm causing Nephrotic Syndrome
- proteinuria with hematuria with RBC's casts ( Nephritic syndrome
- isolated hematuria ( with dysmorphic RBC's )
🔷 Many cases of lupus nephritis needs biopsy to assess the staging !;
International Society Of Nephrology ( ISN staging of lupus Nephritis )
Class I – Minimal mesangial lupus nephritis
Class II – Mesangial proliferative lupus nephritis
Class III – Focal lupus nephritis (active and chronic; proliferative and sclerosing)
Class IV – Diffuse lupus nephritis (active and chronic; proliferative and sclerosing; segmental and global)
Class V – Membranous lupus nephritis
Class VI – Advanced sclerosis lupus nephritis
✏️Note ✏️
Lesions resolve with minimal scarring
Affects trunk and arms
Flares on exposure to the sun, but usually spares face and hands
🟤Chronic cutaneous lupus
``Classic discoid lupus is most common: indurated hyperpigmented plaques
Localised (above the neck in 80%) or generalised (above and below the neck in 20%)
🟤Joint pain
===========
✅Arthralgia is more common than Arthritis
Often, there is pain in joints ( small hands joints , large joints of arms like Elbows, shouders and large joints of legs ( knees)
✏️Note 👥
🔷The pain is of Inflammatory nature !!
(↓with movemens of the joints ➕ morning stiffness)
🔷If arthritis occurs ( true synovitis ) with joints swellings , hotness , redness , tenderness and limitations in movements --> it is non erosive Arthritis , unlike Rheumatoid arthritis!!
🕵️Quiz !!
Are there any deformities that could occur due to Arthritis of SLE ?!
✏️Answer
Arthritis related to SLE often doesn't lead to deformities except in special form called Jaccoud's arthropathy
🕵️Jaccoud's Arthropathy is a deforming, non-erosive arthritis, occurring in 10 % of SLE patients. It is correctable with physical manipulation
🚩While Jaccoud's Arthropathy can involve all joints, it most commonly manifests as severe deformations of the hands, including ulnar deviation, swan neck and boutonniere deformities, and Z-deformity of the thumb, with multiple non-erosive subluxations.
🔎Ulnar drift with subluxation of the MCP joint is often the first sign, whereas swan neck, boutonniere, and Z-deformities may occur at later stages.
🟤Oral ulcers
===========
They are often painless and commonly affecting the palate !!
🟤Serosal membrane affection { Serositis }
°°°°°|°°°°°°°°°°°°°°°°°°°|°°°°°°°°°°°°°°°°°°°|°°°°°°
👥Pleural affection ;
✅Pleurisy = pleuritic localized stitching chest pain ↑ é inspiration
Or
✅Pleural effusion ; dyspnea preceded by chest pain
👥Pericardial affection
✅Pericarditis ; pleuritic type chest pain which ↑ with inspiration and ↓ on leaning forwards { rub may be heard on the heart
Or
✅Pericardial effusion ; often manifested by Tamponade { Beck's triad : hypotension + high JVP and distant Heart sounds )
N .B : both Pleural effusion and pericardial effusion are exudative ( high protein & ↑LDH )
🟤Blood affection
==|====|=====|==
🕵️Hematological affection might be in the form of ⤵️
✅ Thrombocytopenia
( either isolated or in association with anemia )
Features : purpura ( petechiae & echymosis & orificial bleeding like vaginal bleeding , epistaxis , etc )
🟤Anemia
Either caused by autoimmune destruction ( warm type of Autoimmune hemolytic anemia ; AIHA)
Or
Anemia of chronic disease ( active collagen disease .
- Leucopenia , mainly due to lymphopenia ( note that isolated lymphopenia is a common lab sign in SLE , also it indicates activity
- Pancytopenia ( the least common feature )
🟤Kidney Affection
==============
SLE causes Glomerulonephritis ( immune complexes mediated ; immune deposits )
Renal affection can occur in some patients but not all patients
🟤Features of renal affection
°°°°°|°°°°°°°°°°°|°°°°°°°°°°|°°°°°°°
-Isolated Proteinuria > 0.5 gm
It might be heavy ≥ 3.5 gm causing Nephrotic Syndrome
- proteinuria with hematuria with RBC's casts ( Nephritic syndrome
- isolated hematuria ( with dysmorphic RBC's )
🔷 Many cases of lupus nephritis needs biopsy to assess the staging !;
International Society Of Nephrology ( ISN staging of lupus Nephritis )
Class I – Minimal mesangial lupus nephritis
Class II – Mesangial proliferative lupus nephritis
Class III – Focal lupus nephritis (active and chronic; proliferative and sclerosing)
Class IV – Diffuse lupus nephritis (active and chronic; proliferative and sclerosing; segmental and global)
Class V – Membranous lupus nephritis
Class VI – Advanced sclerosis lupus nephritis
✏️Note ✏️
Class II & III & IV --> nephritic syndrome with active urinary sediments(cellular & RBC's casts )
🚩Class III & IV are more serious , why ?!
✅Because , they have the potential to cause Crescentic GN with Rapidly progressive GN and AKI
✅Class V ( membranous ) often causes Nephrotic syndrome with heavy proteinuria
✅Class VI likely to cause CKD
🟤CNS/PNS affection
======== =====||===
➡️ Cerebral affection
-It is also called " Lupus Cerebritis "
🟢The major features of lupus Cerebritis are ⤵️
- Seizures ( not explained by another disease)
- Psychosis ( abnormal behaviour , severe depression and/or delerium)
PNS : Mononeuritis Multiplex ⤵️
( affection of a nerve in different group in different anatomical locations )
🚩Class III & IV are more serious , why ?!
