Glossary of rheumatic disorders

Achilles tendinitis Pain and sometimes swelling of Achilles tendons ('heel cords'); may be traumatic, or secondary to underlying inflammatory arthritis (such as Reiter's disease) AcromegaJic arthritis Articular cartilage hypertrophy; enlarged wrists: compres• sion of median nerves in carpal tunnels; synovial joints may be painful and enlarged; backache: enlarged vertebrae, calcified intervertebral discs Acromioclavicular arthritis Pain and swelling due to osteoarthritis/mild subluxation of acromioclavicular joints Agammaglobinaemia arthritis See: hypogammaglobinaemia Amyloid joint disease Amyloid infiltration of joints, tendons and carpal tunnels; in association with multiple myeloma, or secondary to severe rheumatoid disease Ankylosing hyperostosis (Forestier's disease) Backache: large bridging vertebrae and form• ing anterior band simulating ankylosing spondylitis, but sacroiliac joints normal; some patients are diabetic or pre• diabetic. Ankylosing spondyHtis Backache: mainly young adult males; marked hereditary factors - histocompatibility antigen HLA-B27 present in over 90% of patients; limited back movements in all planes, limited chest expansion; typical radiological changes in

139 Problems in arthritis and rheumatism

spine and sacroiliac joints; hips and often affec• ted, rarely small joints; anterior uveitis (common), specific aortic lesion (rare) Aortic arch syndrome See Pulseless disease Atrophic polychondritis See:

Behttet's syndrome Episodic iritis and painful orogenital ulceration; occasional thrombophlebitis, neurological and other manifestations; arthritis in over 50 % of cases, chronic or episodic Bicipital tendinitis Non-specific inflammation of tendon of long head of biceps, either at anterior aspect of or at its insertion in cubital fossa Brachial neuralgia See Neuralgia Brucella arthritis Arthralgia or backache (due to spondylitis) in brucellosis; occasionally, chronic destructive changes due to joint or spine infection Swelling or effusions into bursae; traumatic or secondary to rheumatoid arthritis or gout

Caplan's syndrome (rheumatoid pneumoconiosis) Characteristic radiological appearance of lungs in patients with pneumoconiosis who develop rheumatoid disease; multiple nodules on fibrotic background Capsulitis of shoulder (periarthritis, frozen shoulder) Inflammation and fibrosis of shoulder-joint capsule and surrounding tissues; shoulder initially painful and stiff, later pain subsides but stiffness persists for months; usually idiopathic, but predisposing causes include trauma, myo• cardial infarction, cervical spondylosis Carpal tunnel syndrome Pain and paraesthesiae in median nerve distribution of hand due to compression of nerve in carpal tunnel; usually no obvious cause, occasionally oedema, , etc. compresses nerve; occasionally, wasting of thenar emin• ence; median nerve conduction latency increased Cervical disc lesion/spondylosis Lateral disc herniation/osteoarthritis of cervical spine;

140 Appendix-Glossary

pain and stiffness; segmental pain and paraesthesia in arm and hand; occasionally, segmental wasting of hand muscles, cord pressure causing cervical myelopathy), faint• ing attacks due to vertebrobasilar insufficiency. Charcot's joints (neuropathic arthritis) In certain lower motor neurone diseases, especially tabes, diabetes, syringomyelia and polyneuritis; joints enlarged, usually painless, sometimes unstable Chondrocalcinosis Crystal deposition in joints of soft tissues (urate, apatite or pyrophosphate crystals); recurrent attacks of pain (pseudo• gout), effusions or chronic arthritis Chondromalacia patellae Premature degeneration of patellar cartilage; recurrent pain/slight swelling of knees Colitic arthritis See Enteropathic arthritis Crohn's disease See: Enteropathic arthritis Crystal deposition disease See: Chondrocalcinosis

Dermatomyositis Systemic connective tissue disorder characterized by and skin lesions especially in the elderly; some• times secondary to (latent) malignant neoplasm; proximal muscles weak, may be painful; serum muscle enzymes raised; rashes: heliotrope eruption on face, circumorbital oedema, violaceous rash on knuckles; arthralgia often occurs Disc lesions See under Cervical, Thoracic and Lumbar disc lesions

Enteropathic arthritis Peripheral arthritis and sacroiliitis associated with ulcer• ative colitis, Crohn's disease or Whipple's disease (q.v.); episodic seronegative arthritis affecting mainly lower limb joints, flaring with activity of intestinal disease; backache due to sacroiliitis (does not parallel intestinal disease) Epicondylitis See: , and Golfer's elbow Erythema nodosum, arthritis with Painful bluish papulonodular rash on legs; arthralgia, usually lower limbs, for a few weeks or months; most cases

141 Problems in arthritis and rheumatism

are associated with pulmonary sarcoid (bilateral hilar adenopathy), occasionally focal streptococcal infections, enteropathic arthritis or Beh.;:et's disease.

