Rheumatology

Basic Science

• The synovial joint
• see Orthopaedics for the anatomy of joints
• HLA and basics of autoimmunity

Core clinical presentations

• Neck pain/Back pain
• Shoulder pain
• Elbow pain
• Wrist/hand pain
• Knee pain
• Monoarticular pain/inflammation
• Polyarticular pain/inflammation
• Widespread pain
• Generalised Weakness

Clinical skills/Investigations

• Examinations
  • GALS
  • Spine/Neck
  • Shoulder
  • Elbow
  • Wrist/hand
  • Hip
  • Knee
  • Ankle/foot
• Investigations
  • Autoantibodies
• Joint Aspiration and Joint injection

Conditions

• Arthritides
  • Rheumatoid arthritis
  • Polyarticular disease in children (rheumatoid factor positive)
  • Still’s disease
  • Osteoarthritis
  • Crystal arthropathy– (Gout and Pseudogout)
    • Other crystal arthropathy (Calcium phosphate and oxalate disease)
  • Spondyloarthropathy
    • Ankylosing spondylitis
    • Psoriatic arthritis
    • Reactive arthritis
    • Enteropathic arthritis
  • Juvenile idiopathic arthritis
• Systemic diseases
  • Systemic lupus erythematosis (SLE)
  • Anti-phospholipid syndrome
  • Sjogren’s disease
  • Systemic sclerosis and CREST syndrome
  • Reynaud’s
• Myopathies
  • Inflammatory myopathy
    • Includes:
      • Polymyositis
      • Dermatomyositis
      • Inclusion body myositis
  • Polymyalgia rheumatica
• Vasculitides
  • Large vessel
    • Takayasu’s vasculitis
    • Giant cell arteritis
  • Medium vessels
    • Polyarteritis nodosa
    • Kawasaki’s disease
  • ANCA-associated small vessel disease
    • Granulomatosis with polyangitis (Wegener’s)
    • Microscopic polyangitis
    • Eosinophilic granulomatosis with polyangitis (Churg-Strauss)
  • Immune-mediated small vessel disease
    • Henoch Schonlein purpura
    • Anti GBM disease (Previously Goodpasture’s syndrome)
• Behcet’s disease
• Sarcoidosis
• Adhesive capsulitis
• Complex regional pain syndrome
• Relapsing polychondritis
• Amyloidosis
• Fibromyalgia and chronic widespread pain syndrome
• Molecular abnormalities of collagen and fibrin
  • Marfan’s syndrome
  • Ehler-Danlos syndrome
• Metabolic bone disease and Osteoporosis
• Iatrogenic
  • Methotrexate induced pneumonitis
  • Infections in patients on biologics

Management/Pharmacology

• Biologic agents
• Methotrexate
• Disease Modifying Anti-Rheumatic Drugs (DMARDs)
• Steroids