MosaicED Brain Teaser!
A young woman presents to ED with painful joints. She says that the pain has stopped her being able to unwrap gifts with her buddy the BFG from all the different countries in the world because her hands hurt, they look funny too but she can mover them to look normal. She has also noticed that when the BFG takes her above the clouds and she gets a bit of sun she gets a weird rash. When you ask her what else she gets she says she's noticed some mouth ulcers, "No" you say "what other presents did you get from the countries? and is the BFG big everywhere?"
What disease is being described?
- D-Osteogenesis imperfecta.
- H-Paget’s disease
- I-Psoriatic arthritis
- J-Rheumatoid arthritis
L-SLE. SLE arthropathy is DIP sparring, symptoms of SLE can be remembered by; SOAP BRAIN MD
S - Serositis - inflammation of serous tissues in the body (pleura, pericardium, and peritoneum)
O - Oral ulcers
A - Arthritis (Jaccoud arthritis - reversible tendon shortening)
P - photosensitive
B - Blood cells
R - renal
A - ANA
I - immunological (anti LSm; anti dsDNA)
N - Neuropsych
M - Malar rash
D - Discoid rash
On x ray their won't be any bone erosions. It will have Rh factor neagive, ANA antibody positive, Anti dsDNA positive, low platelet count, elevated ESR. Treatment:
NSAIDS & Lifestyle changes (smoking cessation, diet, sun avoidance, and exercise), hydroxychloroquine, corticosteroids, methotrexate and folinic acid.