Quick Rheumatology Notes (Based on Harrison’s 21st Edition by ChatGPT)

Systemic Lupus Erythematosus (SLE)

System Involvement Manifestations

Cutaneous Malar rash, discoid rash, photosensitivity, alopecia, oral ulcers
Renal Lupus nephritis (proteinuria, hematuria, RBC casts, hypertension)
CNS Seizures, psychosis, cognitive dysfunction, transverse myelitis, aseptic meningitis
Musculoskeletal Non-erosive arthritis, myositis
Vascular/Occlusions Raynaud’s phenomenon, thrombosis (APAS), livedo reticularis
Pulmonary Pleuritis, pneumonitis, pulmonary hypertension, shrinking lung syndrome
Cardiac Pericarditis, myocarditis, Libman-Sacks endocarditis (nonbacterial)
Hematologic Anemia (chronic disease, hemolytic), leukopenia, thrombocytopenia
Gastrointestinal Mesenteric vasculitis, hepatopathy, pancreatitis
Ocular Retinal vasculitis, optic neuritis, sicca syndrome
Diagnosis & Laboratory Imaging Treatment
ANA+, anti-dsDNA, anti-Sm, low C3/C4, proteinuria, RBC Joint XR: Steroids, HCQ, MMF, Rituximab (severe cases)
casts Normal

Rheumatoid Arthritis (RA)

System Manifestations
Involvement
Musculoskeletal Symmetrical polyarthritis (MCP, PIP, wrist), morning stiffness >1 hour, ulnar deviation, swan-neck deformity, boutonnière
deformity
Pulmonary Interstitial lung disease- periphery, main histo: UIP (+) honeycomb, NSIP: bilateral ground glass oopacitiesrheumatoid
nodules, pleuritis, bronchiolitis obliterans, PFT: restrictive
Cardiac Pericarditis, myocarditis, increased risk of CAD
Vasculitis Rheumatoid vasculitis (digital infarcts, mononeuritis multiplex)
Hematologic Anemia of chronic disease, Felty’s syndrome (RA, splenomegaly, neutropenia)
Malignancy Diffuse Large B cell Lymphoma
Diagnosis & Laboratory Imaging Treatment
RF+, anti-CCP+, high ESR/CRP, synovial fluid XR: Joint space narrowing, DMARDs (MTX, Leflunomide), Biologics (TNFi,
WBC >2000 erosions Rituximab), Steroids
 Feature Rheumatoid Arthritis (RA) Osteoarthritis (OA) Gout Arthritis CPPD / Pseudogout
Pathophysiology Autoimmune, synovial inflammation Mechanical wear & tear → Hyperuricemia → Monosodium Calcium pyrophosphate dihydrate
leading to pannus formation → cartilage degeneration & urate (MSU) crystal deposition → (CPPD) deposition in cartilage &
cartilage & bone destruction osteophyte formation inflammation synovium → inflammatory response
Pathology / Clinical • Symmetric polyarthritis, • Asymmetric joint pain Sudden onset, podagra (1st MTP), Acute monoarthritis, knee most
Clues • Early morning stiffness >1 hr, • Morning stiffness brief red, swollen joint, tophi (chronic common, pseudo-tophi
• Improved with physical activity <30 mins cases)
• hand involvement (MCP, PIP, • worsens with activity or
wrist) after using then gradually
resolves
• bony crepitus, Heberden's
& Bouchard’s nodes
Musculoskeletal Small joints (MCP, PIP, wrist) Weight-bearing joints Lower extremities (1st MTP > ankle Large joints (knee > wrist >
Involvement atlantoaxial subluxation cervical spine cervical, lumbosacral > knee) shoulder)
spares :DIP but if + with OA, (-) Spine, knees, hips, spine,first
thoracic & lumbar MTP
Hands: DIP, PIP, base of
thumb
Spared: wrist, elbow, ankle
Hallmark Flexor tendon synovitis
Gene HLA-DRB1 gene none
Diagnosis RF, Anti-CCP (+), ↑ ESR/CRP, Normal inflammatory Serum uric acid (>6.8 mg/dL), Synovial fluid analysis (rhomboid,
anemia of chronic disease markers, clinical + X-ray synovial fluid (needle-shaped, weakly positive birefringent CPPD
SF: 5000- 50,000 findings negatively birefringent MSU crystals)
crystals)
Imaging Findings Subchondral erosions: MCP,PIP, Joint space narrowing, Punched-out erosions with Chondrocalcinosis (linear
MTP (5th) osteophytes, subchondral overhanging edges ("rat-bite" calcification in cartilage)
symmetrical joint space narrowing, sclerosis, cysts lesions)
swan-neck & boutonnière
deformities
Specific Treatment § DMARDs (Methotrexate 1st-line) Weight loss, PT, NSAIDs, Acute: NSAIDs (indomethacin), Acute: NSAIDs, Colchicine,
/ Management others: hydroxycholoroquine, intra-articular steroids, Colchicine, Steroids; Chronic: Steroids; Chronic: Colchicine
sulfasalazine, leflunomide joint replacement (severe Allopurinol / Febuxostat (urate- (prophylaxis), joint lavage (severe
§ NSAIDs cases) lowering), Probenecid cases)
§ Steroids (acute flares)
§ Biologics (TNF inhibitors,IL-6
inhibitors)
Mnemonic: "J♥NES PEACE"

