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\author{ksellybelly}
\pdfinfo{
  /Title (msk-i-arthritis-rheum.pdf)
  /Creator (Cheatography)
  /Author (ksellybelly)
  /Subject (MSK I: Arthritis/Rheum Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{MSK I: Arthritis/Rheum Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{ksellybelly} via \textcolor{DarkBackground}{\uline{cheatography.com/19318/cs/2449/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}ksellybelly \\
  \uline{cheatography.com/ksellybelly} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 12th August, 2014.\\
   Updated 13th May, 2016.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Osteoarthritis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Progressive loss of articular cartilage with reactive changes in the bone, results in pain and joint destruction (most common arthropathy in adults)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Decreased ROM, joint crepitus, pain worsening througout the day} \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Common sites} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}DIP joint (Heberden's nodes + PIP joint (Bouchard's nodes), and wrist/hip/knee/spine} \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Imaging} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Asymmetric narrowing or joint spaces, subchondral sclerosis, cysts, marginal osteophytes} \tn 
% Row Count 14 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Weight reduction, physical actibity, acetaminophen, NSAIDs, intra-articular steroids. Total joint replacement in advanced cases.} \tn 
% Row Count 18 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Rheumatoid Arthritis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}A chronic autoimmune disease with synovitis affecting multiple joints and other systemic extra-articular manifestations. Joint destruction ultimately occurs.} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Typical patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}F\textgreater{}\textgreater{}M, 40-60yo at onset (juvenile in pts \textless{}16yo)} \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Morning stiffness, symmetric, subcutaneous nodules, RF level \textgreater{}95th percentile, arthritis of hand joints, soft-tissue swelling (DIP joints spared)} \tn 
% Row Count 12 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Extra-articular manifestations} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Osteoporosis, changes in \seqsplit{skin/lungs/kidneys/eyes/liver/bloodstream/heart}} \tn 
% Row Count 15 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Elevated ESR + CRP, RF and anti-CCP positive in up to 80\%} \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}PT + NSAIDS + DMARDS (MTX, corticosteroids, biologics) and reconstructive surgery for severe cases.} \tn 
% Row Count 22 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Gout}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}A systemic disease of altered purine metabolism and subsequent sodium urate crystal precipitation into synovial fluid} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Typical patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}M\textgreater{}\textgreater{}W (until menopause, then 1:1)} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features of Initial Attack} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Metatarsal phalangeal joint of the great toe (podagra)} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Symptoms around involved joint} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Pain, swelling, redness, exquisite tenderness} \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Substance that may form adjacent to the joint, diagnostic!} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Tophi (chalky deposits of uric acid)} \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Joint fluid shows rod-shaped, negatively birefringent urate crystals seen. Serum uric acid level often \textgreater{} 8 mg/dL} \tn 
% Row Count 18 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lifestyle Modifications} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Elevation, dietary modifications (avoid purines and EtOH)} \tn 
% Row Count 21 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pharmacotherapy} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}NSAIDs (indomethacin), corticosteroid injections, colchicine in between attacks} \tn 
% Row Count 24 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Polymyalgia Rheumatica (PMR)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Syndrome with pain and stiffness in the neck/shoulder/pelvic girdles and is accompanied by constitutional symptoms (fever, fatigue, weight loss, depression)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Unknown (F\textgreater{}\textgreater{}M)} \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Associated with} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Temporal arteritis (30\% of cases)} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Stiffness, worse after rest and in the morning. MSK symptoms are bilateral, proximal, symmetrical} \tn 
% Row Count 13 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Must r/o...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Giant Cell Arteritis (scalp tenderness, jaw claudication, headache, temporal artery tenderness-{}-\textgreater{}can lead to vision loss)} \tn 
% Row Count 17 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}ESR elevated (\textgreater{}50mm/hr)} \tn 
% Row Count 19 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Low-dose corticosteroids (higher doses if GCA), might need to be on for 2 years} \tn 
% Row Count 22 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Sjogren's Syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}An autoimmune disease that destroys the salivary and lacrimal glands (exocrine glands)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{May be a secondary complication to pre-existing disorders like...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}RA, SKE, polymyositis, scleroderma} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Classic Patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Middle-aged females} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Mucus membranes}} most affected. Parotid glands might be enlarged.} \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Characteristic features of primary Sjogren's} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Dry mouth (xerostomia) + dry eyes (seropthalmia or keratoconjunctivitis)} \tn 
