Rheuma: Introduction to Rheumatology Flashcards
what are the 2 main divisions of diseases that rheumatologists deal with?
musculoskeletal (structural) and locomotor (functional)
in which population are these conditions more common?
- no particular difference in gender (unless autoimmune)
- increasing age
misconceptions about rheumatic disease
- this is part of the ageing process
- considered irreversible
what is the musculoskeletal unit
the joint containing the articular and periarticular structures
how can rheumatic disease be classified?
- articular or periarticular
- monoarticular or polyarticular
- inflammatory or noninflammatory
what are the signs of inflammation?
- heat
- redness
- swelling
- pain
- loss of function
- stiffness (EMS)
how is gout classified?
monoarticular
articular
inflammatory
how is OA classified?
monoarticular/polyarticular
articular
non-inflammatory
how is bursitis classified?
one-site
periarticular
inflammatory
how is trigger finger classified?
one-site
periarticular
non-inflammatory
how is RA classified?
polyarticular
articular
inflammatory
how is polymyalgia rheumatica?
many sites
periarticular
inflammatory
how are fibromyalgia and osteoporosis?
many sites
periarticular
non-inflammatory
how can inflammatory rheumatic disease be classified?
limited to the musculoskeletal system or having systemic symptoms
what are the 5 main outcomes of rheumatic diseases?
- discomfort
- disability
- dollars
- drug toxicity
- death
from where would rheumatic pain originate from?
- inflammation
- muscle spasm
- articular cartilage loss
how to assess daily living (screening questions)
- getting out of bed
- getting out of the house
- doing work, housework
- cook
- dress independently
- eat independently
- perform personal hygiene
what are the finanical implications?
- direct cost (health care, meds, related items)
- indirect cost (due to loss of function)
- intangible cost (increased pain, reduced life quality)
- communal cost (access facilities)
complications of rheumatic disease
- renal failure (SLE)
- premature coronary artery disease from inflammatory disease
- hip fracture (osteoporosis)
key questions in a rheumatic history?
- is the problem from the joint or around the joint?
- acute or chronic condition?
- inflammatory or non-inflammatory condition?
- what is the pattern of the affected areas/joints?
- impact of the condition on the patient’s life?
how do you do a musculoskeletal examination?
GALS (gait, arms, legs, spine)
observe and make the patient move
investigation of pain
SOCRATES
pain might be referred from somewhere else
classification of joint involvement
monoarticular
pauci/oligoarticular (less than 4)
polyarticular (more than 4)
axial (spine is mainly affected)
involvement of other symptoms
check for general symptoms
look for features of inflammation in other body parts
how do you make an accurate diagnosis?
full history and physical examination
may need few investigations to make an accurate diagnosis
investigations in rheumatic disease
- inflammatory markers
- serum uric acid
- autoantibodies
- end-organ damage
- synovial fluid
- radiology (xray, US, isotope scan, CI, MRI)