Felty's syndrome Rheumatoid arthritis with hypersplenism: splenomegaly, leukopenia, thrombocytopenia; recurrent infections, due to poor neutrophil chemotaxis Fibrositis Lay term for pain due to muscle spasm, often in the spine; it usually represents referred pain from spinal conditions such as spondylosis Frozen shoulder See: Capsulitis

Giant cell See: Temporal arteritis Golfer's elbow Epicondylitis (a form of ) at medial side of elbow, involving common flexor origin from medial epi• condyle of humerus Gout A form of acute due to deposition of urate crystals, in patients (mainly males) who have metabolic error leading to high serum urate levels; strong familial tendency; class• ical attacks of severe pain in metatarsophalangeal joint of big toe spreading up the foot; occasionally, polyarticular attacks; when chronic: urate deposits lead to tophi form• ation, chronic arthritis and renal failure; secondary gout: due to excess urate production (as in polycythaemia vera) or decreased urate excretion (as in chronic renal failure); raised serum uric acid, synovial fluid contains needle• shaped urate cyrstals.

Haemarthrosis Bleeding into a synovial joint causing severe pain and swell• ing (as in haemophilia) and not infrequently in osteoarthritic joints in elderly patients Haemophilic arthritis Acute haemarthroses due to haemorrhages into joints in haemophilia and other haemorrhagic disorders; secondary osteoarthritis often supervenes Henoch-Schonlein purpura Acute arthritis, usually of knees or ankles, with petechial

142 Appendix-Glossary

rash particularly on buttocks, usually in children; abdom• inal pain and melaena may occur; haematuria, nephritis in some cases Hydrarthrosis. intermittent Periodic effusions into large joints, especially knees; aetiology uncertain - no connection with rheumatoid disease syndrome Local or generalized pain syndromes due to strain on liga• mentsinhypermobilejoints; effusions may occur, eventually osteoarthritis; sometimes hereditary (as in Marfan's syndrome) or metabolic (such as homocystinuria); backache due to 'loose back syndrome' often associated with general• ized hypermobility Hyperparathyroidism Abnormal calcium metabolism may lead to spinal osteo• porosis, metastatic calcification or pyrophosphate arthro• pathy (q.v.); synovitis associated with softening of para• articular bone Hypertrophic osteoarthropathy Arthropathy, finger clubbing and periostitis usually assoc• iated with malignant tumour (especially bronchogenic carCinoma) Hypogammaglobinaemia, arthritis with Seronegative arthritis resembling rheumatoid in patients with low or absent gammaglobulin and immunoglobulin G; congenital and acquired varieties; mainly large joints involved, often asymmetrical; recurrent respiratory tract infections Hypothyroidism Muscular rheumatism or arthralgia may occur; symptoms respond to thyroid replacement; carpal tunnel syndrome is common

Infective arthritis See: Septic arthritis Intermittent hydrarthrosis See: Hydrarthrosis, intermittent

Jaccoud syndrome (chronic secondary polyarthritis) Tendon lesions of hands due to fibrosis, hand deformities (ulnar deviation) following recurrent attacks of rheumatic fever

143 Problems in arthritis and rheumatism

Juvenile chronic arthritis Arthritis in children (see Still's disease)

Leukaemic arthritis Arthritis in acute leukaemia in children; secondary gout may occur; arthritis in chronic leukaemia of adults Lumbar disc lesions/spondylosis Traumatic or degenerative lesions of vertebrae and inter• vertebral discs; low back pain with or without sciatica in lateral disc prolapse, paraesthesiae in root distribution (commonly L5-S1); occasionally, segmental muscle weak• ness and wasting; limited straight leg raising (lower lumbar lesions), positive femoral nerve stretch (upper lumbar lesions); cauda equina lesions: weakness, bladder and bowel sphincter disturbance, perianal analgesia erythematosis See: Systemic lupus erythematosus (SLE)

Mixed connective tissue disease Combination of various systemic connective tissue diseases, such as rheumatoid arthritis, systemic sclerosis and SLE, overlapping in the same patient. ANA-positive but DNA• binding negative and antiRNA antibodies positive; prog• nosis said to be good but many cases later 'polarize' to become a more definite systemic connective tissue disorder with its appropriate prognosis Morton's Pain between toes, said to be due to neurofibroma of anastomosing plantar digital nerves Myelomatosis (multiple myeloma) Monoclonal gammopathy due to excess plasma cells, with paraprotein deposition in bone and soft tissues; electro• phoresis shows paraprotein (dense abnormal band); back pain due to vertebral involvement; peripheral arthropathy from secondary amyloid deposition; Bence-Jones protein• uria in some cases; carpal tunnel syndrome, secondary gout, hypercalcaemia and renal failure may occur Myxoedema See: Hypothyroidism