✅Because , they have the potential to cause Crescentic GN with Rapidly progressive GN and AKI
✅Class V ( membranous ) often causes Nephrotic syndrome with heavy proteinuria
✅Class VI likely to cause CKD
🟤CNS/PNS affection
===
➡️ Cerebral affection
``|````|````|```|````|````|``-It is also called " Lupus Cerebritis "
🟢The major features of lupus Cerebritis are ⤵️
- Seizures ( not explained by another disease)
- Psychosis ( abnormal behaviour , severe depression and/or delerium)
PNS : Mononeuritis Multiplex ⤵️
( affection of a nerve in different group in different anatomical locations )
🎯إزاى تشخص مرض ال Mixed Connective tissue disease طبقا للمعايير التشخيصية العالميه؟ 🎯
🔷 Alarcón-Segovia diagnostic criteria
~|~~||||~~~
The Alarcón-Segovia diagnostic criteria consist of a positive anti–U1 RNP titer (>1:1600) and at least three of the following five clinical findings ⤵️
1️⃣Hand edema
2️⃣Synovitis
3️⃣Biologically or histologically proven myositis
4️⃣Raynaud phenomenon
5️⃣Acrosclerosis with or without proximal systemic sclerosis
🔷Kasukawa Criteria ( Japanese 🇯🇵)
1️⃣ Common manifestations: Raynaud phenomenon, puffy fingers and/or swollen hands
2️⃣ Immunologic manifestation: Anti–U1-RNP antibody positivity
3️⃣ Characteristic organ involvement: Pulmonary arterial hypertension, aseptic meningitis, trigeminal neuropathy
4️⃣ Overlapping manifestations: (A) Systemic lupus erythematosus (SLE)–like, (B) systemic sclerosis–like, (C) polymyositis/dermatomyositis-like
🅰️: SLE-like manifestations include the following ⤵️
✓Polyarthritis
✓Lymphadenopathy
✓Malar rash
✓Pericarditis or pleuritis
✓Leukopenia (4,000/μL or less) or thrombocytopenia (100,000/μL or less)
🅱️Systemic sclerosis–like manifestations include the following ⤵️
✓Sclerodactyly
✓Interstitial lung disease
✓Esophageal dysmotility or dilatation
©️Polymyositis/dermatomyositis-like manifestations include the following ⤵️
✓Muscle weakness
✓Elevated levels of myogenic enzymes
✓Myogenic abnormalities on electromyogram
🕵️For diagnosis of MCTD, the patient must have the following ⤵️
✓At least one common manifestation
➕
✓Anti–U1-RNP antibodies
➕
✓At least one characteristic organ involvement, or at least one feature of at least two of the three disorders in the overlapping manifestations category (A, B, and C)
🔷 Alarcón-Segovia diagnostic criteria
The Alarcón-Segovia diagnostic criteria consist of a positive anti–U1 RNP titer (>1:1600) and at least three of the following five clinical findings ⤵️
1️⃣Hand edema
2️⃣Synovitis
3️⃣Biologically or histologically proven myositis
4️⃣Raynaud phenomenon
5️⃣Acrosclerosis with or without proximal systemic sclerosis
🔷Kasukawa Criteria ( Japanese 🇯🇵)
``|````|````|````|````|```|```|```|```|```|```|````1️⃣ Common manifestations: Raynaud phenomenon, puffy fingers and/or swollen hands
2️⃣ Immunologic manifestation: Anti–U1-RNP antibody positivity
3️⃣ Characteristic organ involvement: Pulmonary arterial hypertension, aseptic meningitis, trigeminal neuropathy
4️⃣ Overlapping manifestations: (A) Systemic lupus erythematosus (SLE)–like, (B) systemic sclerosis–like, (C) polymyositis/dermatomyositis-like
🅰️: SLE-like manifestations include the following ⤵️
✓Polyarthritis
✓Lymphadenopathy
✓Malar rash
✓Pericarditis or pleuritis
✓Leukopenia (4,000/μL or less) or thrombocytopenia (100,000/μL or less)
🅱️Systemic sclerosis–like manifestations include the following ⤵️
✓Sclerodactyly
✓Interstitial lung disease
✓Esophageal dysmotility or dilatation
©️Polymyositis/dermatomyositis-like manifestations include the following ⤵️
✓Muscle weakness
✓Elevated levels of myogenic enzymes
✓Myogenic abnormalities on electromyogram
🕵️For diagnosis of MCTD, the patient must have the following ⤵️
✓At least one common manifestation
➕
✓Anti–U1-RNP antibodies
➕
✓At least one characteristic organ involvement, or at least one feature of at least two of the three disorders in the overlapping manifestations category (A, B, and C)
🎯ازاى تقدر تشخص مرض بهجت المناعى باستخدام المعايير التشخيصية العالميه المختلفه 🎯
___________
🌎International Criteria for the diagnosis of Behcet's disease 🌏. 🧑🏫🧑🏫🧑🏫🧑🏫🧑🏫🧑🏫🧑🏫
-------------------------------------------------------------------------
🅰️ The International study group criteria
» The most widely recognized criteria «
🧑🏫 To diagnose Behcet's disease , the patient must have the following features
⤵️⤵️⤵️
🕵️ Recurrent painful oral ulcerations
( aphthous or herpetiform) at least 3 times in one year
🕵️ القُرَح المُؤلمه فى الفم دى عرض أساسى لابد يكون موجود طبعا ( نوبات شديده من القُرح على الاقل ٣ مرات فى السنه ...
➕
≥ 2️⃣ of the following ⤵️
🕵️ مطلوب اتنين على الاقل من الاربعه دول 🤷
🔶1️⃣ Recurrent genital aphthous ulceration
or scarring observed by a physician or reported reliably by patient
قُرَح مُؤلمه فى الاعضاء التناسليه ↙️↙️↙️
Scrotal ulcers in ♂️ & labial ulcers in ♀️
🔶2️⃣ Skin lesions (including erythema nodosum-like lesions, pseudofolliculitis, papulopustular lesions, or acneiform nodules) observed by a physician in a post-adolescent patient not receiving corticosteroids.
🕵️انواع مختلفه من ال skin lesions كما هو موضح،، ممكن تستعين بطبيب الجلديه لمعرفتها والتأكد من تشخيصها ❗
🔶3️⃣ Eye involvement with anterior/posterior uveitis or retinitis ( retinal vasculitis )observed by an ophthalmologist.
🕵️ التهاب مناعى داخل العين ولازم تستعين بطبيب رمد ضرورى عشان يأكد وجود الحاجات دى أو لا ‼️
🔶4️⃣ Positive pathergy test performed with oblique insertion of a ≤21-gauge needle under sterile conditions and interpreted by a physician at 48 hours.
