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Rheumatology I 03 Connective Tissue Diseases
Rheumatology I 03 Connective Tissue Diseases
Rheumatology I 03 Connective Tissue Diseases
Classification
• Prototype is Systemic Lupus Erythematosus
(SLE)
• Used as screen for CTDs (except RA; i. e., possesses high sensitivity, low specificity)
• (+) ANA also seen with aging, HIV, viral hepatitis, interstitial lung disease, TB,
malignancy (especially B-cell lymphomas)
• SS-A/Ro: seen in Sjögren’s syndrome, SLE; associated with photosensitivity, neonatal lupus,
fetal congenital heart block in mothers with SLE
Other labs:
• Rheumatoid factor: seen in RA, Hep C
• IgG anti-IgM
• Seen in RA:
• Higher the number, the higher level of acute phase reactants (esp. fibrinogen)
• Acute phase reactants coat RBCs, decreasing repulsive zeta forces, increasing rouleaux
formation of RBCs and thereby packing in ESR tube
• Felty’s syndrome
• Pericarditis
Destruction of cartilage
Bone
Inflamed joint
capsule
Inflamed
synovium
Synovial fluid
Joint pain occuring
(Enlarged view of a joint)
in various joints
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Wen Jie Lau, j.wenjie93@hotmail.com
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Rheumatoid Arthritis
• RA is a polyarticular, symmetric, inflammatory, arthritis.
• Active synovitis: on examination the joints will be warm, swollen,
red, and tender.
• Patients complain of morning stiffness that improves with use.
• Patients have involvement of multiple joints.
• The wrists, MCPs, and PIPs are most commonly involved.
• Joints are involved in a symmetric fashion.
Signs & symptoms
• Patients may develop rheumatoid nodules along extensor
tendons.
• Only in RF+ patients
• Synovium also line tendons (called tenosynovium), causing carpal
tunnel syndrome (palmar flexor tendonitis) or rotator cuff tendonitis
Zarei-Ghanavati S, Javadi MA, Yazdani S, Bilateral Terrien's Marginal Degeneration and Posterior Polymorphous Dystrophy (…) https://openi.nlm.nih.gov/
detailedresult.php?img=PMC3381109_jovr-07-60f1&query=Rheumatoid+Arthritis&it=xg&lic=by&req=4&npos=2, no changes, CC BY 2.5
Wen Jie Lau, j.wenjie93@hotmail.com
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Rheumatoid Arthritis
F.l.t.r.: E. Goljan, Rapid Review Pathology E-Book, 4th Edition, 2013, p. 642, Fig. 24-8 B, Mosby (Elsevier), Agrawal RV, Murthy S, Sangwan V et al., Current approach in diagnosis and management
of anterior uveitis., https://openi.nlm.nih.gov/detailedresult.php?img=PMC2841369_IJO-58-11-g010&query=rheumatoid+arthritis&it=xg&lic=by&req=4&npos=242, CC BY 2.0, resized and cropped
Wen Jie Lau, j.wenjie93@hotmail.com
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Rheumatoid Arthritis
• Episcleritis/scleritis
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