Rheumatology
Rheumatology is a high-yield topic for USMLE Step 2 CK, frequently tested through case-based questions requiring knowledge of autoimmune diseases, inflammatory arthritis, vasculitis syndromes, and connective tissue disorders. Mastering these topics can significantly boost your exam score and improve clinical decision-making skills.In this quick review, we’ll cover the most commonly tested rheumatology topics to help you maximize your performance on Step 2 CK.
1. Rheumatoid Arthritis (RA) vs. Osteoarthritis (OA)
📌 Key Exam Tip: RA improves with movement, OA worsens!
2. Systemic Lupus Erythematosus (SLE)🦋
SLE is an autoimmune disease affecting multiple organ systems.
🔹 Clinical Features (Mnemonic: "RASH OR PAIN")
✔ Rash (Malar, Discoid)
✔ Arthritis (Non-erosive, symmetric)
✔ Serositis (Pleuritis, Pericarditis)
✔ Hematologic Disorders (Anemia, Leukopenia, Thrombocytopenia)
✔ Oral/Nasopharyngeal Ulcers
✔ Renal Disease (Nephritis, Proteinuria)
✔ Photosensitivity
✔ ANA Positive (Screening Test)
✔ Immunologic (Anti-dsDNA, Anti-Smith)
✔ Neurologic (Seizures, Psychosis)
📌 Key Lab Findings:
✔ ANA (Sensitive, but not specific)
✔ Anti-dsDNA, Anti-Smith (Highly Specific!)
✔ Low Complement (C3, C4)
✔ Proteinuria (Lupus Nephritis – Requires Biopsy!)
📌 Treatment:
✔ Mild SLE: Hydroxychloroquine
✔ Severe (Nephritis, CNS Involvement): High-dose steroids + Mycophenolate/Cyclophosphamide
🚨 Avoid sun exposure – UV light worsens SLE flares!
3. Gout vs. Pseudogout
📌 Key Exam Tip: Gout = Big Toe (Podagra), Pseudogout = Knee!
4. Vasculitis Syndromes
🔹 Small Vessel Vasculitis
📌 Treatment: Steroids ± Immunosuppressants (Cyclophosphamide, Rituximab)
5. Polymyalgia Rheumatica (PMR) & Giant Cell Arteritis (GCA)
🚨 GCA is a medical emergency! Treat with steroids ASAP to prevent blindness!
6. Scleroderma (Systemic Sclerosis)
🖐 Autoimmune disease causing collagen deposition in skin & organs.
🔹 Types
✔ Limited Scleroderma (CREST Syndrome)CalcinosisRaynaud’s PhenomenonEsophageal DysmotilitySclerodactylyTelangiectasias
✔ Diffuse SclerodermaWidespread skin involvementOrgan fibrosis (lungs, heart, kidneys)
📌 Key Antibodies:
✔ Anti-Centromere (Limited CREST)
✔ Anti-Scl-70 (Diffuse SSc)
✔ Anti-RNA Polymerase III (Renal Crisis)
📌 Treatment:
✔ Raynaud’s Phenomenon: CCBs (Nifedipine, Amlodipine)
✔ Pulmonary HTN: Bosentan, Sildenafil
✔ Scleroderma Renal Crisis: ACE Inhibitors (Captopril)
🚨 Never use steroids in scleroderma – risk of renal crisis!
Key Takeaways for Step 2 CK
✔ RA vs. OA: Know key differences!
✔ Gout vs. Pseudogout: Crystals matter!
Vasculitis syndromes: c-ANCA vs. p-ANCA!
✔ GCA: Start steroids immediately to prevent blindness!
✔ Scleroderma renal crisis: Treat with ACE inhibitors!
How IMG Rotations Can Help You Match into your Desired Specialty:
At IMG Rotations, we provide:
✔ Hands-on U.S. Clinical Experience (USCE) in Rheumatology & Internal Medicine
✔ Exposure to autoimmune diseases, arthritis, and vasculitis management
✔ Expert mentorship from U.S.-based physicians
✔ Research opportunities to boost your residency application
