rheumnemonics

23/05/2024

Heerfordt syndrome is a form of sarcoid. The manifestations are . Uveitis , parotid enlargement and facial palsy

22/05/2024

Musculoskeletal X-ray findings in the hands secondary to sarcoid are usually a lace like pattern appearance. The joint spaces are usually maintained.

22/05/2024

Per the 2019 EULAR/ERA/EDTA update on the management of lupus nephritis the addition of ACEI or ARB ( -Sartans ) is recommended when the proteinuria is > 500 mg

22/05/2024

In a lupus patient a kidney biopsy is needed in cases where: 1) there is an active urine sediment with dysmorphic RBCs 2) increasing Creatinine without any other explanation 3) proteinuria of more than 500 mg

22/05/2024

One of the main tricks to use during rounds as a resident to impress your attending is to make them ask you the question you already know the answer for. For example when you get your next case of lupus nephritis bring up the kidney biopsy result and mention the activity and chronicity index. Activity above 12 ( dozen eggs ) and chronicity above 3 ( tree ) are markers of worse prognosis in lupus nephritis. This will work for both nephrology and rheumatology rotations

21/05/2024

Another way to remember that GPA ( Wegener ) affects upper airways and is associated with C-ANCA is to visualize a guy wearing a ( wig ) with his sinuses affected. He is also wearing a wet suit to remind of the Sea-ANCA ( C-ANCA ) !

21/05/2024

It can be tricky to differentiate between GPA ( granulomatosis with polyangiitis ) and MPA ( microscopic polyangiitis ). Remember that MPA doesn’t usually affect the upper airways as opposed to GPA which usually does. GPA is associated with C ANCA while MPA is associated with P ANCA . They are both small vessel vasculitides.

20/05/2024

Anti synthetase syndrome : Interstitial lung disease, mechanics hands , myositis , symmetric non erosion arthritis , raynauds , fever

20/05/2024

Bone marrow aspirate confirms MAS

20/05/2024

Macrophage activation syndrome is a life threatening condition where there is dysregulation of T lymphocytes and overproduction of cytokines ( a cytokine storm ). The macrophages proliferate and this causes rapidly progressive cytopenia. The phagocytosis happens in the lymph nodes, liver and spleen and hence you can see hepatosolenomegaly and elevated liver enzymes. There is also consumptive coagulopathy and DIC causing low fibrinogen. The low fibrinogen level results in low sed rate. Ferritin is usually more than 10k ( acute phase reactant ). Soluble IL-2 receptor levels are extremely elevated pointing towards dysregulation and over activation of lymphocytes.

19/05/2024

Foods that are good for gout and help lower uric acid

19/05/2024

19/05/2024

Crowned dens syndrome is a form of Chondrocalcinosis affecting the C spine that can cause attacks of headache and neck pain. It is caused by Calcium pyrophosphate deposition around the odontoid in a pattern resembling a crown ( crowned dens ). It can also cause fever and elevated sed rate which makes it mimic GCA and meningitis. Attacks happen in older patients only.

19/05/2024

Chondrocalcinosis ( condor ) is associated with hemochromatosis and iron overload. Remember that the condor sometimes has hook looking claws made of iron. Always screen for hemochromatosis by checking ferritin level with any new diagnoses of CPPD

19/05/2024

One of the classic radiographic patterns seen on a hand XR in chondrocalcinosis ( condor ) aka CPPD is the finding of “ hook osteophytes “ . The joint narrowing pattern usually affects the 3nd and 3rd MCP without affecting the 4th and 5th #

18/05/2024

Chondocalcinosis ( condor ) usually affects older patients and should not be on the DDX of a young patient with joint pain. The most commonly affected joints are the wrist and the knee. On X-rays you can see the calcium deposits usually.

18/05/2024

In chondrocalcinsis aka pseudogout ( fake goat ) the crystals are usually rhomboid and positively birefringent ( blue when parallel )

18/05/2024

Anakinra ( Anna Karenina from Tolstoy ) is an IL -1 receptor blocker ( has one finger up ) which can be used in gout attacks when the patient has comorbidities or contraindications to other meds

18/05/2024

It’s not uncommon to have fever during a gout attack due to the activation of the inflammasome which increases the production of IL-1 which is a pyrogen and is associated with fever. atoid arthritis

18/05/2024

Anakinra ( Anna Karenina ) is an IL-1 receptor antagonist. It’s administered under the skin and is used to treat RA, FMF, Stills, cryopyrin-associated periodic syndromes and gout !

17/05/2024

With Apremilast then oral ulcer won’t last !! . Apron to remind of Apremilast . Turkish guy to remind of Behçet’s disease . Apremilast is used to treat recurrent oral ulcers in Behçet’s disease

16/05/2024

Teripara(tide) = (fort)eo is a form of PTH hormone ( first 34 amino acids that are bioactive ) which is used an anabolic agent for osteoporosis. As you remember PTH causes bone resorption when high chronically ( such as secondary Parathyroidism ) but will help bone formation if given in a pulsatile form. Hence forteo ( the fort ) activates osteoblasts more than osteoclasts. Loci story : The fort is “ strong b***d “ and can withstand the ( tide ) !!

16/05/2024

Tocilizumab ( toe-six) lizumab ( IL-6) inhibitor is approved for SS-ILD for people who fail or cannot tolerate Mycophenolate. ( faSSinate trial ), Khanna et.al, Lancet 2016

16/05/2024

Mycophenolate ( my cough ) is the preferred first line in ILD in the setting of scleroderma and is preferred over cyclophosphamide given the better safety profile.

16/05/2024

Hulusi Behçet was a Turkish dermatologist who first described the manifestations of disease named after him . I will use the Turkish Fez ( Tarboosh ) and the stash to represent Behçet disease from this point on

16/05/2024

Rituximab is an anti-CD 20 used in the treatment of ANCA associated vasculitis , ITP and lupus

16/05/2024

Vasculitis of Behçet’s disease involves all types and sizes of vessels . More frequently the venous side causing thrombotic events

16/05/2024

“ Cyclops Cytoxan “ : the active metabolite of cytoxan is phosphoramide mustard which cross links DNA hence prevents it from replicating . C*C is cytotoxic to both resting and dividing lymphocytes. It affects both T and B cells. It’s basically derived from mustard gas which was used in chemical warfare. So it’s not surprising to have the adverse reactions associated with it.