• J – Joints (Migratory Polyarthri/s)

• ♥ – Cardi+s (Clinical or Subclinical via Echo)
• N – Nodules (Subcutaneous)
• E – Erythema Marginatum
• S – Sydenham’s Chorea

👉 Major Criteria Differentiation:

• Low-risk: Requires strict arthri/s defini/on (migratory polyarthri/s).

• Moderate-to-High Risk: Polyarthri+s, monoarthri+s, or polyarthralgia count.

Minor Criteria (Mnemonic: "PEACE")

• P – PR Interval Prolonga/on (ECG change)

• E – Elevated Acute Phase Reactants (↑ESR/CRP)
• A – Arthralgia (If arthri/s isn’t major)
• C – Clinical Fever (≥38.5°C in low-risk; ≥38.0°C in high-risk)
• E – ESR/CRP increase

👉 Diagnosis:

• Low-risk popula+ons:
o 2 Major OR 1 Major + 2 Minor + Evidence of recent GAS infec+on
• Moderate-High risk popula+ons:
o Either Polyarthri+s, Monoarthri+s, OR Polyarthralgia can be major

Easy Recall for Treatment: "PEN-NSAID"

• PENicillin (or Amoxicillin) for GAS eradica+on

• NSAIDs for arthri+s
• Steroids if severe cardi/s
• Aspirin (high-dose) in cardi/s cases
Other Rheumatologic Conditions

Disease Pathology & Clues Clinical Features & Organ Diagnosis & Imaging Treatment
Involvement Laboratory
Antiphospholipid Thrombosis, DVT, stroke, livedo reticularis, Lupus NA Anticoagulation
Antibody Syndrome recurrent pregnancy catastrophic APS (multiorgan anticoagulant, (warfarin, heparin for
(APAS) loss, anticardiolipin failure) anticardiolipin, β-2 pregnancy)
Abs, lupus glycoprotein I Abs
anticoagulant
Ankylosing HLA-B27, enthesitis, Chronic back pain, morning ESR/CRP elevated, XR: Sacroiliitis, NSAIDs, TNF
Spondylitis (AS) sacroiliitis stiffness, uveitis, aortic HLA-B27+ bamboo spine inhibitors, exercise
regurgitation, restrictive lung (late)
disease
Psoriatic Arthritis HLA-B27, T-cell Asymmetric arthritis, dactylitis RF-, elevated XR: Pencil-in- NSAIDs, MTX, TNF
(PsA) mediated, enthesitis (sausage fingers), nail pitting, ESR/CRP, HLA- cup deformity inhibitors
psoriasis B27+
Vasculitis (General) Immune-mediated Small: Palpable purpura, ANCA+ Vessel imaging Steroids,
vessel inflammation glomerulonephritis; Medium: (Wegener’s, MPA), (MRA/CTA for Cyclophosphamide,
Digital ischemia, mesenteric Biopsy, ESR/CRP large vessel Rituximab (ANCA+
ischemia; Large: Limb vasculitis) cases)
claudication, headache

