A rare syndrome / workup of arthritis
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Transcript of A rare syndrome / workup of arthritis
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Learning points
Sandra P. Susanibar Adaniya Chief Resident IM - UAMS
ACD06/12
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What is the diagnosis?
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Sweet syndrome• Sweet syndrome = acute febrile neutrophilic dermatosis• Inflammatory disorder characterized by the presence of inflammatory papules, plaques, or nodules on the skin, systemic symptoms, and neutrophilic infiltration of the skin.• Cutaneous lesions of Sweet syndrome are typically painful,
erythematous to violaceous papules and plaques• Fever, malaise, joint pain, and muscle pain often accompany the
cutaneous lesions.
• Three categories based on etiology: • Classical Sweet syndrome• Malignancy-associated Sweet syndrome (most common acute
myelogenous leukemia)• Drug-induced Sweet syndrome (MCC granulocyte-colony
stimulating factor (G-CSF).
Clinical features of Sweet syndrome
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Sweet syndrome – diagnosis
1. Abrupt onset of painful erythematous plaques or nodules
2. Histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis.
3. Pyrexia >38°C
4. Excellent response to treatment with systemic corticosteroids or potassium iodide.
5. Abnormal laboratory values at presentation (three of four): erythrocyte sedimentation rate >20 mm/hr; positive C-reactive protein; >8,000 leukocytes; >70 percent neutrophils
A. Abrupt onset of painful erythematous plaques or nodules.
B. Histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis
C. Pyrexia >38°C
D. Temporal relationship between drug ingestion and clinical presentation, or temporally-related recurrence after oral challenge.
E. Temporally-related resolution of lesions after drug withdrawal or treatment with systemic corticosteroids
Classical = The presence of both major criteria (1 and 2), and two of the four minor criteria.
Drug induced = All five criteria (A, B, C, D, and E) are required for the diagnosis.
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LEARNING POINTS
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Does this patient have arthralgia or arthritis?
• Key = presence of inflammation• Cardinal signs of inflammation: erythema, warmth, pain, and swelling. • Severe joint inflammation or systemic disease: fatigue, weight loss, or fever. • Morning stiffness lasting > 1 hour = underlying inflammation
Richie AM, Francis ML. Diagnostic approach to polyarticular joint pain. Am Fam Physician 2003; 68: 1151–60Samanta J, Kendall J. Polyarthralgia. British medical journal. 2003; 326:859.
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Approach to arthritis
Duration?Cut-off=6
weeks
Acute
Infection
Trauma
Crystals
Reactive
Early chronic cause
Chronic
Pocket Medicine. Fifth Edition. Marc S. Sabatine, MD, MPH
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Approach to arthritis
Duration?
Chronic # joints involved
Mono (1) Indolent infection
Oligo (2-4)
Indolent infection
Spondylo-
arthropathy
Poly (≥5)
RA
SLE
Myositis
Systemic sclerosis
CPPD
Acute
Adapted from Pocket Medicine. Fifth Edition. Marc S. Sabatine, MD, MPH
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Evaluation of polyarthritis or polyarthralgia
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