Neur~,brachUd Pain radiating down arm usually with paraesthesia of root distribution; commonly due to nerve-root involvement in cervical spondylosis or disc lesion 144 Appendix-Glossary

Neuropathic arthritis See: Charcot joints

Ochronotic arthropathy (ochronosis) Hereditary arthropathy due to disorder of tyrosine metab• olism: accumulation of homogentisic acid in cartilage; alcaptonuria (urine goes black on standing due to homo• gentisic acid; spine: calcification of intervertebral discs, limited movements; large joints (knees and shoulders) pain• ful and stiff; ear and nose cartilages appear brown Osteitis condensans iJii Radiological appearance of para-articular sclerosis of ilial side of sacroiliac joints without erosions or narrowing of the joints; a disputed cause of low back pain, especially in females Osteoarthritis (osteoartbrosis) Degenerative joint disease; involvement of certain joints (such as TIP joints of fingers, MTP joints of big toes) char• acteristic; joints stiff, moderately painful, movements limited; effusions in large joints sometimes due to crystal deposition; deformities mainly due to cartilage loss, such as genu valgum; acute synovitis and attacks of pain (probably due to calcium apatite deposition) may occur Osteochondritis Non-specific inflammation of bone and cartilage in young people often affecting epiphyses of growing bones; examples: Perthes disease (osteochondritis of femoral head), Schuermann's disease (vertebrae), Osgood• Schlatter's disease (tibial tubercle)

Paget's disease of bone Bone absorption with concurrent new bone formation; asymptomatic lesions (seen on X-ray) common; back andlimb pains are common and deformity may occur; skull large, when involved; raised serum alkaline phosphatase (acid phosphatase normal) in active disease; complications: osteoarthritis of associated joints, osteogenic sarcoma PaHndromicrheumatism Episodic arthritis or arthralgia; joint pain is often very severe, swelling slight or absent; intervals between attacks almost symptom free; many patients later develop rheum• atoid arthritis

145 Problems in arthritis and rheumatism

PannicuHtis Painful localized fat deposits, often around knees in meno• pausal women; pain is often confused with that due to associated osteoarthritis. Plantar Commonest cause of pain under the heel: an enthesopathy (tenoperiostitis of attachment of plantar fascia to inferior surface of calcaneum); a 'simple spur' is commonly seen in X-ray; rarely, a 'compound spur' indicating inflammation and periosteal reaction secondary to ankylosing spondyl• itis, Reiter's disease or other seronegative spondarthritis Polyarteritis (polyarteritis nodosa) Systemic connective tissue disorder involving arteries; necrotizing arteritis of all three coats, Australia antigen (hepatitis B) occasionally present; protein manifestations: arthralgia, fever, peripheral neuropathy, renal disease, lung disease, coronary artery disease, peripheral neuro• pathy, abdominal pain and intestinal infarction; negative tests for rheumatoid factor (unless polyarteritis is second• ary to rheumatoid disease) Polymyalgia rheumatica Syndrome of central joint pain, morning stiffness and high ESR in the elderly. Some cases due to cranial arteritis, some idiopathic, some are prodromal rheumatoid arthritis and some herald malignancy or myelomatosis Polymyositis is (q.v.) without skin lesions; secondary polymyositis may occur in any systemic connec• tive tissue disorder, such as polyarteritis, systemic sclero• sis, mixed connective tissue disease and systemic lupus Pseudolout See: Chondrocalcinosis Psoriatic arthritis Atypical seronegative arthritis associated with psoriasis (or psoriasis in a close relative); 10% of psoriatic patients with psoriasis will develop psoriatic arthritis Four types: (a) indeterminate, resembling rheumatoid arthritis, (b) classical, characterized by erosions of term• inal interphalangeal joints, (c) mutilating, with osteolysis and gross deformities of hands and feet, (d) spondylitic, resembling ankylosing spondylitis. Special features include 'sausage toes' (inflammation of joints and soft tissues), bony anIcylosis, sacroiliitis, spondy• litis, paravertebral ligamentous ossification

146 Appendix-Glossary

Pulseless disease (aortic arch syndrome or Takayusu's disease) variety of arteritis affecting branches of aortic arch; absent upper limb pulses, cerebral ischaemia, involvement of retinal arteries Pyrophosphate arthropathy See: Chondrocalcinosis de Quervain's disease Common form of tenosynovitis affecting flexor sheath of abductor pollicis longus and extensor pollicis brevis at radial side of the wrist

