Approach to the Patient With Rheumatologic Disease
Rheumatology · Approach to the Patient With Rheumatologic Disease 🎯 Practice these cards
Inflammatory arthritis causes morning stiffness lasting >____ min that improves with activity; mechanical stiffness lasts <____ min.
Inflammatory arthritis: morning stiffness >60 min, improves with activity. Non-inflammatory (mechanical): morning stiffness <30 min, worsens with use, eases with rest.
A synovial fluid leukocyte count greater than ____/µL indicates inflammatory arthritis.
Synovial fluid leukocyte count >2000/µL indicates inflammatory arthritis (neutrophil-predominant acutely, monocyte-predominant chronically). Non-inflammatory fluid has 200–2000/µL.
The upper limit of normal ESR is approximately age/2 for men and (age + ____) / 2 for women.
Rule of thumb for the upper limit of normal ESR: age/2 for men; (age + 10)/2 for women. ESR >100 mm/h suggests giant cell arteritis, multiple myeloma, metastatic cancer, or overwhelming inflammation.
In rheumatoid arthritis, the more SPECIFIC antibody is ____ (~95% specific), while ____ is present in <70% of patients and is nonspecific.
Rheumatoid factor is present in <70% of RA (sensitive but nonspecific; also in endocarditis, hepatitis C). Anti-CCP antibodies are ~95% specific but ~67% sensitive; positivity predicts erosive disease. Hepatitis C is typically RF+ but anti-CCP−.
The better inflammatory activity marker is ____ for spondyloarthritis and ____ for SLE.
CRP tracks disease activity better in spondyloarthritis. In SLE, ESR is the better activity marker and CRP may stay normal despite active disease (a raised CRP in SLE often signals infection).
Inflammation at a tendon/ligament insertion is called ____, and the resulting "sausage digit" is called ____; both suggest spondyloarthritis.
Persistent inflammation at a tendon/ligament insertion (enthesitis), especially at multiple sites, strongly suggests spondyloarthritis. Extension along the tendon produces dactylitis ("sausage digits"), classic for psoriatic arthritis.
Oligoarthritis involves ____ to ____ joints; polyarthritis involves ____ or more.
Monoarthritis = 1 joint; oligoarthritis = 2–4 joints (typically asymmetric); polyarthritis = ≥5 joints (often small joints of hands/feet).
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