Rheumatic manifestation of systemic diseases
–hypertrophic osteoarthropathy HOA
Long bone perostitis with clubbing of
fingers and toes ,90%with lung CA,other disease like lung fibrosis ,cirrhosis
and another tumors
Mostly
involved long bones ,distal ends ,pathogenesis unknown but may due to increase
the blood flow in that area ,it result in pain and swelling but no inflammation
Leukemia and lymphoma :
They
may simulate various rheumatic disease by synovitis and bone pain from direct
invasion or bone marrow expansion
6%
of adult patients with leukemia present with rheumatic manifestation before
diagnosis by three months, present with
Symmetrical
arthritis and oligoarthritis .
In
children 60% of acute leukemia present with mono or poly arthritis .
In
lymphoma arthritis rare but bone pain is common
The
treatment directed to the disease itself
.
Hemophilia:
Hemoarthosis most common complication of
either type A,FACTOR 8,deficiency or
type B FACTOR 9 deficiency
It
occur in 2\3 of patients ,may occur spontaneously or with minor trauma and it
depend of it severity on level of deficiency
Chronic
arthropathy with persistent arthritis may occur result degenerative arthritis
disease.
Treatment
depend on replacement therapy ,local ice, local corticosteroid ,rest later
physiotherapy .
Sickle cell disease:
SS,
S Talasemia,SC, SD,all result joints problem ,painful crisis ,arthropathy
,dactylitis ,osteonecrosis,gout, and osteomylitis painful arthritis affect big joints ,the
synoival fluid is non inflammatory
with increase the incidence of septic
arthritis ,salmonella most frequent isolated organism,
Thalasemia :
B
thalasemia major result in osteoporosis, pathological fracture, and epiphysis
deformities ,minor type associated with non inflammatory arthritis .
Multiple myloma and amylodosis:
MM
is plasma cell dyscerasias result in bone pain from lytic bone lesion, and
pathological fracture with osteoporosis ,amyloid joint infiltration produce
symmetrical small joints polyarthritis simulate RA.
Some
time infiltrate shoulder with amyloid deposit result in soft tissue deformities
[shoulder pad sign],the diagnosis is made by demonstrate of the apple green
birefringent fluorescence on congo red staining of abdominal fat this is
primary amylodosis.
The
AA type secondary form result from chronic inflammatory disease like RA,IBD,
LEPROSY ,TB,OSTEOMYLITIS.they lead to arthralgia the diagnosis made by biopsy
of the involved organ , and the treatment directed to the under line disease.
B2
microglobemia[B2M]associated amylodsis occur in patients with long standing
hemodialysis CRF ,present with C.T.S,flexor tendons deposit in hands and shoulder result from B2 microgloin deposit
the treatment supportive unless transplant is done.
Whipple disease:
Arthritis
occur in 60%-90%usually intermittent, migratory and oilgarthritis last few hours
to days with spontaneous remission some time only arthralgia synovial fluid is
inflammatory with increase mono nuclear cells ,it treated with antibiotics
therapy [tetracycline] result in complete remission with one week to one month
,it caused by organism trophenyma whippleii.
Hemochromatosis
Arthritis
result from iron deposition disease with increase iron absorption ,it result in
symmetrical arthritis of 2nd-3rd MCP occur in 50% of patients ,X-ray show same change of osteoarthritis with
presence of condrocalcinosis definite diagnosis made by identification of
mutant gene sequence in the peripheral blood.
Endocrine diseases :
DM-
C.T.S
Adhesive
capsulitis
Charcot
joint
Syndromes
of limited joints mobility [cheiroarthropathy]
DM
arthropathy
Diabetic
muscle infarction
Hypothyroidism:
Proximal
myopathy
Arthralgia
Joint
effusion
C.T.S
Chondroclacinosis
Hyperthyroidism :
Myopathy
Osteoporosis
Thyroid
acropchy
Hyperparathyroidism :
Mypathy
Arthralgia
Erosive
arthritis
Chondrocalcinosis
Hypoparathyrodism :
Muscles
cramps
Soft
tissue calcification and
spondyloarthropathy
Acromegly :
C.T.S
Myopathy
Raynauds
phenomenon
Back
pain
Premature
osteoarthritis
Cushing :
Myopathy
Osteoporosis
A
vascular necrosis