Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Rheumatoid Arthritis Rhinitis 1303

➣Rheumatoid nodules in viscera (eg, lungs, heart)

➣Eyes: sicca syndrome, part of Sjogren’s syndrome, episcleritis

➣Lungs: nodules, pleurisy w/ effusion, interstitial fibrosis

➣Heart: pericarditis, nodules, valvulitis

➣Vasculitis

■Disability

➣30% of work capacity lost. Only about half still working at old job

w/out adaptation at 5 yrs.

■Death

➣Excess mortality from 20–40%

➣GI bleeding from NSAIDs is by far the most common drug side

effect

➣Infection in pts immunocompromised by DMARDs

➣Lung or liver damage from MTX

➣Increased cardiovascular disease

■Prognosis (see risk factors in Management section above)

➣Only 4% will achieve a complete remission

➣W/ appropriate therapy, most pts will have some joint problems

but maintain satisfactory overall function

RHINITIS

ANDREW N. GOLDBERG, MD

history & physical

■Nasal congestion

■Nasal obstruction

■Clear or white nasal discharge

➣Sinusitis

➣Pregnancy or high progesterone (e.g., BCPs)

➣Underlying illness such as hypothyroidism, sarcoid, Wegener

granulomatosis, sarcoid, lymphoma in a rare situation

➣Topical nasal decongestant abuse (rhinitis medicamentosa)

➣Systemic medications (e.g., beta blockers, reserpine)

➣Atrophic rhinitis or ozena in the elderly where mucosa has

thinned

➣Two predominant types occur which may have similar symptoms

and appearance

Allergic Rhinitis

Sneezing / itchy eyes / watery eyes / allergy symptoms