🕵️ اختبار سهل ممكن تعمله بواسطه ابره تخترق الجلد بعد تطهيرها ومتابعة حدوث Papule اكبر من ٢ مم او Pustule فى خلال ٢٤ - ٤٨ ساعه
🕵️The positivity of Skin Pathergy Test
is defined as the presence of an erythematous papule ≥2 mm or a pustule after 24–48 h.
🅱️International criteria for Behcet's disease
🧑🏫 معايير تشخيصه معتمده على نظام سكور ‼️
💁Oral Aphthosis ( ulcers )--»2️⃣
💁Genital Aphthosis( ulcers ) --» 2️⃣
💁Ocular Lesion --» 2️⃣
💁Skin Lesion --» 1️⃣
💁Neurological Manifestation --» 1️⃣
💁Vascular Manifestations --» 1️⃣
💁Positive Pathery Test -» 1️⃣ ( optional ❗)
🧑🏫 Scoring at least 4️⃣ ( total score ≥ 4️⃣) indicates Behcet's disease !!
🕵️ Note ✍️
🔶Neurological involvement 🧠
-------------------------------------------------
✓Neurologic involvement is seen in 5% of patients with Behcet's Diseaee .
✓There are two main forms:
vascular and parenchymal.
✓Parenchymal neuro-Behcet's Disrase leads to inflammatory lesions in the brain stem, diencephalon, basal ganglia and, less frequently, the spinal cord and cerebellum.
✓ It usually presents with bilateral pyramidal signs, unilateral hemiparesis, behavioral changes, sphincter disturbances, and headache.
✓The vascular neuro-Behcet's Disease
is dural sinus thrombosis, mainly characterized by headache and papilledema. It usually associates with venous thrombosis in lower extremities, and has better prognosis compared to parenchymal neuro-Behcet's disease
🔶Vascular involvement
--------------------------------------
✓Vascular Neuro Behcet's
✓DVT ± Pulmonary embolism
✓pulmonary vascular affection
✓possible arteritis
©️Japanese criteria
توجد معايير تشخيصه قام بوضعها خبراء يابانيون ومش هنذكرها عشان الناس ما تتلخبطش . اردت فقط ان اذكر ان هناك معايير يابانيه خاصه بمرض بهجت المناعى..
___________
🌎International Criteria for the diagnosis of Behcet's disease 🌏. 🧑🏫🧑🏫🧑🏫🧑🏫🧑🏫🧑🏫🧑🏫
-------------------------------------------------------------------------
🅰️ The International study group criteria
» The most widely recognized criteria «
🧑🏫 To diagnose Behcet's disease , the patient must have the following features
⤵️⤵️⤵️
🕵️ Recurrent painful oral ulcerations
( aphthous or herpetiform) at least 3 times in one year
🕵️ القُرَح المُؤلمه فى الفم دى عرض أساسى لابد يكون موجود طبعا ( نوبات شديده من القُرح على الاقل ٣ مرات فى السنه ...
➕
≥ 2️⃣ of the following ⤵️
🕵️ مطلوب اتنين على الاقل من الاربعه دول 🤷
🔶1️⃣ Recurrent genital aphthous ulceration
or scarring observed by a physician or reported reliably by patient
قُرَح مُؤلمه فى الاعضاء التناسليه ↙️↙️↙️
Scrotal ulcers in ♂️ & labial ulcers in ♀️
🔶2️⃣ Skin lesions (including erythema nodosum-like lesions, pseudofolliculitis, papulopustular lesions, or acneiform nodules) observed by a physician in a post-adolescent patient not receiving corticosteroids.
🕵️انواع مختلفه من ال skin lesions كما هو موضح،، ممكن تستعين بطبيب الجلديه لمعرفتها والتأكد من تشخيصها ❗
🔶3️⃣ Eye involvement with anterior/posterior uveitis or retinitis ( retinal vasculitis )observed by an ophthalmologist.
🕵️ التهاب مناعى داخل العين ولازم تستعين بطبيب رمد ضرورى عشان يأكد وجود الحاجات دى أو لا ‼️
🔶4️⃣ Positive pathergy test performed with oblique insertion of a ≤21-gauge needle under sterile conditions and interpreted by a physician at 48 hours.
🕵️ اختبار سهل ممكن تعمله بواسطه ابره تخترق الجلد بعد تطهيرها ومتابعة حدوث Papule اكبر من ٢ مم او Pustule فى خلال ٢٤ - ٤٨ ساعه
🕵️The positivity of Skin Pathergy Test
is defined as the presence of an erythematous papule ≥2 mm or a pustule after 24–48 h.
🅱️International criteria for Behcet's disease
``````|``````````|``````````|```````````|``````````|`````````🧑🏫 معايير تشخيصه معتمده على نظام سكور ‼️
💁Oral Aphthosis ( ulcers )--»2️⃣
💁Genital Aphthosis( ulcers ) --» 2️⃣
💁Ocular Lesion --» 2️⃣
💁Skin Lesion --» 1️⃣
💁Neurological Manifestation --» 1️⃣
💁Vascular Manifestations --» 1️⃣
💁Positive Pathery Test -» 1️⃣ ( optional ❗)
🧑🏫 Scoring at least 4️⃣ ( total score ≥ 4️⃣) indicates Behcet's disease !!
🕵️ Note ✍️
🔶Neurological involvement 🧠
-------------------------------------------------
✓Neurologic involvement is seen in 5% of patients with Behcet's Diseaee .
✓There are two main forms:
vascular and parenchymal.
✓Parenchymal neuro-Behcet's Disrase leads to inflammatory lesions in the brain stem, diencephalon, basal ganglia and, less frequently, the spinal cord and cerebellum.
✓ It usually presents with bilateral pyramidal signs, unilateral hemiparesis, behavioral changes, sphincter disturbances, and headache.
✓The vascular neuro-Behcet's Disease
is dural sinus thrombosis, mainly characterized by headache and papilledema. It usually associates with venous thrombosis in lower extremities, and has better prognosis compared to parenchymal neuro-Behcet's disease
🔶Vascular involvement
--------------------------------------
✓Vascular Neuro Behcet's
✓DVT ± Pulmonary embolism
✓pulmonary vascular affection
✓possible arteritis
©️Japanese criteria
توجد معايير تشخيصه قام بوضعها خبراء يابانيون ومش هنذكرها عشان الناس ما تتلخبطش . اردت فقط ان اذكر ان هناك معايير يابانيه خاصه بمرض بهجت المناعى..