% Row Count 14 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}RF in 70\% of cases, ANA in 60\%, anti-Ro Abs in 60\%, anti-La in 40\%. Schirmer's tear test wetting of \textless{}5mm of filter paper in lower eyelid in 5min = + for decreased secretions} \tn 
% Row Count 19 (+ 5)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{How to confirm lymphocytic infiltrate and gland fibrosis} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Lip bx} \tn 
% Row Count 22 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Mainly symptomatic management, goal of keeping mycosal surfaces moist. Can give artificial tears and saliva, increased oral fluid intake, and lubricants for eyes/vagina. Pilocarpine may increase saliva flow} \tn 
% Row Count 28 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Childhood-onset idiopathic arthritis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Characterized by chronic synovitis and extra-articular manifestations (fever, rash, weight loss)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Typical Patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}F\textgreater{}\textgreater{}M, at age 1-3yo (males older 8-12yo)} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Forms of arthritis} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Pauciarticular (50\%) polyarticular (35\%), systemic (15\%)} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Systemic (JRA) clinical features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Spiking fevers, myalgias, salmon-pink maculopapular rashin evening. Hepatosplenomegaly, lymphadenopathy, leukocytosis, pericarditis, myocarditis} \tn 
% Row Count 14 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Pauciarticular clinical features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}4 or less medium to large joints. Also at risk for asymptommatic uveitis (can lead to blindness if +ANA)} \tn 
% Row Count 18 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Polyarticular clinical features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Resembles adult RA, symmetri, 5+ joints. Systemic sx: low-grade fever, fatigue, rheumatoid nodules, anemia.} \tn 
% Row Count 22 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}PT + NSAIDs} \tn 
% Row Count 24 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Psoriatic Arthritis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}An inflammatory arthritis with skin involvement usually preceding joint disease} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Symmetric, hands and feet. Affects few joints. Pitting of nails and onycholysis. "Sausage-finger" appearance} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}ESR elevated, hyperuricemia if severe skin involvement, "pencil in a cup" deformity on x-ray} \tn 
% Row Count 10 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}NSAIDs, MTX, reconstructive surgery as last resort} \tn 
% Row Count 13 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pseudogout}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Intra-articular deposition of calcium pyrophosphate dehydrate (CPPD) in peripheral joints} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Acute presentations mimic...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Gout (may be recurrent and abrubt)} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Painful inflammation (when crystals shed into joint), most common in knees/wrist/elbow} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Rhomboid-shaped CPPD crystals, negatively birefringement. Will see chondrocalcinosis in radiographs (fine, linear calcifications)} \tn 
% Row Count 12 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}NSAIDS, colchicine, and intra-articular steroid injections} \tn 
% Row Count 15 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Polymyosotis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}An inflammatory disease of striated muscle affecting the proximal limbs/neck/pharynx (skin can also be \seqsplit{affected=dermatomyositis)}} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Etiology} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Unknown, but strong association with occult malignancy} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Classic patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}F\textgreater{}\textgreater{}M} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Insidious painless proximal muscle weakness, dysphagia, skin rash (malar or heliotrope), polyarthralgias, muscle atrophy} \tn 
% Row Count 13 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}CPK and aldolase elevated. Muscle bx will show myopathic inflammatory changes} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}High-dose steroids, MTX, or azathioprine} \tn 
% Row Count 18 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Scleroderma (Systemic Sclerosis)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definitions} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Characterized by deposition of collagen in the skin, and also lungs, kidney, heart stomach. Unknown etiology.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Classic Patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}F\textgreater{}\textgreater{}M, 30-50yo} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features in general} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}95\% of patients have skin involvement, starts with swelling of fingers and hands, may spread to trunk and face. R} \tn 
% Row Count 10 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features: Limited} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Mostly affects skin of face, neck, distal elbows and knees. Causes pulmonary hypertension later in disease.} \tn 
% Row Count 14 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features: Diffuse} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Affects the skin plus the heart, lungs, GI tract, kidneys} \tn 
% Row Count 17 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{CREST Syndrome (associated with limited scleroderma} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Calcinosis, Raynaud's, esophageal dysfunction, sclerodactyly, telangiectasias} \tn 
% Row Count 21 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Initial presentation} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Skin changes, polyarthralgias, esophageal dysfunction} \tn 
% Row Count 24 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}+ANA in 90\% of pts, +anticentromere Ab assoc. w/ limited scleroderma, watch for HTN} \tn 
