Anterior uveitis affects the front of the eye (usually the iris) and is the most common type. Only one eye is usually affected. Symptoms include: an aching, painful, red eye blurred or cloudy vision, a small pupil, an iris that may have a slightly different color sensitivity to light (photophobia), floaters (dots that move across the field [...]

  Reiter’s Syndrome Bechet’s Syndrome Oral Ulcers Yes Yes Genital Ulcers Yes Yes Uveitis Iritis Yes Arthritis Yes Axial Yes Rash +/- Yes Male vs Female Males > Females Male = Female Genetics HLA B27 HLA B51 STD associated Chlamydia No Rx Doxycycline/NSAIDS Colchicine: 0.6 mg b.i.d. for mucocutaneous and joint symptoms Who?? Multiple sex [...]

Polyarteritis nodosa is a systemic vasculitis characterized by necrotizing inflammatory lesions that affect medium and small muscular arteries, preferentially at vessel bifurcations, resulting in microaneurysm formation, aneurysmal rupture with hemorrhage, thrombosis, and, consequently, organ ischemia or infarction.  Nonspecific, firm, tender subcutaneous nodules without livedo reticularis and/or systemic involvement may be the first sign of polyarteritis [...]

Psoriatic Arthritis is a seronegative spondyloarthropathy caused by the macrophage-induced enzymatic breakdown of bone, tendons, and cartilage. It effects 25% of people suffering from psoriasis. Psoriatic arthritis occurs more commonly in patients with tissue type HLA-B27. Treatment of psoriatic arthritis is similar to that of rheumatoid arthritis. More than 80% of patients with psoriatic arthritis will have [...]

Adult Still’s disease is a rare illness marked by high fevers, rash, and joint pain. It may lead to chronic arthritis. It is more commonly called adult-onset Still’s disease (AOSD). Fewer than 1 out of 100,000 people develop adult Still’s disease each year. It affects women more often than men. Still’s disease that occurs in [...]

Antiphospholipid antibody syndrome , also known as lupus anticoagulant syndrome, or Hugh syndrome  is characterized by the presence of anti-phospholipid antibodies, which are frequently linked to pregnancy losses in the pre-embryonic (<6 wk), embryonic (6-9 wk), and fetal (≥10 wk gestation) time periods. 10-20% of women with early losses are positive for the anti-phospholipid antibodies, [...]

Polymyalgia rheumatica (PMR) is a clinical syndrome characterized by severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle.  It causes severe pain in the proximal muscle groups; however, no evidence of disease is present at muscle biopsy. Muscle strength and electromyographic findings are normal.  It is closely linked to giant cell arteritis [...]

Limited systemic sclerosis/scleroderma is well described by the CREST syndrome (Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasias). Diffuse systemic sclerosis/scleroderma is rapidly progressing and affects a large area of the skin and one or more internal organs, frequently the kidneys, esophagus, heart and lungs. Typical scleroderma is classically defined as symmetrical skin thickening, with about [...]

Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia (a heightened and painful response to pressure).  Other symptoms include severe fatigue, insomnia, and joint problems. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia frequently co-exists with psychiatric conditions such as depression [...]

Similar to polymyositis in muscle presentation (ie weakness of proximal muscles, minimal if any pain). Some cases of dermatomyositis actually “overlap” other autoimmune diseases such as: Sjögren’s syndrome, lupus, scleroderma, or vasculitis. Because of the link between dermatomyositis and autoimmune disease, run an ANA test. Skin findings occur in dermatomyositis but not polymyositis and are generally [...]

Patients present with proximal muscle weakness usually in the legs/thighs.  They have difficulty arising from a chair or bed, and cannot kneel or squat. Invariably the presentation is with WEAKNESS, not pain (pain should suggest PMR). Polymyositis, like dermatomyositis, strikes females with greater frequency than males. (Remember: Inclusion Body Myositis effects men more !!) 1.) [...]

A common inflammatory myositis occurring in men (usually) over 50. The disease is characterized by distal muscle weakness, most prominently demonstrated in the hand (wimpy hand shake). Prominent weakness can occur elsewhere, but look for dysphagia as a co-symptom. Drug exposure is the cause, with special attention to cocaine, alcohol, statins, steroids, and colchicine. Labs [...]

Most studies demonstrate a spontaneous miscarriage rate of 10-15%. However, the true rate of early pregnancy loss is close to 50% because of the high number of chemical pregnancies that are not recognized in the 2-4 weeks after conception. Most of these pregnancy failures are due to gamete failure (eg, sperm or oocyte dysfunction). In [...]

Felty’s syndrome is defined by a clinical triad of: seropositive rheumatoid arthritis (RA) neutropenia (<2000/uL) splenomegaly . . . and, on occasion, anemia and thrombocytopenia. Develops in individuals with long standing RA Rare in African-Americans Hypersplenism has been blamed for the syndrome, but not all patients have splenomegaly and splenectomy does not cure all patients. [...]

Characterized by painful swelling and thickening of the skin in the extremities, limitations of movements due to contractures, and mild muscle weakness Labs include elevated sedimentation rate, peripheral eosinophilia, hypergammaglobulinemia, and mildly elevated CK (not always). Histology shows marked thickening and infiltration of the deep fascia with mononuclear cells and eosinophils. Most patients respond to [...]

More common in women Associated with ingestion of L-tryptophan (essential amino-acid) Symptoms include fever and rash, arthralgia and myalgia, cough and dyspnea, and edema. Accompanied with eosinophilia (>1000 cells/microL). Peripheral neuropathy, myositis (with lymphocytic and eosinophilic infiltration) Tryptophan (contaminating L-tryptophan preparations) has been implicated as a cause.

Deficiencies of C1, C2, and C4 lead to abnormalities in immune complexes and may cause a wide variety of rheumatic diseases. C1- (C1q component is usually deficient) SLE is common and membranoproliferative glomerulonephritis may occur. C2 – Common deficiency (1:10,000) SLE is common; (50%) discoid lupus, vasculitides, Henoch-Schonlein purpura also occur. C4 – Total deficiency [...]

  Granulomatous vasculitis of multiple organ systems, particularly the lungs. Similar to polyarteritis nodosa Granulomas may be found in the tissue far from blood vessels (these are associated with eosinophilic infiltration). Besides lungs, the skin, cardiovascular system, kidney, peripheral nerves, and GI tract may also be affected. Severe asthmatic attacks with pulmonary infiltrates dominate the [...]

This is a rare syndrome of unknown etioligy in which small blood vessels, particularly small venules, become acutely inflamed. This results in ulceration of the affected organs. Diagnostic criteria require recurrent oral ulcerations and 2 of the following:  - Recurrent genital ulcerations (painful aphtous ulcers that last 1-2 weeks),  - Eye lesions (iritis, uveitis, retinal [...]

A “reactive” arthritis with a high male to female ratio (20:1). The primary infectious site is usually urogenital or occasionally intestinal. Classic infection is Chlamydia urethritis. 90% of patients possess the HLA-B27 antigen. Diagnosis of Reiter’s syndrome should be used only for patients who have classic triad (uveitis, urethritis, and arthritis). The arthritis usually involves [...]

Systemic vasculitis with palpable purpura Most patents are 4-7 years of age. Presumptive mechanism – immune complex deposition IgA is most commonly seen in the complexes. Symptoms related to skin, gut and joints are present in 50% of pediatric patients. In adults 70% have skin symptoms but only 20% have gut and joint symptoms. Renal [...]