what are the top 5 rheumatology diseases tested on the ABIM, and how can I diagnose and treat each of them?

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Welcome to this overview of the top 5 rheumatology diseases commonly tested on the ABIM Internal Medicine exam. These conditions represent the most high-yield topics you need to master for successful board preparation. We'll cover rheumatoid arthritis, systemic lupus erythematosus, gout, pseudogout, and seronegative spondyloarthropathies. Each of these diseases has distinct diagnostic features and treatment approaches that are frequently tested. Rheumatoid arthritis is a chronic autoimmune inflammatory arthritis that typically presents with symmetric polyarthritis affecting small joints of the hands and feet. Key diagnostic features include morning stiffness lasting more than 30 minutes, positive rheumatoid factor or anti-CCP antibodies, and elevated inflammatory markers. Treatment focuses on achieving remission using disease-modifying antirheumatic drugs like methotrexate as first-line therapy, with biologics such as TNF inhibitors for refractory cases. Systemic lupus erythematosus is a complex multisystem autoimmune disease that can affect virtually any organ system. Classic diagnostic features include the malar or butterfly rash, photosensitivity, arthritis, and serositis. Laboratory findings include positive ANA, anti-double-stranded DNA antibodies, and low complement levels. Treatment varies by organ involvement, with hydroxychloroquine as a cornerstone therapy, immunosuppressants for severe organ involvement like lupus nephritis, and corticosteroids for acute flares. Gout and pseudogout are crystal arthropathies with distinct features. Gout typically presents as acute monoarthritis affecting the first metatarsophalangeal joint, with negatively birefringent uric acid crystals on synovial fluid analysis. Acute treatment includes NSAIDs or colchicine, while prevention uses urate-lowering therapy like allopurinol. Pseudogout or CPPD commonly affects the knee and wrist, showing positively birefringent calcium pyrophosphate crystals and chondrocalcinosis on imaging. Treatment focuses on joint aspiration and anti-inflammatory medications. Seronegative spondyloarthropathies include ankylosing spondylitis, psoriatic arthritis, and reactive arthritis. Key features include inflammatory back pain that improves with activity, sacroiliitis on imaging, and frequent HLA-B27 positivity. Unlike rheumatoid arthritis, these conditions are seronegative for rheumatoid factor and anti-CCP. Characteristic features include enthesitis and dactylitis. Treatment includes NSAIDs for axial symptoms, with TNF inhibitors and IL-17 inhibitors highly effective for both axial and peripheral manifestations. Physical therapy is essential for maintaining spinal mobility.