___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

___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 )

↪️ 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 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