🎯ازاى تقدر تشخص متلازمة ال Anti-phospholipid syndrome طبقا للمعايير التشخيصية العالميه 🎯
----------------------------------------------------------------------
SYDNEY CLASSIFICATION CRITERIA FOR
ANTIPHOSPHOLIPID SYNDROME ( APS)
----------------------------------------------------------------------
A] Clinical Criteria
-----------------------------
1) Vascular thrombosis :
➡ either arterial or venous thrombosis
جلطات شريانيه مثل ال stroke مثلا وجلطات وريديه مثل ال DVT ‼️
2) Pregnancy Morbidity :
مشاكل متعلقه بالحمل ‼️
a) death of normal fetus at ≥ 10 weeks
b) premature birth at ≤ 34 weeks.
c) ≥ 3 consecutive abortions at ≤ 10 weeks
d) placental insufficiency at < 34 weeks .
B] LAB CRITERIA :
----------------------------
1) Anti- cardiolipin IgG/IgM
2) lupus anticoagulant
3) anti beta 2 glycoprotein
The labs should be proved positive at medium to high titre at least 2 times 12 weeks apart .
To diagnose APS , the patient must have at least one clinical and at least one lab test .
➡ Diagnosis of Catastrophic Antiphospholpid syndrome (CAPS) 👇👇
1) history of APS or persistence aPL Abs
2) 3 or more organs involved simultaneously or within 1 week ( blood, kidney , liver etc )
قصور حاد فى وظائف الكبد أو الكلى مع مشاكل فى الدم (انيميا ونقص صفائح )
3) microvscular thrombosis on histopathology
4) Exclusion of other causes of multi-organ thrombosis
N.B ✍️ : CAPS is a fatal condition
----------------------------------------------------------------------
SYDNEY CLASSIFICATION CRITERIA FOR
ANTIPHOSPHOLIPID SYNDROME ( APS)
----------------------------------------------------------------------
A] Clinical Criteria
-----------------------------
1) Vascular thrombosis :
➡ either arterial or venous thrombosis
جلطات شريانيه مثل ال stroke مثلا وجلطات وريديه مثل ال DVT ‼️
2) Pregnancy Morbidity :
مشاكل متعلقه بالحمل ‼️
a) death of normal fetus at ≥ 10 weeks
b) premature birth at ≤ 34 weeks.
c) ≥ 3 consecutive abortions at ≤ 10 weeks
d) placental insufficiency at < 34 weeks .
B] LAB CRITERIA :
----------------------------
1) Anti- cardiolipin IgG/IgM
2) lupus anticoagulant
3) anti beta 2 glycoprotein
The labs should be proved positive at medium to high titre at least 2 times 12 weeks apart .
To diagnose APS , the patient must have at least one clinical and at least one lab test .
➡ Diagnosis of Catastrophic Antiphospholpid syndrome (CAPS) 👇👇
1) history of APS or persistence aPL Abs
2) 3 or more organs involved simultaneously or within 1 week ( blood, kidney , liver etc )
قصور حاد فى وظائف الكبد أو الكلى مع مشاكل فى الدم (انيميا ونقص صفائح )
3) microvscular thrombosis on histopathology
4) Exclusion of other causes of multi-organ thrombosis
N.B ✍️ : CAPS is a fatal condition
❤1
___بوست 1️⃣__
Rheumatology Made Easy
-------------------------------------------
🎯 Smart simplified proposed Guide for classification of rheumatological diseases
( Rheumatology Mindmap) 🧠
عشان ترتب كل الأمراض الروماتيزميه فى دماغك بطريقه ذكيه بحيث تلم كل الأمراض ... فعليك أن تقرأ البوست ده
البوستات القادمه هتكون بوستات تجميعيه لكل الاعراض الشهيره لكل امراض الروماتيزم ببساطه .. لكل من يعانى من صعوبه فى التعامل مع ال Rheumatology ‼️
✍️ الأمراض الروماتيزميه قد تكون ⤵️
Either
✔️Musculoskeletal disease ‼️
Or
Multi-system Collagen/connective tissue
disease ‼️
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
🅰️ Musculoskeletal diseases include
----⤵️---------⤵️---------⤵️----------⤵️----
1️⃣Articular diseases
(mainly joint problem )
🔴 Inflammatory arthritis
✓ Rheumatoid Arthritis
✓Seronegative Spondyloarthritides
🔴 Mechanical arthropathies
✓Degenerative joint diseases
Osteoarthritis & Spondylosis
🔴 Metabolic joint diseases
Crystal arthropathies
✓ Gout
✓ Pseuogout
🔴 Infectious arthritis
( viral & bacterial; septic arthritis )
-----------------------
2️⃣ Bone diseases
🔴 Osteomalacia
🔴 Osteoporosis
🔴 Paget's disease
------------------------------
3️⃣ Muscle disease
( inflammation of the muscles : myositis)
🔴 Polymyositis
🔴 Dermatomyositis
--------- Note ✍️ -------
They might be Multi-system along with muscle affection , with prescence of Autoantibodies
-------------------
4️⃣Pain Syndromes
🔴 Diffuse pain syndromes
✓ Fibromyalgia
✓ Polymyalgia Rheumatica
🔴Localized pain syndromes
✓Complex regional pain syndrome
Severe pain with allodynia
✓Specific syndromes
- Shoulder
Adhesive capsulitis ( frozen shoulder)
Rotator calf tendinitis
- Elbow ( e.g tennis elbow )
_________
🅱️Multi-system Collagen/connective tissue diseases that include
⤵️ ⤵️⤵️⤵️⤵️⤵️
1️⃣ Group of systemic autoimmune diseases associated with the Prescence of Antibodies
ℹ️ Group of systemic autoimmune
Collagen diseases associated with
positive ANA and other specific antibodies
✔️ SLE
✔️ Scleroderma
✔️ Sjogren's syndrome
✔️ Polymyositis & dermatomyositis
✔️ Mixed connective tissue disease
✔️ Overlap syndromes
-------------
ℹ️ℹ️ Anti-phospholipid Syndrome
-------------
ℹ️ℹ️ℹ️ ANCA associated vasculitides
✔️ GPA ( Wegener's granulomatosis)
✔️ EGP ( Churg strauss syndrome )
✔️ Microscopic Polyangiitis( MPA)
-------------------------
2️⃣ Group of diseases that are not associated with the prescence of Autoantibodies
⚡Vasculitides except ANCA-associated type
⚡Behcet's disease
⚡Relapsing Polychondritis
⚡Sarcoidosis
⚡Amyloidosis
⚡Febrile Syndromes including
⤵️⤵️⤵️
✓ Rheumatic fever
✓Still's disease
✓Autoinflammatory Periodic fever
