Rheumatology
Inflammatory & Degenerative Arthritis · Connective Tissue Disease · Vasculitis & Autoinflammatory · Crystal & Metabolic Bone Disease · Regional Pain & Soft Tissue · Drugs, Fibromyalgia & Miscellaneous
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Inflammatory & Degenerative Arthritis
- Ankylosing Spondylitis: Features — Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy. It typically presents in males (sex ratio 3:1) aged
- Reactive Arthritis: Features — Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies
- Ankylosing Spondylitis: Investigation and Management — Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy. It typically presents in males (sex ratio 3:1) aged
- Rheumatoid Arthritis: X-Ray Changes — Early x-ray findings
- Rheumatoid Arthritis: Epidemiology — Peak onset: 30–50 years, although it occurs in all age groups
- Still's Disease in Adults — Adult Still's disease
- Psoriatic Arthropathy — Psoriatic arthropathy correlates poorly with cutaneous psoriasis and often precedes the development of skin lesions.
- Rheumatoid Arthritis: Antibodies — Rheumatoid factor Rheumatoid factor (RF) is a circulating antibody (usually IgM) which reacts with the Fc portion of the
- Reactive Arthritis — Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies, encompassing what was previously
- Septic Arthritis — Most common organism overall: Staphylococcus aureus; consider Neisseria gonorrhoeae in sexually active young adults.
- Rheumatoid Arthritis: Management — NICE NG100: offer conventional DMARD MONOTHERAPY (oral methotrexate, leflunomide or sulfasalazine) as first-line, ideall
- Rheumatoid Arthritis: Prognostic Features — A number of features have been shown to predict a poor prognosis in patients with rheumatoid arthritis, as listed below
- Rheumatoid Arthritis: Complications — A wide variety of extra-articular complications occur in patients with rheumatoid arthritis (RA):
- Osteoarthritis: Management — Osteoarthritis management per NICE NG226 (2022), which replaced CG177 (2014)
- Rheumatoid Arthritis: Pregnancy — Rheumatoid arthritis (RA) typically develops in women of a reproductive age. Issues surrounding conception are therefore
Connective Tissue Disease
- Systemic Lupus Erythematosus: Dermatomyositis: an inflammatory myopathy with characteristic skin signs (heliotrope rash, Gottron's papules, shawl sign); idiopathic or paraneoplastic. — 99% are ANA positive
- Extractable Nuclear Antigens — Note: the original source text for this chapter did not match its title — rewritten here with proper Extractable Nuclear
- Myopathies — symmetrical muscle weakness (proximal > distal)
- Systemic Lupus Erythematosus: Pregnancy — Maternal autoantibodies can cross the placenta, leading to a condition termed neonatal lupus erythematosus
- Systemic Sclerosis — Systemic sclerosis is a condition of unknown aetiology characterised by hardened, sclerotic skin and other connective ti
- Antiphospholipid Syndrome — Antiphospholipid syndrome is an acquired disorder characterised by a predisposition to both venous and arterial thrombos
- Mixed Connective Tissue Disease — Mixed connective tissue disease (MCTD, Sharp's syndrome) is a rare, heterogeneous, multi-system autoimmune disorder. It
- Dermatomyositis — an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions
- Raynaud's — Raynaud's phenomenon may be primary (Raynaud's disease, no underlying cause) or secondary (associated with an underlying
- Sjogren's Syndrome — Sjogren's syndrome is an autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces. It may be prim
- Discoid Lupus Erythematous — Discoid lupus erythematosus is a benign disorder generally seen in younger females. It very rarely progresses to systemi
- Drug-Induced Lupus — In drug-induced lupus, not all the typical features of SLE are seen — renal and nervous system involvement are unusual,
- Dermatomyositis: Dermatomyositis: an inflammatory myopathy with characteristic skin signs (heliotrope rash, Gottron's papules, shawl sign); idiopathic or paraneoplastic. and Management — Dermatomyositis: an inflammatory myopathy with characteristic skin signs (heliotrope rash, Gottron's papules, shawl sign); idiopathic or paraneoplastic.
- Systemic Lupus Erythematosus — much more common in females (F:M = 9:1)
- Systemic Lupus Erythematosus: Features — Systemic lupus erythematosus (SLE) is a multisystem, autoimmune disorder. It typically presents in early adulthood and i
Vasculitis & Autoinflammatory
- Temporal Arteritis — Large-vessel vasculitis overlapping with PMR; histology shows 'skip lesions'.