% Row Count 27 (+ 3)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}No cure. Treat specific manifestations of disease (ie PPIs for GERD, ACEis for renal dz, aboid triggers, and immunosuppressives for pulmonary HTN)} \tn 
% Row Count 32 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Septic (Infectious) Arthritis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}The hematogenous spread of bacteremia infection (osteomyelitis) caused by diagnostic or therapeutic procedure (injection) or infection elsewhere (cellulitis, bursitis)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Classic joint} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Single joint, usually knee (can also be hip, shoulder, ankle)} \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Most common pathogen} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Staph. aureus}}} \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pathogen in sexually-active young adults} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}{\emph{Neisseria gonorrhea}}} \tn 
% Row Count 12 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Presentation} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Acute swelling, fever, joint warmth and effusion, tenderness to palpation, increased pain w/ minimal ROM} \tn 
% Row Count 16 (+ 4)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Collect/aspirate synovial fluid, many will also have a positive blood culture.} \tn 
% Row Count 19 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Aggressive IV Abx followed by oral antibiotics, sometimes arthrotomy and arthrocentesis are required.} \tn 
% Row Count 23 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Reactive Arthritis (Reiter Syndrome)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}A seronegative arthritis that has a tetrad of: urethritis, conjunctivitis, oligoarthritis, and mucosal ulcers (leading cause of nontraumatic monoarthritis)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Can be seen as a sequele to...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}STDs or gastroenteritis} \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Asymmetric arthritis in large joints below the waist (knee, ankle), mucocutaneous lesions (balanitis, stomatitis), urethritis, conjunctivitis} \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Typical patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}M\textgreater{}\textgreater{}F  after STDs (1:1 ratio after enteric infx)} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Up to 80\% HLA-B27+, synovial fluid negative culture} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}PT + NSAIDs. Abx can reduce chance of developing disorder, but they don't alleviate sx of the reactive arthritis} \tn 
% Row Count 20 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{SLE (Systemic Lupus Erythematous)}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}An autoimmune disorder characterized by inflammation, plus +ANA, and involvement of multiple organs} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Classic Patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Women of childbearing age, and more in African-American women} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}(4+ criteria including high ANA): malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal dz, ANA, \seqsplit{hematologic/immunologic/neurologic} disorders} \tn 
% Row Count 12 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{What must be ruled out?} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Drug-induced lupus/lupus-like syndrome (from INH, hydralazine, quinidine). Usually pt. will have positive antihistone Abs} \tn 
% Row Count 16 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Get CBC BUN, Cr, U/A, ESR, serum complement (C3 or C4), anti-Smith antibodies to mark for progression. ANA is present 99\% of the time, but low titers have a low predictive value.} \tn 
% Row Count 21 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Exercise + sun protection, NSAIDs, Antimalarials (hydroxychloroquine), corticosteroids, MTX} \tn 
% Row Count 24 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Polyarteritis Nodosa}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Small/medium artery inflammation involving the skin, kidney, peripheral nerves, muscles, and gut} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Classic patient} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}M\textgreater{}\textgreater{}F, 40-60yo, Hep B pts} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Etiology} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Unknown (concurrent in Hep B pts. 30\% of the time)} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Clinical Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Fever, anorexia, weight loss, abdominal pain, peripheral neuropathy, arthralgias, arthritis, skin lesions. If renal involvement: HTN, edema, oliguria, uremia (if renal involvement.} \tn 
% Row Count 14 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Vessel bx or angiography to diagnose (might also see ANCA, elevated ESR and CRP)} \tn 
% Row Count 17 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}High-dose corticosteroids, cytotoxic drugs, immunotherapy. Might need to also treat for Hep B. Treat HTN if present} \tn 
% Row Count 21 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Fibromyalgia Syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Definition} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}A central pain disorder; cause and pathogenesis are poorly understood} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Can occur concurrently with...} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}RA, SLE, Sjogren's} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Clinicla Features} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Nonarticular MSK aches, fatigue, sleep disturbance, multiple tender points on exam, anxiety, depression, headaches, irritable bowel syndrome, dysmenorrhea, paresthesias} \tn 
% Row Count 10 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Lab Studies} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Diagnosis of exclusion, must r/o hormonal and vitamin disturbances. Sometimes abnormalities of T-cell subsets} \tn 
% Row Count 14 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Treatment} \tn 
\mymulticolumn{1}{x{5.377cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}SSRIs, SSNRIs, RCAs. Lyrica is only FDA-approved drug to specifically treat fibromyalgia. Aerobic exercise, stress reduction, and sleep assistance are helpful.} \tn 
% Row Count 19 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}