Syndromes e g FMF etc
Rheumatology Made Easy
-------------------------------------------
🎯 Smart simplified proposed Guide for classification of rheumatological diseases
( Rheumatology Mindmap) 🧠
عشان ترتب كل الأمراض الروماتيزميه فى دماغك بطريقه ذكيه بحيث تلم كل الأمراض ... فعليك أن تقرأ البوست ده
البوستات القادمه هتكون بوستات تجميعيه لكل الاعراض الشهيره لكل امراض الروماتيزم ببساطه .. لكل من يعانى من صعوبه فى التعامل مع ال Rheumatology ‼️
✍️ الأمراض الروماتيزميه قد تكون ⤵️
Either
✔️Musculoskeletal disease ‼️
Or
Multi-system Collagen/connective tissue
disease ‼️
ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ
🅰️ Musculoskeletal diseases include
----⤵️---------⤵️---------⤵️----------⤵️----
1️⃣Articular diseases
(mainly joint problem )
🔴 Inflammatory arthritis
✓ Rheumatoid Arthritis
✓Seronegative Spondyloarthritides
🔴 Mechanical arthropathies
✓Degenerative joint diseases
Osteoarthritis & Spondylosis
🔴 Metabolic joint diseases
Crystal arthropathies
✓ Gout
✓ Pseuogout
🔴 Infectious arthritis
( viral & bacterial; septic arthritis )
-----------------------
2️⃣ Bone diseases
🔴 Osteomalacia
🔴 Osteoporosis
🔴 Paget's disease
------------------------------
3️⃣ Muscle disease
( inflammation of the muscles : myositis)
🔴 Polymyositis
🔴 Dermatomyositis
--------- Note ✍️ -------
They might be Multi-system along with muscle affection , with prescence of Autoantibodies
-------------------
4️⃣Pain Syndromes
🔴 Diffuse pain syndromes
✓ Fibromyalgia
✓ Polymyalgia Rheumatica
🔴Localized pain syndromes
✓Complex regional pain syndrome
Severe pain with allodynia
✓Specific syndromes
- Shoulder
Adhesive capsulitis ( frozen shoulder)
Rotator calf tendinitis
- Elbow ( e.g tennis elbow )
_________
🅱️Multi-system Collagen/connective tissue diseases that include
⤵️ ⤵️⤵️⤵️⤵️⤵️
1️⃣ Group of systemic autoimmune diseases associated with the Prescence of Antibodies
ℹ️ Group of systemic autoimmune
Collagen diseases associated with
positive ANA and other specific antibodies
✔️ SLE
✔️ Scleroderma
✔️ Sjogren's syndrome
✔️ Polymyositis & dermatomyositis
✔️ Mixed connective tissue disease
✔️ Overlap syndromes
-------------
ℹ️ℹ️ Anti-phospholipid Syndrome
-------------
ℹ️ℹ️ℹ️ ANCA associated vasculitides
✔️ GPA ( Wegener's granulomatosis)
✔️ EGP ( Churg strauss syndrome )
✔️ Microscopic Polyangiitis( MPA)
-------------------------
2️⃣ Group of diseases that are not associated with the prescence of Autoantibodies
⚡Vasculitides except ANCA-associated type
⚡Behcet's disease
⚡Relapsing Polychondritis
⚡Sarcoidosis
⚡Amyloidosis
⚡Febrile Syndromes including
⤵️⤵️⤵️
✓ Rheumatic fever
✓Still's disease
✓Autoinflammatory Periodic fever
Syndromes e g FMF etc
___بوست 2️⃣ __
Rheumatology Made Easy
-----------------------------------------------
🎯كيف تتعرف على أعراض كل مرض من أمراض ال ⤵️
Musculoskeletal diseases
بكـــل بســــاطه 🎯
🅰️Articular diseases
( Mainly joint problem )
1️⃣ Inflammatory ( arthritis )
««««««««««««««««««««««««««««
ودى امراض بيكون فيها التهاب فى المفاصل وبيكون من النوع المناعى وبالتالى عدم علاج المرض مرتبط بحدوث تشوهات فى المفاصل على المدى البعيد ‼️
⚫ أنواع الامراض دى كالاتى ⤵️
🟫 Rheumatoid Arthritis { RA}
========================
ملخص المشكله فى الروماتويد ⤵️
⭕ Classic presentation ⤵️
Peripheral symmetrical Polyarthritis mainly affecting hand joints ) in the form of pain
➕ swelling ➕ " morning " Stiffness )
⭕The most common affected joints are
MCP , PIP , wrist joints sparing the DIP joints
⭕ The pain improves with movement & worsens at the morning with stiffness for at least 1 hour
⭕ if untreated , deformities like Swan neck , buttoniere , Z shaped thumb and Ulnar deviation would occur ‼️
⭕ it is a chronic disease in which arthritis persists more than 6 weeks ❗
⭕it is often "seropositive " , positive RF and /or positive Anti-CCP Ab along with ↑ inflammatory markers ( ↑ ESR & ↑ CRP )
⭕ The disease may have Extra-articular features e g RA- associated Lung fibrosis etc
⭕ The official criteria for diagnosis are⤵️
Last EULAR/ACR criteria ( تابع معانا )
👥👥👥👥👥👥
🟫 Seronegative Spondyloarthritides SpA
=================================
⭕ General features
✔️ The predominant affection is mainly ( axial ) Joint affection ‼️
Spine + sacroiliac joints in the form of ⤵️
" Inflammatory back pain + stiffness "
➕
Enthesitis ( tendinitis & ligament affection )
±
Peripheral asymmetric oligoarthritis
±
Skin lesions
±
eye affection
➕
(Positive HLA-B27)
⭕Classification ⤵️
✔️ Ankylosing Spondylitis ( main presentation is Inflammatory type of Back Pain )
✔️Psoriatic arthritis
(May be associated with Psoriatic rash/nail changes ) ➕ Axial or peripheral joint affection
✔️ Enteropathic arthritis
( IBD + other features)
✔️ Reactive arthritis ( Reiter's syndrome)
↪️Triad of Arthritis + urethritis + conjunctivitis after infection ) ± other features ❗
✨✨✨✨✨✨
2️⃣ Degenerative joint diseases
»»»⤵️»»»»⤵️»»»»⤵️»»»»⤵️»»»
امراض شهيره جدا مرتبطه أكثر بتقدم العمر وزيادة الوزن وعوامل أخرى وراثيه
⭕ ملخص المشكله فى الامراض دى ⤵️
⚡Non inflammatory arthritis ➕ cartilage degeneration with formation of osteophytes ( bony projections with narrow joint spaces )
📜 اوعى تنسى ال Osteophytes ❗
Classification ⤵️
#Peripheral Osteoarthritis
↓↓↓
⚡Mechanical joint pain without swelling or stiffness affecting weight bearing joints ( kness, hips ) in LL and DIPs , PIPs , CMC joints in UL.