Condition Pathophysiology / Clinical Clues Musculoskeletal Diagnosis Imaging Treatment /

Etiology Involvement Management
Bursitis Inflammation of bursa Localized swelling, Shoulder Clinical, US/MRI if NSAIDs, rest,
due to trauma, overuse, pain, tenderness (subacromial), aspirate if unclear steroid injection,
infection (septic over affected bursa elbow (olecranon), suspect aspiration &
bursitis) knee (prepatellar, infection antibiotics if septic
pes anserine), hip
(trochanteric)
Rotator Cuff Overuse → microtears Shoulder pain, worse Shoulder Clinical US/MRI if NSAIDs, PT,
Tendinitis of supraspinatus with overhead (supraspinatus (Neer/Hawkins chronic subacromial
tendon activity, painful arc tendon) test +) steroid injection
(60-120°)
Calcific Calcium Acute, severe Shoulder Clinical X-ray: NSAIDs, PT,
Tendinitis hydroxyapatite shoulder pain, night (supraspinatus, calcifications, steroid injection,
deposits in tendons pain, decreased rotator cuff) US/MRI extracorporeal
(often supraspinatus) ROM shockwave
therapy (ESWT)
Bicipital Overuse → Anterior shoulder Long head of Clinical (Speed US/MRI NSAIDs, PT,
Tendinitis / inflammation/rupture pain, worse with biceps (shoulder to test, Yergason steroid injection
Rupture of biceps tendon flexion/supination, elbow) test) (rupture:
Popeye sign (if conservative or
ruptured) surgery in active
patients)
De Quervain’s Inflammation of APL Radial wrist pain, 1st extensor Clinical US (if needed) Thumb splint,
Tenosynovitis & EPB tendons due to worsens with thumb compartment of NSAIDs, steroid
repetitive motion movement, + wrist injection
Finkelstein test
Patellar Overuse injury of Anterior knee pain, Patellar tendon Clinical US/MRI NSAIDs, PT
Tendinitis patellar tendon worsens with (below kneecap) (chronic cases) (eccentric
("Jumper’s (sports-related) jumping/squatting strengthening),
Knee") avoid steroid
injection
Drug-Induced Fluoroquinolones, Generalized tendon Common in Clinical None unless Stop offending
Tendinitis statins, steroids pain, risk of Achilles Achilles, patellar, rupture drug, NSAIDs,
rupture shoulder tendons suspected PT
(MRI)
Iliotibial Band Friction of IT band Lateral knee pain, Lateral knee (IT Clinical US/MRI if NSAIDs, PT (IT
Syndrome over lateral femoral worse with band) unclear band stretching),
condyle running/cycling, + activity
Ober’s test modification
Adhesive Fibrosis of Severe shoulder Shoulder Clinical X-ray (to rule NSAIDs,
Capsulitis glenohumeral capsule stiffness, loss of (glenohumeral out OA), MRI aggressive PT,
("Frozen active & passive joint) (capsular steroid injection,
Shoulder") ROM, common in thickening) manipulation
diabetics under anesthesia
(if severe)
Lateral Overuse → Lateral elbow pain, Lateral elbow Clinical US/MRI NSAIDs, PT
Epicondylitis degeneration of worse with (chronic cases) (eccentric
("Tennis extensor carpi gripping/lifting, + exercises), brace,
Elbow") Cozen’s test steroid injection
 radialis brevis
(ECRB)
Medial Overuse → Medial elbow pain, Medial elbow Clinical US/MRI if NSAIDs, PT,
Epicondylitis degeneration of flexor worse with wrist chronic brace, steroid
("Golfer’s tendons (FCR, flexion/pronation injection
Elbow") pronator teres)
Plantar Microtears of plantar Heel pain, worst in Plantar fascia (heel Clinical X-ray (± heel NSAIDs, PT
Fasciitis fascia the morning or after region) spur), US (stretching),
rest, improves with orthotics, steroid
activity injection (severe
cases)