Radiograph of the

knee showing
moderate to
severe
osteoarthritis.
Note the marked
joint space
narrowing of the
medial
compartment.

Distribution of disease activity in rheumatoid arthritis.

Delayed image of the hands from 99mTc-MDP scintigraphy
showing distribution of active disease in a patient with
rheumatoid arthritis.

Psoriatic arthritis. There is extensive destruction of the interphalangeal

joint of the great toe with resorption of the terminal tuft. A similar lesion
may be seen in Reiters syndrome. Note severe destructive changes in
the terminal interphalangeal joint of the fifth digit and the lack of
osteoporosis. The lesions in the feet in this patient were symmetric.

Photomicrographs of fresh preparation of synovial fluid

obtained from the inflamed knee of a 45 year-old man with
acute gouty arthritis. Note numerous small and large needleshaped crystals of monosodium urate monohydrate that have
been engulfed by neutrophilic leukocytes.

Reactive arthritis (Reiters syndrome)

Epidemiologic Characteristics of the Connective Tissue Disease

Incidence

Rheumatoid

Systemic Lupus Progressive

Arthritis

Erythematosus

~500

~30

Polymyositis

Systemic Sclerosis

Cases/yr/
1,000,000

~12

~20

1.5:1

2:1

Population
Black to White

<1.5:1

4:1

2.5:1

>5:1

2:1

2:1

in childhood

5%-10%

5%-10%

<5%

20%

Adult pattern

Increase
with age

Peak at 15
to 44 yr

Increases
with age

Peak at 45
to 64yr

Female to
Male
% diagnosed

RNP
ANA

ENA

(Speckled pattern)

RNAse

MCTD

(+)
(-)
Sm

(high titer)

Laboratory differentiation MCTD/SLE

SLE

Summary and Laboratory Test for

Rheumatic Diseases
1.
2.
3.
4.
5.
6.
7.

Osteoarthritis (OA)
Rheumatoid arthritis (RA)
Sjgrens syndrome
Systemic lupus erythematosus (SLE)
Psoriatic arthritis
Reactive arthritis (Reiters syndrome)
Gout

Testing for Rheumatic Diseases

1. Osteoarthritis (OA)

Plain films*
MRI
Arthroscopy
No blood test or laboratory analysis to
confirm the diagnosis

2. Rheumatoid arthritis (RA)

CBC
Acute phase reactants
Rheumatoid factor*
Biopsy of rheumatoid nodules
X-ray

Testing for Rheumatic Diseases

(cont.)

3. Sjgrens Syndrome

Salivary gland biopsy*

Parotid sialography
ANA speckled pattern
Antibody to Ro/ss-A or La/ss-B antigens

4. Systemic Lupus Erythematosus

Hematologic disorder-complement
ANA (Anti dsNA or SM)
Antiphospholipid antibodies
Biopsy*
X-ray

Testing for Rheumatic Diseases

(cont.)

5. Psoriatic arthritis

X-ray
Characteristic skin involvement*

6. Reactive Arthritis

X-ray
CBC
Acute phase reactants
HLA-B27*
Synovial fluid

Testing for Rheumatic Diseases

(cont.)

7. Gout

Synovial fluid*
X-ray
Tophus
Uric acid