__Note ✍️ ____
Mechanical joint pain = Pain ↑ with movement and ↓ é rest , Unlike inflammatory joint pain which ↑ é rest with stiffness for at least 45 min and ↓ é movement !
#Axial Osteoarthritis ( Spondylosis )
Disc problems ‼️
ℹ️Cervical spine ( cervical Spondylosis )
⤵️
Mechanical neck pain with movement with or without compression on nerve roots or cord
ℹ️ℹ️Lumbar spine ( lumbar Spondylosis)
Mechanical low back pain with movement with or without root or cord compression.
✨✨✨✨✨✨✨✨✨
3️⃣ Metabolic joint diseases or Crystal arthropathy : deposition of crystals in joints )
»»»»»»⤵️»»»»»»⤵️»»»»»»⤵️»»»»»»⤵️»»»»»»
🔴 Gout :
مشكله النقرس فى الآتى ⬇️
⭕ formation of monosodium urate needle shaped crystals in joints
↪️Leading to ---> Arthritis in the form of ( pain , swelling , marked tenderness , limitation of movement ) ‼️
Classification of Gout :
⚡Acute Monoarthritis
( knees, MTP joint; Podagra ❗)
⚡ oligoarthritis
⚡Chronic gout
Tophi in kidneys ( stones), Ears , hands )
~~
🔴 Pseudogout
( deposition of Calcium pyrophosphate )
Rheumatology Made Easy
-----------------------------------------------
🎯كيف تتعرف على أعراض كل مرض من أمراض ال ⤵️
Musculoskeletal diseases
بكـــل بســــاطه 🎯
🅰️Articular diseases
( Mainly joint problem )
1️⃣ Inflammatory ( arthritis )
««««««««««««««««««««««««««««
ودى امراض بيكون فيها التهاب فى المفاصل وبيكون من النوع المناعى وبالتالى عدم علاج المرض مرتبط بحدوث تشوهات فى المفاصل على المدى البعيد ‼️
⚫ أنواع الامراض دى كالاتى ⤵️
🟫 Rheumatoid Arthritis { RA}
========================
ملخص المشكله فى الروماتويد ⤵️
⭕ Classic presentation ⤵️
Peripheral symmetrical Polyarthritis mainly affecting hand joints ) in the form of pain
➕ swelling ➕ " morning " Stiffness )
⭕The most common affected joints are
MCP , PIP , wrist joints sparing the DIP joints
⭕ The pain improves with movement & worsens at the morning with stiffness for at least 1 hour
⭕ if untreated , deformities like Swan neck , buttoniere , Z shaped thumb and Ulnar deviation would occur ‼️
⭕ it is a chronic disease in which arthritis persists more than 6 weeks ❗
⭕it is often "seropositive " , positive RF and /or positive Anti-CCP Ab along with ↑ inflammatory markers ( ↑ ESR & ↑ CRP )
⭕ The disease may have Extra-articular features e g RA- associated Lung fibrosis etc
⭕ The official criteria for diagnosis are⤵️
Last EULAR/ACR criteria ( تابع معانا )
👥👥👥👥👥👥
🟫 Seronegative Spondyloarthritides SpA
=================================
⭕ General features
✔️ The predominant affection is mainly ( axial ) Joint affection ‼️
Spine + sacroiliac joints in the form of ⤵️
" Inflammatory back pain + stiffness "
➕
Enthesitis ( tendinitis & ligament affection )
±
Peripheral asymmetric oligoarthritis
±
Skin lesions
±
eye affection
➕
(Positive HLA-B27)
⭕Classification ⤵️
✔️ Ankylosing Spondylitis ( main presentation is Inflammatory type of Back Pain )
✔️Psoriatic arthritis
(May be associated with Psoriatic rash/nail changes ) ➕ Axial or peripheral joint affection
✔️ Enteropathic arthritis
( IBD + other features)
✔️ Reactive arthritis ( Reiter's syndrome)
↪️Triad of Arthritis + urethritis + conjunctivitis after infection ) ± other features ❗
✨✨✨✨✨✨
2️⃣ Degenerative joint diseases
»»»⤵️»»»»⤵️»»»»⤵️»»»»⤵️»»»
امراض شهيره جدا مرتبطه أكثر بتقدم العمر وزيادة الوزن وعوامل أخرى وراثيه
⭕ ملخص المشكله فى الامراض دى ⤵️
⚡Non inflammatory arthritis ➕ cartilage degeneration with formation of osteophytes ( bony projections with narrow joint spaces )
📜 اوعى تنسى ال Osteophytes ❗
Classification ⤵️
#Peripheral Osteoarthritis
↓↓↓
⚡Mechanical joint pain without swelling or stiffness affecting weight bearing joints ( kness, hips ) in LL and DIPs , PIPs , CMC joints in UL.
