Pneumoconioses:Coalworkerspneumoconiosis,silicosis,andasbestosisriskof

corpulmonaleandCaplansyndrome(rheumatoidarthritisandpneumoconioseswith
intrapulmonarynodules).
HLAB27:Psoriaticarthritis,Ankylosingspondylitis,arthritisofInflammatory
boweldisease,Reactivearthritis(formerlyReitersyndrome).PAIR.Alsoknown
asseronegativearthropathies.
DR4:Rheumatoidarthritis,diabetesmellitustype1.Thereare4wallsina
rheum(room).
LymeDisease:Latersymptomsmonoarthritis(largejoints)andmigratory

polyarthritis,cardiac(AVnodalblock),neurologic(meningitis,facialnervepalsy,
polyneuropathy).AKeyLymepietotheFACE:Facialnervepalsy(typically
bilateral)ArthritisCardiacblockErythemachronicummigrans.
AmyloidosisAA(secondary):Seenwithchronicinflammatoryconditionssuchas
rheumatoidarthritis,IBD,spondyloarthropathy,protractedinfection.Fibrils
composedofserumAmyloidA.OftenmultisystemlikeALamyloidosis.
Gout:Acuteinflammatorymonoarthritiscausedbyprecipitationofmonosodium
uratecrystalsinjoints.
p.429FA2015OsteoarthritisandRheumatoidarthritis
p.432FA2015
CrohnsDiseasesextraintestinalmanifestations:Migratorypolyarthritis,erythema

nodosum,ankylosingspondylitis,pyodermagangrenosum,aphthousulcers,uveitis,
kidneystones.
Diseasesassociatedwithpseudogoutincludehemochromatosis,
hyperparathyroidism,osteoarthritis.
Streptococcuspyogenes(groupAstreptococci):RheumaticFever:JNES(major
criteria):Joint(migratorypolyarthritis)(carditis)Nodulesinskin(subcutaneous)
ErythemamarginatumSydenhamchorea.
Swollen,hard,painfulfingerjointsOsteoarthritis(osteophytesonPIP[Bouchard
nodes],DIP[Heberdennodes])
Urethritis,conjunctivitis,arthritisinamaleReactivearthritisassociatedwith
HLAB27.

Weightloss,diarrhea,arthritis,fever,adenopathyWhippledisease(Tropheryma
whipplei)
CelecoxibusedinRheumatoidarthritis,osteoarthritis
Polished,ivorylikeappearanceofboneatcartilageerosionEburnation(osteoarthritis
resultinginbonysclerosis).

Urethritis,cervicitis,conjunctivitis,reactivearthritis,PIDChlamydiatrachomatis
(DK)
Urethritis,cervicitis,PID,prostatitis,epididymitis,arthritis,creamypurulent
dischargeNeisseriagonorrhoeae
RituximabTargetsCD20;usedforBcellnonHodgkinlymphoma,CLL,
rheumatoidarthritis,ITP
Adalimumab,infliximabTargetsSolubleTNF;usedforIBD,rheumatoid
arthritis,ankylosingspondylitis,psoriasis.
EtanerceptMOA:Fusionprotein(receptorforTNF+IgG1Fc),producedby
recombinantDNA.EtanerceptisaTNFdecoyreceptor.Usedfor:Rheumatoid
arthritis,psoriasis,ankylosingspondylitis
Azathioprine,6mercaptopurine(6MP),6thioguanine(6TG)MOA:Purine
(thiol)analogs->decreasesdenovopurinesynthesis.ActivatedbyHGPRT.
Azathioprineismetabolizedinto6MP.USE:Preventingorganrejection,
rheumatoidarthritis,IBD,SLE;usedtoweanpatientsoffsteroidsinchronicdisease
andtotreatsteroidrefractorychronicdisease.TOXICITY:Myelosuppression,GI,
liver.Azathioprineand6MParemetabolizedbyxanthineoxidase;thusbothhave
increasedtoxicitywithallopurinolorfebuxostat.
Methotrexate(MTX)MOA:olicacidanalogthatcompetitivelyinhibits
dihydrofolatereductase>decreasesdTMP -> decreasesDNAsynthesis.USE:
Cancers:leukemias(ALL),lymphomas,choriocarcinoma,sarcomas.Nonneoplastic:
ectopicpregnancy,medicalabortion(withmisoprostol),rheumatoidarthritis,
psoriasis,IBD,vasculitis.TOXICITY:Myelosuppression,whichisreversiblewith
leucovorinrescue.Hepatotoxicity.Mucositis(e.g.,mouthulcers).Pulmonary
fibrosis.
Uveitis:Inflammationofuvea(e.g.,iritisakaanterioruveitis,choroiditisaka

posterioruveitis).Mayhavehypopyon(accumulationofpusinanteriorchamber)
orconjunctivalredness.Associatedwithsystemicinflammatorydisorders(e.g.,

