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diagnosis rheumatology cardiology causes erythematosus pain regurgitation sle arthritis msk primary systemic algorithm aortic approach clues comparison conditions dermatology extrarticular
Primary and Secondary Causes of Mitral Regurgitation Primary (organic) chronic mitral regurgitation: • Leaflet: Rheumatic fever, Infective
Leaflet: Rheumatic fever ... • Prosthetic valve ... annulus valve: ... cardiomyopathy - VA Joint ... Regurgitation #differential
Clinical Features of Systemic Lupus (SLE) General: Fever (50%), Depression, Fatigue (75%), Weight loss (50%) Eye: Sjögrens (15%) Skin
Features of Systemic Lupus ... (SLE) General: Fever ... phenomenon (20%) Joints ... Pericarditis, Endocarditis ... , Aortic valve lesions
Myositis and Myopathies Polymyositis • Progressive, symmetric muscle weakness • Elevated CK, +Anti-Jo, +Anti-Mi2 Dermatomyositis
, Fever, No muscle ... Detectable HIV viral ... Anti-retrovirals, Gemcitabine Lupus ... uncommon 5-15% of lupus ... Myopathies #myopathy #differential
Approach to Joint Pain - Diagnostic Framework 1) Chronicity 2) Inflammatory vs Non-Inflammatory 3) Number of Joints Involved 1) Chronicity:
Approach to Joint ... acute rheumatic fever ... spondyloarthropathies, lupus ... • Acute = Viral ... approach #workup #differential
Extra-articular and Other Conditions Associated with Joint Pain Eyes • Iritis or uveitis - Spondyloarthropathies, Sarcoidosis,
Associated with Joint ... Subacute bacterial endocarditis ... Cardiovascular system • Mitral ... - Bacterial endocarditis ... #pain #differential
Causes of Severe Aortic Regurgitation - Differential Diagnosis Acute: • Leaflet: Traumatic Rupture, Acute Infective Endocarditis, Acute
Regurgitation - Differential ... Acute Infective Endocarditis ... Acute Prosthetic Valve ... , Rheumatic Fever ... Inflammatory: Lupus
Endocarditis Summary Who? Infectious: • Pre-existing valvular disease • Prosthetic valve • Congenital heart disease • IV substance use • IV catheter • Recent
Involves aortic and mitral ... night sweats, fever ... Marantic (NTBE) Differential ... Paradoxical emboli via ASD ... Persistent bacteremia/fevers
Top 10 situations when to think about lupus 1) Inflammatory joint pain (especially in the wrists and
to think about lupus ... ) Inflammatory joint ... the face (many differential ... ; sometimes « viral ... 9) Unexplained fever
SLE (Systemic Lupus Erythematosus) Suspect: Clinical evidence of (fatigue, rash, photosensitivity, inflammatory arthritis, weight loss, and fever) and
weight loss, and fever ... permanent alopecia Differential ... Arthritis: • Joint ... • Libman-Sacks endocarditis ... Cytopenias • Cardiac valve
Approach to Joint Pain - Arthritis Differential Diagnosis Framework Inflammatory Versus Noninflammatory Pain • Is it inflammatory
Pain - Arthritis Differential ... • Rheumatic fever ... Viral Infections ... • Bacterial endocarditis ... #pain #Differential
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