__Note ✍️ ____
Mechanical joint pain = Pain ↑ with movement and ↓ é rest , Unlike inflammatory joint pain which ↑ é rest with stiffness for at least 45 min and ↓ é movement !
#Axial Osteoarthritis ( Spondylosis )
Disc problems ‼️
ℹ️Cervical spine ( cervical Spondylosis )
⤵️
Mechanical neck pain with movement with or without compression on nerve roots or cord
ℹ️ℹ️Lumbar spine ( lumbar Spondylosis)
Mechanical low back pain with movement with or without root or cord compression.
✨✨✨✨✨✨✨✨✨
3️⃣ Metabolic joint diseases or Crystal arthropathy : deposition of crystals in joints )
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🔴 Gout :
مشكله النقرس فى الآتى ⬇️
⭕ formation of monosodium urate needle shaped crystals in joints
↪️Leading to ---> Arthritis in the form of ( pain , swelling , marked tenderness , limitation of movement ) ‼️
Classification of Gout :
⚡Acute Monoarthritis
( knees, MTP joint; Podagra ❗)
⚡ oligoarthritis
⚡Chronic gout
Tophi in kidneys ( stones), Ears , hands )
🔴 Pseudogout
( deposition of Calcium pyrophosphate )
❤2
↪️ Often associated with metabolic conditions like hypercalcemia & hemochromatosis
It is Either monoarthritis like gout
Or oligoarthritis ( 2 - 4 joints) without tophi ‼️
✨✨✨✨✨✨✨
4️⃣ infectious joint diseases
»»»⤵️»»»⤵️»»»⤵️»»»⤵️»»»
Bacterial versus Viral ❗
▶ Bacterial ⤵
◾ Septic arthritis :
✓ Acute monoarthritis caused by bacteria ( e.g staph aureus )
✓ It Affects older people with comorbidities
✓Affected joint : swollen , hot, red, tender with limitation of movement ❗
✍️ Diagnosis ⤵️
joint aspiration ( microscopy for Neutrophils, Gram stain & culture )
⚠️It is an emergency : start IV antibiotics ❗
▶ Viral Arthritis
( Parvovirus B19, HBV, HIV)
✔️Often acute polyarthritis , migratory
✔️parvovirus B19 polyarthritis is acute migratory polyarthritis associated with rash ( contact with children is important risk factor)
✨✨✨✨✨✨✨
🅱️ Bone diseases
( metabolic bone disease )
•••••••••••••••••••••••••••••••••••••
ℹ️ Osteomalacia ( vitamin D deficiency )
»»»»»»❗مرض لين العظام ❗««««««
⭕المشكله فيه ⤵️
⚡defect in osteoid tissue formation
->Leading to proximal myopathy + bone pain
⚡Risk factors : decreased sun exposure , Vitamin D malabsorption , etc
⚡X ray : will show looser zones ❗
ℹ️ℹ️ Osteoporosis
»»»»»»مرض هشاشة العظام ««««««
⭕ المشكله فى المرض ده ⤵️⤵️⤵️
✔️increased osteoclastic activity
--> Bone resorption --> decreased bone mass
↪️ risk of fragility fractures ❗
⚡Risk factors : postmenopausal women
Steroid use , etc
⚡Diagnosis :
DEXA scan ( special imaging )
ℹ️ℹ️ℹ️ Paget's disease
⭕ المشكله فى المرض ده ⤵️
Metabolic bone disease in which there is ⬆️increased bone formation ( active osteoblasts ) +⬆️ increased bone resorption ( active osteoclasts)
⚡ It is a disease of old age
Features include ⤵️
✓bone deformities ( large skull , bowing of legs )
✓metabolic effects ( deafness, tinnitus)
✓Congestive heart failure .
▶Others rare disease like osteopetrosis
______
©️ Muscle diseases
( inflammation of the muscles : myositis )
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
⭕ ايه المشكله فى الامراض دى ⤵️
-Autoimmune condition characterized by the presence of autoantibodies against the muscles leading to myopathy ( proximal myopathy ❗)
⚡It has two types ⤵
ℹ️ Polymyositis ( muscles without skin affection )
ℹ️ℹ️dermatomyositis ( muscles affection ➕ skin affection )
⚡Muscle affection = proximal myopathy
⤵⤵️⤵️
✔️ UL :
The patient can't comb the hair and he can't raise the arms over the head level !
✔️LL :
The patient can't stand from seated position without support !
⚡muscles of swallowing :
dysphagia, chocking , and aspiration
⚡muscles of respiration : respiratory failure ( rare❗)
✍️ Skin affection in dermatomyositis
⤵️⤵️⤵️
✔️Face : heliotrope rash in eye lids ❗
✔️Trunk /back : shawl sign ❗
✔️Hands : Gottron's papules ( knuckles) ❗
✍️ search for underlying malignancy ❗ مهم
✍️EMG is essential in diagnosis .
