SLE - SOAP serositis, oral ulcers, arthritis, photosensitivity

(+)ANA, but not diagnostic, make sure you see other features of SLE
Sjogrens - autoimmune, glands
dry eye lady, woman (9to1), mouth
Mainly treatment
elvated ESR
sicca(keratoconjutavitis)
xerostomea (dry mouth)
lymphocytic infiltrate
**Peripheral neuropathys
thryoid and renal dys(fx)
can occur alone (1*) or with others
Differential (2ndary) 60% RA, sle, systemic sclerosis
1st 20's-30's
following menapause
Schirmer - tear test x less than 5
anti-Ro(ss-a) anti-la(ss-b)
Technitium-99m, decreased uptake, measures salivary F(x)

systemic sclerosis - SCLERODERMA!

initially, non-specific fatigue, diffuse swelling of hands,rayna
uds, telaecstasia
key factors of history
ANA, (+) 90% WITH THESE SIGNS
connective tissue d(x), 30-50 women
atrophy of the skin, and epithelial parts of internal organs
distal and upper extremities
anticentromere antibody
CREST??
treatment to symptoms,
renal dys possible but small (treat with ACE inhibitors)
cardiac invloment
S&S
diabetes, only skin, doughy neck back face,
TESTS
crp esr cbc (possibly) bun, ecg, usually all normal
advanced these would be increased

mixed connective tissue disorders - be on all Diff(DX)

overlap syndromes of SLE, scleroderma, mysotits, and RA, w/ HIGH
Titers of U1-ribonucleoprotien
female 20-30
90% have Raynauds phenomenom on presentation
arthritis, GERD, swollen hands, mysotits, sclerodermatous skin c
hanges
TESTS, cbc, esr, esr, bun, ana, High Anti-jo-1 (+) anti synthest
ase

RA sysmmetric, lab and radiograph

NSAIDS just for pain, Methotrexate
 morning stiffness great than ONE hour, 3 more joints, nodules,
active arhtritis greater than 6 weeks
female 50 years,
Felty syndrome - Triad of RA, splenomegaly, neutropenia
RA-factor test,
diff diag, scleroderma, xrays
Reiter's syndrome
Reactive arthritis
Males 20-40, HLA-B27 post gonnococcoal (STD), then tendons invol
ved
eye inflammatiom/urethritis
most often on side with a few joints, ASSYMETRIC, sacroiliac joi
nt
Common in knee and back
more than 6 months is chronic
back pain relieved by exercise
fever fatique
ENTHESITIS- achilles, and plantar fascia, manifest as heel pain
TESTs
ESR, CRP, elveated
x-rays