sarcoidosis,rheumatoidarthritis,juvenileidiopathicarthritis,HLAB27associated
conditions).
CyclosporineCalcineurininhibitor;bindscyclophilin.BlocksTcellactivationby
preventingIL2transcription.USE:Transplantrejectionprophylaxis,psoriasis,
rheumatoidarthritis.TOXICITY:Nephrotoxicity,hypertension,hyperlipidemia,
neurotoxicity,gingivalhyperplasia,hirsutism.
PrimarybiliarycirrhosisAutoimmunereactionlymphocyticinfiltrate+
granulomasdestructionofintralobularbileducts.Classicallyseeninmiddleaged
women.ADDITIONALFEATURES:Antimitochondrialantibody,including
IgM.Associatedwithotherautoimmuneconditions(e.g.,CREST,Sjgren
syndrome,rheumatoidarthritis,celiacdisease).
AUTOANTIBODY:Rheumatoidfactor(IgMantibodythattargetsIgGFcregion),
antiCCP(morespecific)=DISEASE:RheumatoidArthritis.
SLE:RASHORPAIN:Rash(malarordiscoid)ArthritisSofttissues/serositis

Hematologicdisorders(e.g.,cytopenias)Oral/nasopharyngealulcersRenaldisease,
RaynaudphenomenonPhotosensitivity,PositiveVDRL/RPRAntinuclear
antibodiesImmunosuppressantsNeurologicdisorders(e.g.seizures,psychosis)
RituximabMonoclonalantibodyagainstCD20,whichisfoundonmostBcell
neoplasms.USE:NonHodgkinlymphoma,CLL,IBD,rheumatoidarthritis.
TOXICITY:riskofprogressivemultifocalleukoencephalopathy.
RubellaMODEOFTRANSMISSION:respiratorydroplets.MATERNALSIGNS:Rash,
lymphadenopathy,arthritis.NEONATALSIGNS:Classictriad:PDA(orpulmonary
arteryhypoplasia),cataracts,anddeafness,+/blueberrymuffinrash
AcutegastritisEspeciallycommonamongalcoholicsandpatientstakingdaily
NSAIDs(e.g.,patientswithrheumatoidarthritis).
CarpaltunnelsyndromeEntrapmentofmediannerveincarpaltunnel;nerve
compressionparesthesia,pain,andnumbnessindistributionofmediannerve.
Associatedwithpregnancy,rheumatoidarthritis,hypothyroidism;maybeassociated
withrepetitiveuse.
GonococciNopolysaccharidecapsule;Nomaltosefermentation;Novaccinedue
toantigenicvariationofpilusproteins;Sexuallyorperinatallytransmitted;Causes
gonorrhea,septicarthritis,neonatalconjunctivitis,pelvicinflammatorydisease
(PID),andFitzHughCurtissyndrome;Treatment:ceftriaxone+(azithromycinor

doxycycline)forpossiblechlamydialcoinfection.
Parvovirus(DNAvirus)NOenvelope;Singlestrandedandlinear(smallestDNA
virus);B19virusaplasticcrisesinsicklecelldisease,slappedcheeksrashin
children(erythemainfectiosum,orfifthdisease);RBCdestructioninfetusleadsto
hydropsfetalisanddeath,inadultsleadstopureRBCaplasiaandrheumatoid
arthritislikesymptoms.
CampylobacterjejuniMajorcauseofbloodydiarrhea,especiallyinchildren.
Fecaloraltransmissionthroughpersontopersoncontactorviaingestionof
poultry,meat,unpasteurizedmilk.Contactwithinfectedanimals(dogs,cats,pigs)is
alsoariskfactor.CommaorSshaped,oxidase,growsat42C(Campylobacter
likesthehotcampfire).CommonantecedenttoGuillainBarrsyndromeand
reactivearthritis.
Nonhemolytic,normocyticanemiaAnemiaofchronicdiseaseInflammation
increasehepcidin(releasedbyliver,bindsferroportinonintestinalmucosalcellsand
macrophages,thusinhibitingirontransport)>decreasereleaseofironfrom
macrophages.Associatedwithconditionssuchasrheumatoidarthritis,SLE,
neoplasticdisorders,andchronickidneydisease.;FINDINGS:decreaseiron,
decrease TIBC,increaseferritin.Normocytic,butcanbecomemicrocytic.
Treatment:EPO(chronickidneydiseaseonly).
ChlamydiaeChlamydiatrachomatiscausesreactivearthritis(Reitersyndrome),
follicularconjunctivitis,nongonococcalurethritis,andPID.
TakayasuarteritisUsuallyAsianfemales<40yearsold.Pulselessdisease
(weakupperextremitypulses),fever,nightsweats,arthritis,myalgias,skinnodules,
oculardisturbances.
Dryeyes,drymouth,arthritisSjgrensyndrome(autoimmunedestructionof
exocrineglands)

1. CorticospinalTractdescendingmotortracttolimbmuscles.
2. Dorsalcolumns:ascendingepicritic
3. Spinothalamictract:ascendingprotopathic