______
D] Pain Syndromes
===↘️===↘️===↘️==
⚡ Pain syndromes are either ⤵️
Diffuse muscle pain vs localized pain ❗
ℹ️ Muscle pain ( myalgia )
=======================
#Fibromyalgia
⭕ مرض الفيبرو ميالجيا او متلازمة الالم الليفى العضلى وده مشهور جدا ❗
🔴 Features
⚡ diffuse muscle pain allover the body
With the presence of multiple tender points
⚡ it could be primary
( mostly psychosomatic disease related to depression , stress with or without
Overlapping Chronic fatigue syndrome
⚡ it could be secondary to any collagen disease like SLE
⚡ if it primary , the general condition is good , labs are all normal
~~~~~
#Polymyalgia Rheumatica
⭕ Features
✔️ autoimmune disease characterized by
Muscle pain ( myalgia ) which affects the shoulder, or pelvic girdle with stiffness at the morning that improves with movements
✔️ it is the disease of old people
✔️it is usually associated with feature of inflammatory disease ( night sweats , weight loss , fever) high ESR
It is Either monoarthritis like gout
Or oligoarthritis ( 2 - 4 joints) without tophi ‼️
✨✨✨✨✨✨✨
4️⃣ infectious joint diseases
»»»⤵️»»»⤵️»»»⤵️»»»⤵️»»»
Bacterial versus Viral ❗
▶ Bacterial ⤵
◾ Septic arthritis :
✓ Acute monoarthritis caused by bacteria ( e.g staph aureus )
✓ It Affects older people with comorbidities
✓Affected joint : swollen , hot, red, tender with limitation of movement ❗
✍️ Diagnosis ⤵️
joint aspiration ( microscopy for Neutrophils, Gram stain & culture )
⚠️It is an emergency : start IV antibiotics ❗
▶ Viral Arthritis
( Parvovirus B19, HBV, HIV)
✔️Often acute polyarthritis , migratory
✔️parvovirus B19 polyarthritis is acute migratory polyarthritis associated with rash ( contact with children is important risk factor)
✨✨✨✨✨✨✨
🅱️ Bone diseases
( metabolic bone disease )
•••••••••••••••••••••••••••••••••••••
ℹ️ Osteomalacia ( vitamin D deficiency )
»»»»»»❗مرض لين العظام ❗««««««
⭕المشكله فيه ⤵️
⚡defect in osteoid tissue formation
->Leading to proximal myopathy + bone pain
⚡Risk factors : decreased sun exposure , Vitamin D malabsorption , etc
⚡X ray : will show looser zones ❗
ℹ️ℹ️ Osteoporosis
»»»»»»مرض هشاشة العظام ««««««
⭕ المشكله فى المرض ده ⤵️⤵️⤵️
✔️increased osteoclastic activity
--> Bone resorption --> decreased bone mass
↪️ risk of fragility fractures ❗
⚡Risk factors : postmenopausal women
Steroid use , etc
⚡Diagnosis :
DEXA scan ( special imaging )
ℹ️ℹ️ℹ️ Paget's disease
⭕ المشكله فى المرض ده ⤵️
Metabolic bone disease in which there is ⬆️increased bone formation ( active osteoblasts ) +⬆️ increased bone resorption ( active osteoclasts)
⚡ It is a disease of old age
Features include ⤵️
✓bone deformities ( large skull , bowing of legs )
✓metabolic effects ( deafness, tinnitus)
✓Congestive heart failure .
▶Others rare disease like osteopetrosis
______
©️ Muscle diseases
( inflammation of the muscles : myositis )
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
⭕ ايه المشكله فى الامراض دى ⤵️
-Autoimmune condition characterized by the presence of autoantibodies against the muscles leading to myopathy ( proximal myopathy ❗)
⚡It has two types ⤵
ℹ️ Polymyositis ( muscles without skin affection )
ℹ️ℹ️dermatomyositis ( muscles affection ➕ skin affection )
⚡Muscle affection = proximal myopathy
⤵⤵️⤵️
✔️ UL :
The patient can't comb the hair and he can't raise the arms over the head level !
✔️LL :
The patient can't stand from seated position without support !
⚡muscles of swallowing :
dysphagia, chocking , and aspiration
⚡muscles of respiration : respiratory failure ( rare❗)
✍️ Skin affection in dermatomyositis
⤵️⤵️⤵️
✔️Face : heliotrope rash in eye lids ❗
✔️Trunk /back : shawl sign ❗
✔️Hands : Gottron's papules ( knuckles) ❗
✍️ search for underlying malignancy ❗ مهم
✍️EMG is essential in diagnosis .
______
D] Pain Syndromes
===↘️===↘️===↘️==
⚡ Pain syndromes are either ⤵️
Diffuse muscle pain vs localized pain ❗
ℹ️ Muscle pain ( myalgia )
=======================
#Fibromyalgia
⭕ مرض الفيبرو ميالجيا او متلازمة الالم الليفى العضلى وده مشهور جدا ❗
🔴 Features
⚡ diffuse muscle pain allover the body
With the presence of multiple tender points
⚡ it could be primary
( mostly psychosomatic disease related to depression , stress with or without
Overlapping Chronic fatigue syndrome
⚡ it could be secondary to any collagen disease like SLE
⚡ if it primary , the general condition is good , labs are all normal
#Polymyalgia Rheumatica
⭕ Features
✔️ autoimmune disease characterized by
Muscle pain ( myalgia ) which affects the shoulder, or pelvic girdle with stiffness at the morning that improves with movements
✔️ it is the disease of old people
✔️it is usually associated with feature of inflammatory disease ( night sweats , weight loss , fever) high ESR
✔️it is often associated with Temporal arteritis ( type of large vessel vasculitis )
✨✨✨✨✨✨
ℹ️ℹ️Localized pain syndromes
=====⤵️=========⤵️=======
#Complex regional pain syndrome
Severe pain with allodynia
#Specific syndromes
_Shoulder
Adhesive capsulitis ( frozen shoulder)
Rotator calf tendinitis
- Elbow ( e.g tennis elbow )
__Note ✍️___
🟫Features of Frozen shoulder
✓Frozen shoulder occurs when the connective tissue enclosing the joint thickens and tightens. Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the shoulder joint. Signs and symptoms typically begin slowly, then get worse
✓ Insidious onset of vague, dull pain at the deltoid insertion. Pain with shoulder movement. Nagging pain at night, with sleep deprivation and the inability to sleep on the affected side.
✓ it is more common in diabetics
✨✨✨✨✨✨
ℹ️ℹ️Localized pain syndromes
=====⤵️=========⤵️=======
#Complex regional pain syndrome
Severe pain with allodynia
#Specific syndromes
_Shoulder
Adhesive capsulitis ( frozen shoulder)
Rotator calf tendinitis
- Elbow ( e.g tennis elbow )
__Note ✍️___
🟫Features of Frozen shoulder
✓Frozen shoulder occurs when the connective tissue enclosing the joint thickens and tightens. Frozen shoulder, also called adhesive capsulitis, involves stiffness and pain in the shoulder joint. Signs and symptoms typically begin slowly, then get worse
✓ Insidious onset of vague, dull pain at the deltoid insertion. Pain with shoulder movement. Nagging pain at night, with sleep deprivation and the inability to sleep on the affected side.
✓ it is more common in diabetics
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