- Polyarteritis Nodosa — Polyarteritis nodosa (PAN) is a vasculitis affecting medium- sized arteries with necrotizing inflammation leading to ane
- Behcet's Syndrome — Behcet's syndrome is a complex multisystem disorder associated with presumed autoimmune mediated inflammation of the art
- Familial Mediterranean Fever — Familial Mediterranean Fever (FMF, also known as recurrent polyserositis) is an autosomal recessive disorder typically p
Crystal & Metabolic Bone Disease
- Mcardle's Disease — autosomal recessive type V glycogen storage disease
- Gout: Drug Causes — Gout is a form of microcrystal synovitis caused by deposition of monosodium urate monohydrate in the synovium, due to ch
- Osteogenesis Imperfecta — Osteogenesis imperfecta (more commonly known as brittle bone disease) is a group of disorders of collagen metabolism res
- Osteoporosis: Glucocorticoid-Induced — Corticosteroid use is one of the most important risk factors for osteoporosis; given how widely these drugs are used, ma
- Avascular Necrosis of the Hip — Avascular necrosis (AVN) may be defined as death of bone tissue secondary to loss of the blood supply. This leads to bon
- Gout: Management — Gout: monosodium urate deposition from chronic hyperuricaemia · a normal serum urate during an acute attack does not exc
- Bisphosphonates — Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoc
- Osteomalacia — normal bony tissue but decreased mineral content
- Pseudogout — Pseudogout is a form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate in the synovi
- Osteoporosis: Causes — Advancing age and female sex are significant risk factors for osteoporosis. Prevalence of osteoporosis increases from 2%
- Osteoporosis: Management — Assess fracture risk with FRAX or QFracture in anyone aged 50+ with a clinical risk factor, or younger adults with major
- Vitamin D Supplementation — Vitamin D supplementation has been a hot topic for a number of years now. The muddied waters are now slightly clearer fo
- Osteoporosis: Dexa Scan — T score: based on bone mass of young reference population
- Gout: Features — Gout is a form of inflammatory arthritis; patients typically have episodes lasting several days when their gout flares,
- Gout: Predisposing Factors — Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is
- Osteoporosis — Family history
Regional Pain & Soft Tissue
- Carpal Tunnel Syndrome — Carpal tunnel syndrome is caused by compression of median nerve in the carpal tunnel. History
- Lower Back Pain: Prolapsed Disc — A prolapsed lumbar disc usually produces clear dermatomal leg pain associated with neurological deficits
- Elbow Pain — Lateral epicondylitis (tennis elbow): pain and tenderness localised to the lateral epicondyle; worse on resisted wrist e
- Osteomyelitis — Osteomyelitis describes an infection of the bone. Staph. aureus is the most common cause except in patients with sickle-
- Lateral Epicondylitis — Lateral epicondylitis typically follows unaccustomed activity such as house painting or playing tennis ('tennis elbow').
- Meralgia Paraesthetica — Meralgia paraesthetica comes from the Greek words meros for thigh and algos for pain and is often described as a syndrom
- Cubital Tunnel Syndrome — Cubital tunnel syndrome occurs due to compression of the ulnar nerve as it passes through the cubital tunnel. History an
- Hip Pain in Adults — Osteoarthritis: pain exacerbated by exercise and relieved by rest; reduced internal rotation is often the first sign
- Ankle Injury: Ottawa Rules — The Ottawa Rules for ankle x-rays have a sensitivity approaching 100%
- Adhesive Capsulitis — Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain. It is most common in middle-aged females. The
- Elbow Pain — The table below details some of the characteristic features of conditions causing elbow pain: Lateral epicondylitis (ten
- Lower Back Pain — Lower back pain (LBP) is one of the most common presentations in practice; most cases are non-specific/muscular, but cer
Drugs, Fibromyalgia & Miscellaneous
- Tumour Necrosis Factor — Tumour necrosis factor (TNF) is a pro-inflammatory cytokine with multiple roles in the immune system TNF is secreted mai
- Sulfasalazine — Sulfasalazine is a disease modifying anti-rheumatic drug used in the management of inflammatory arthritis, especially rh
- Methotrexate — Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purine
- Marfan's Syndrome — Marfan's syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chro
- Ehler-Danlos Syndrome — Ehler-Danlos syndrome is an autosomal dominant connective tissue disorder that mostly affects type III collagen.
- Azathioprine — Azathioprine is metabolised to the active compound mercaptopurine, a purine analogue that inhibits purine synthesis
- Fibromyalgia — Fibromyalgia is a syndrome characterised by widespread pain throughout the body with tender points at specific anatomica
- HLA-B27 — Note: the original source text for this chapter did not match its title — rewritten here with proper HLA-B27 content
- Chronic Fatigue Syndrome — Diagnosed after at least 4 months of disabling fatigue affecting mental and physical function more than 50% of the time
- Hydroxychloroquine — Hydroxychloroquine is used in the management of rheumatoid arthritis and systemic/discoid lupus erythematosus; pharmacol
- Lumbar Spinal Stenosis — Lumbar spinal stenosis is a condition in which the central canal is narrowed by tumour, disc prolapse, or other degenera
- Leflunomide — Leflunomide is a disease modifying anti-rheumatic drug (DMARD) mainly used in the management of rheumatoid arthritis. It
- Pseudoxanthoma Elasticum — Pseudoxanthoma elasticum is an inherited condition (usually autosomal recessive) characterised by an abnormality in elas
- Polymyositis — inflammatory disorder causing symmetrical, proximal muscle weakness
- Osteopetrosis — also known as marble bone disease
- Polymyalgia Rheumatica — Pathophysiology
- De Quervain's Tenosynovitis — De Quervain's tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abduct
- Seronegative Spondyloarthropathies — Common features