Rheuma: Introduction to Rheumatology

Question 1

what are the 2 main divisions of diseases that rheumatologists deal with?

Answer 1

musculoskeletal (structural) and locomotor (functional)

Question 2

in which population are these conditions more common?

Answer 2

• no particular difference in gender (unless autoimmune)

- increasing age

Question 3

misconceptions about rheumatic disease

Answer 3

• this is part of the ageing process

- considered irreversible

Question 4

what is the musculoskeletal unit

Answer 4

the joint containing the articular and periarticular structures

Question 5

how can rheumatic disease be classified?

Answer 5

• articular or periarticular
• monoarticular or polyarticular
• inflammatory or noninflammatory

Question 6

what are the signs of inflammation?

Answer 6

• heat
• redness
• swelling
• pain
• loss of function
• stiffness (EMS)

Question 7

how is gout classified?

Answer 7

monoarticular
articular
inflammatory

Question 8

how is OA classified?

Answer 8

monoarticular/polyarticular
articular
non-inflammatory

Question 9

how is bursitis classified?

Answer 9

one-site
periarticular
inflammatory

Question 10

how is trigger finger classified?

Answer 10

one-site
periarticular
non-inflammatory

Question 11

how is RA classified?

Answer 11

polyarticular
articular
inflammatory

Question 12

how is polymyalgia rheumatica?

Answer 12

many sites
periarticular
inflammatory

Question 13

how are fibromyalgia and osteoporosis?

Answer 13

many sites
periarticular
non-inflammatory

Question 14

how can inflammatory rheumatic disease be classified?

Answer 14

limited to the musculoskeletal system or having systemic symptoms

Question 15

what are the 5 main outcomes of rheumatic diseases?

Answer 15

• discomfort
• disability
• dollars
• drug toxicity
• death

Question 16

from where would rheumatic pain originate from?

Answer 16

• inflammation
• muscle spasm
• articular cartilage loss

Question 17

how to assess daily living (screening questions)

Answer 17

• getting out of bed
• getting out of the house
• doing work, housework
• cook
• dress independently
• eat independently
• perform personal hygiene

Question 18

what are the finanical implications?

Answer 18

• 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)

Question 19

complications of rheumatic disease

Answer 19

• renal failure (SLE)
• premature coronary artery disease from inflammatory disease
• hip fracture (osteoporosis)

Question 20

key questions in a rheumatic history?

Answer 20

• 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?

Question 21

how do you do a musculoskeletal examination?

Answer 21

GALS (gait, arms, legs, spine)

observe and make the patient move

Question 22

investigation of pain

Answer 22

SOCRATES

pain might be referred from somewhere else

Question 23

classification of joint involvement

Answer 23

monoarticular
pauci/oligoarticular (less than 4)
polyarticular (more than 4)
axial (spine is mainly affected)

Question 24

involvement of other symptoms

Answer 24

check for general symptoms

look for features of inflammation in other body parts

Question 25

how do you make an accurate diagnosis?

Answer 25

full history and physical examination

may need few investigations to make an accurate diagnosis

Question 26

investigations in rheumatic disease

Answer 26

• inflammatory markers
• serum uric acid
• autoantibodies
• end-organ damage
• synovial fluid
• radiology (xray, US, isotope scan, CI, MRI)