Master the board step 3

Rheumatology
Diagnostic Testing
There is no specific diagnostic test. JRA is characterized by the following:
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Very high ferritin level
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Elevated white blood cell count
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Negative rheumatoid factor and negative ANA are essential to establishing
the diagnosis.
Treatment
Treat with NSAIDs. Unresponsive cases can be treated with steroids. Those
with persistent symptoms need methotrexate or anti-TNF medications to get
off steroids.
Whipple Disease
Although it causes diarrhea, fat malabsorption, and weight loss, the most
common presentation of Whipple disease is with joint pain.
Biopsy of the bowel showing PAS positive organisms is the most specific test.
Treatment with TMP/SMX is curative.
Osteoarthritis (OA)
Osteoarthritis, the most common joint abnormality, is associated with aging
and increased use of a joint. The morning stiffness is < 30 minutes in duration
and there is crepitus on moving the joint. OA affects the distal interphalangeal
(DIP) joints (RA does not affect the DIPs). Note the following:
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Heberden’s nodes: DIP osteophytes
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Bouchard’s nodes: PIP osteophytes
Heberden’s Nodes
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