MOFFITT MORNING REPORT PEARLS 5/24/17: Polyarthralgias and the Red Eye!

Hey Everyone! Thanks to Vaibhav for presenting the case of a young man with recurrent fevers, arthralgias, and eye inflammation (possibly iritis). The workup was pending but he had undergone an extensive infectious and inflammatory workup previously that was negative. We’ll have to wait and see if anything pops up this time. Pearls below on polyarthralgias and the red eye:

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Top Pearls:

  1. SLE joint symptoms usually manifest as a migratory, polyarticular, symmetric, non-erosive, inflammatory arthritis, though arthralgias without synovitis are not uncommon.
  2. When approaching polyarthralgia, look for the presence or absence of synovitis and the symptom duration as initial diagnostic branch points.
  3. Foreign body sensation localizes to the cornea, while photophobia could be corneal, anterior chamber/iris, or acute angle closure glaucoma.

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For those who want more info:

*Pearl: Arthritis/arthralgias in SLE– occurs in >90% and often one of the earliest manifestations. 65-70% of cases are true arthritis with inflammation, and tends to be migratory, polyarticular, symmetric, and non-erosive. However, occasionally erosive arthritis does occur in SLE.

See the algorithm below for an approach to polyarthralgia, and the table below for major causes of inflammatory polyarthritis.

*Take-home points are that the presence or absence of synovitis and the symptom duration are the most helpful initial diagnostic features.

 polyarthralgia

Inflammatory polyarthritis

The Red Eye: Classify by site of disease. The bolded ones require urgent/emergent ophtho referral!

  • Lids/lashes: hordeolum, chalazion, blepharitis
  • Conjunctiva: conjunctivitis (bacterial, viral, allergic), episcleritis/scleritis, hemorrhage
  • Cornea: abrasion, contact lens overwear, foreign body, infectious keratitis (bacterial, viral)
  • Anterior chamber/iris: iritis, hyphema, hypopyon
  • Lens: acute angle closure glaucoma

*Pearl: Foreign body sensation is fairly specific to corneal processes.

*Pearl: Photophobia could be corneal, anterior chamber/iris, or acute glaucoma.

Also see Rachel’s previous pearls on eye complaints in primary care:

https://ucsfmed.wordpress.com/2017/01/23/zsfg-report-pearls-eye-complaints-in-primary-care/

 

Evernote: https://www.evernote.com/shard/s272/sh/49bc2326-ca12-4739-b77f-4e3bb3c6acca/9d5d7ffa8039f7a873007e3e117b80f6

 

Have a great day everyone!

SamMy

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