Spot Diagnosis

Spot Diagnosis

Rheumatology Weekend

Mechanic Hand

•  Hyperkeratosis and fissure of radial side of

2nd _{to 4}th _{fingers and ulnar side of thumb}

•  Associate with antisynthetase syndrome

•  Antibody associated: Anti aminoacyl tRNA

synthetase

Dermatomyositis

•  Pathogenesis: Immune complex to vessel

•  Ischemia due to vasculitis

•  Pathology: perivascular and perifascicular

infiltration (CD₄); perifascicular fiber

atrophy; degeneration and regeneration of muscle

Calcinosis Cutis

•  Abnormal calcification of subcutaneous

tissue

•  DDx: tophi, xanthoma, Heberden and

Lupus Panniculitis

•  Panniculitis in LE

•  Mostly found at face and limb girdles

•  Post inflammation cause atrophy

Anti dsDNA

•  Crithidia leuciliae

•  Crithidia test is gold standard of anti

dsDNA test

•  ELISA test: titer relate to disease activity in

Morphea

•  Localized scleroderma

•  Morphea type: patchy and ivory-colored

Secondary RP

•  Clue of secondary RP

Age of onset older than 30 Asymmetrical

Abnormal nailfold capillary Abnormal serology

Abnormal CBC or ESR/CRP

Severe pain and/or develop digital ulcer, digital pitting, gangrene

Periungual Infarction

•  Small to medium vasculopathy or

vasculitis

SSc-Pattern Nailfold Cap.

•  Early: dilatation of capillary turn to giant

capillary, well-preserved distribution •  Active: more dilatation and

microhemorrhage, mild disorganization •  Late: almost absence dilatation and

hemorrhage, ramified neovascularization and intense disorganization

VEDOSS

•  Very Early Diagnosis of SSc

•  Major criteria: SSc pattern nailfold cap.;

Serology; RP

•  Minor criteria: calcinosis cutis; esophageal

sphincter dysfunction; puffy fingers; digital ulcers; telangiectasia; ground-glass at

chest HRCT

•  Diagnosis: 3 majors or 2 majors and 1

Discoid LE

•  Chronic cutaneous LE

•  Involve skin appendage cause atrophic

scar

•  Typical: erythema or hypertrophic patch,

papule, plaque with follicular plugging and some atrophic center and telangiectasia

Cytoid Bodies

•  Retinal vasculitis

•  Cause exudate and hemorrhage of fundus

Sapporo

•  Sapporo Snow Festival

•  APS meeting Sapporo criteria 1999

GAVE

•  Gastric Antral Vascular Ectasia

•  Vasculopathy manifestation

What

Rheumatoid Nodule

•  Granuloma like: central necrosis and

palisading histiocytes

•  Associate with RF and ACPA

•  Increase prevalence in A2756G

polymorphism of methionine synthase reductase gene

Tophi

•  Granuloma like: central micro-crystal and

surrounding macrophage •  Alcohol fixation

Eosinophilic Fasciitis

•  Groove sign: furrows along fascia and

blood vessels

•  DDx in scleroderma-liked: EF;

scleredema; nephrogenic systemic

Anti-Ro and Anti-La

•  Neonatal lupus

•  Associate antibodies: anti Ro/SSA and

anti La/SSB

•  Manifestation: skin, hemato, liver, cardio

•  Fluorinated steroid: dexamethasone and

Antiphospholipid

•  Anticardiolipin: 40 units or 99th percentile

of IgG or IgM

•  Anti β ₂ glycoprotein I: 99th percentile of

IgG or IgM

•  Anti phosphatidylserine

Erythema Ab Igne

•  Differential diagnosis of livedo reticularis

•  Long term exposure to heat

Scleroderma

•  Vasculopathy: intema media thickening

•  Fibrosis: loss of normal architecture of

dermal ridge, abnormal collagen bundle, loss of skin appendages

Sjogren Syndrome

•  Inflammation of exocrine gland

•  Autoimmune process: alpha frodin

•  Anti Ro, anti La, RF

•  Sicca symptom of eyes and mouth

•  Mikculicz disease

Ultraviolet

•  Trigger of SLE flare: UVB 290-310 nm

•  Exposure of anti Ro and apoptosis of

Tinel Sign

•  Carpal tunnel syndrome

•  Associate: diabetes, hypothyroid, RA, SSc

crystal induced arthropathy, pregnancy, amyloidosis, mechanic use

Sjogren Syndrome

•  Sialogram: cherry-blossom appearance

Rose Bengal

•  Rose Bengal dye

•  Keratoconjunctivitis sicca

•  Schirmer’ test: less than 5 mm. within 5

min.

Parry-Romberg Syndrome

•  Progressive hemifacial atrophy

•  Skin and bone atrophy

En Coup de Sabre

Pannus

•  Lymphoid follicle-like in synovial tissue

•  Cytokine-driven: TNF alpha, IL-1, IL-2,

Saturnine Gout

•  Lead poisoning and gout

•  Roman God Saturn festival: heavy wine

Polyarteritis Nodosa

•  PAN: medium-vessel vasculitis

•  HBV-related and non HBV-related

•  HBV-related treatment: antivirals, plasma

exchange and high-dose steroid

•  Non HBV-related treatment: high-dose

Saddle Nose

•  Rheum.: WG, relapsing polychondritis

•  Hem.: NK/T cell lymphoma

Scleromalacia

•  Episcleritis and scleritis are most common

•  Thinning of sclera: scleromalacia

•  Protrusion of vitreous body: scleromalacia

Anterior Uveitis

•  Ciliary injection and hypopyon

•  Extra-articular symptom of SpA

•  AS: more unilateral

Poliosis

•  Poliosis: absence or decrease melanin of

hair

•  VKH: Vogt-Konayagi-Harada syndrome

•  Autoimmune against melanin-containing

organ

•  Neuro: meningitis, stroke-liked, CN palsy

•  Eye: uveitis

Anti-TNF alpha

•  Etanercept: fusion protein against soluble

TNF receptor

•  Infliximab: chimerical mouse-human mab

•  Adalimumab: fully-humanized mab

•  Golimumab: fully-humanized mab