Erosion of bones seen in all except:

Ans- A SLE Ref: Harrison's Principles of Internal Medicine, 18th edition, pg 2728 Explanation: SLE causes non erosive polyarthritis of the hands, wrist & knees. Can cause avascular necrosis of joints increased by steroid use. Psoriasis, RA & gout cause erosive arthritis. Psoriatic Arthritis (PsA): DIP involved, nail changes (pitting, ridging, onycholysis, yellow discoloration, hyperkeratosis) dactylitis Asymmetrical oligoarthritis Symmetrical polyarthritis Arthritis mutilans with destruction and telescoping of digits CASPAR criteria used to diagnose PsA Treatment; Anti-TNF-a- infliximab, etanercept, adalimumab, golimumab Anti T cell- Alefacept Newer agent- Ustekinumab Methotrexate, sulfasalazine, letlunomide Rheumatoid Arthritis (RA): MCP, PIP, &MTP involved Juxta-articular osteopenia- earliest radiological finding ACR & EULAR revised criteria used to diagnose RA Treatment: Anti TNF- a- Infliximab. Etanercept, adalimumab. golimumab, certolizumab Abatacept, unakinra. rituximab, tocilizumab Gouty arthritis: Acute, monoarthritis, 1st MTP involved Precipitated by diet, trauma, surgery, alcohol.stress Joint aspirate for needle shaped MSU crystals, birefringent with negative elongation. TC 2-60 thousand S.uric acid can be low /normal during attack Acute attack-NSAIDS. Colchicine, steroids, anakinra Hypouricemic drugs- AUopurinoi. febuxostat. Rasburicase, pegloticase