Friday, April 09, 2010
Hospital Medicine 2010 April 9 sessions---rheumatology pearls
Brian Mandell, MD, from Cleveland Clinic gave the talk.
When to suspect vasculitis? Know the red flags: mononeuritis multiplex; ischemic disease if unusual distribution or demographic (eg Takayasu’s); others.
A positive ANCA is meaningless if the patient’s illness doesn’t resemble Wegener’s, MPA or RPGN.
If vasculitis appears to relapse before tapering of immunosuppressive therapy take infection for granted. If apparent flare during taper, be wary of infection but it could be recurrent disease.
Septic arthritis---11% mortality.
Underappreciated complications of immunosuppressive therapy:
Corticosteroids associated with the widest variety of infectious complications, as they affect all arms of the immune system.
Anti-TNFs and Rituximab---Heb B flare, acute liver failure.
Weakness and elevated CK---differentiate between true myositis and non-inflammatory myopathy. EMG may help.
Aldolase not specific for muscle. Acts more like LDH.