Reiter's disease Seronegative spondarthritis (HLA-B27 often present) associated with non-specific urethritis and conjunctivitis, usually post-venereal; lower limb large joints usually affected; tenosynovitis and common; sacroiliitis develops in many cases (occasionally spondyl• itis); other occasional features: balanitis, buccal ulceration, keratoderma blennorhagica Relapsing polychondritis Rare disorder in which cartilage degenerates and becomes inflamed; polyarthritis may occur, ears and nose 'flop' Rheumatic fever Polyarthritis, carditis and fever in children and young adults following focal infection with beta-haemolytic strep• tococcus; sore throat followed by migratory polyarthritis of large joints; carditis often followed by permanent valvular damage; Jaccoud's syndrome (q.v.) rarely follows repeated attacks; occasionally, painful subcutaneous 'rheumatic nodules' (smaller than rheumatoid nodules), erythema nodosum or erythema marginatum Rheumatoid arthritis Inflammatory, usually seropositive polyarthritis (occasion• ally monarthritis or pauciarthritis); classically symmetrical with erosion of joints and subsequent deformity; joints are painful, stiff, tender and swollen due to synovial hyper• trophy or effusion, later articular cartilage is eroded; involvement includes subcutaneous nodules, teno• synovitis, bursitis; extra-articular lesions in some cases: , neuropathy, , eye lesions, pulmonary lesions; anaemia common and proportional to disease 147 Problems in arthritis and rheumatism

activity; sheep cell agglutination and latex tests for rheum• atoid factor positive in 80% of adult cases. Rotator cuff syndrome See: Supraspinatus tendinitis Rubella arthritis Arthralgia or joint effusions following rubella infection, usually a few days after the rash or 2-4 weeks after rubella vaccination; carpal tunnel syndrome common; joint symptoms subside after some weeks.

Sacroiliitis Non-specific inflammation of sacroiliac joints causing low backache in ankylosing spondylitis and other varieties of seronegative spondarthritis; X-rays show widening, irregularity or erosions of sacroiliac joints Sarcoid arthritis Transient polyarthritis, usually with erythema nodosum (q.v.); rarely, chronic asymmetrical joint swelling due to sarcoid involvement of Sciatica Pain radiating down one or both legs, usually due to pro• lapse of lumbar intervertebral disc; paraesthesiae in cor• responding segments often accompanies sciatic pain See: Systemic sclerosis Septic arthritis Severe arthritis, usually monarticular, following pyogenic infection which is either haematogenous or due to local infection of joint; joint is very painful and tender, often red and hot; synovial fluid purulent with marked rise in white cell count, organisms may be cultured Shoulder-hand syndrome Capsulitis of shoulder (q.v.) associated with pain, swelling and vasomotor disturbance of ipsilateral hand in early stages; later hand becomes atrophic, with patchy osteopor• osis on X-ray (a form of algodystrophy) Sjogren's syndrome Rheumatoid arthritis (or other systemic connective tissue disease) with keratoconjunctivitis sicca; exocrine glands involved causing xerostomia, swollen parotid glands, nasal dryness, atrophic vaginitis Spondylitis See: Ankylosing spondylitis. (NB: do not confuse with spondylosis)

148 Appendix-Glossary

Spondylosis Osteoarthritis of spine (see cervical spondylosis, lumbar spondylosis) Still's disease One variety of juvenile chronic arthritis crCA); polyarthritis in some ways resembling rheumatoid arthritis, together with systemic features; arthritis particularly involves wrists and cervical spine at an early stage; seronegative, no subcutaneous nodules; growth stunting and epiphyseal disturbances common; in classical acute cases: pyrexia, maculopapular rash, lymphadenopathy, occasional splen• omegaly; severe iritis is not uncommon, especially in the pauciarticular type of ]CA. Supraspinatus tendinitis 'Painful arc syndrome' - common cause Gf painful shoulder, due to non-specific inflammation of rotator cuff (common insertion of supraspinatus, infraspinatus and teres minor into greater tuberosity of humerus); often traumatic, may be idiopathic (degenerative); severe or recurrent cases may be associated with calcific (apatite) deposits Systemic lupus erythematosus (SLE) Connective tissue disorder characterized by lesions due to fibrinoid degeneration of walls of blood vessels and deposi• tion of immune complexes; arthritis or arthralgia in all cases, but joint destruction and deformity is not common; characteristic rash in butterfly area of face; prognosis is poor, death usually due to re_nal involvement or cerebral involvement (in those without renal disease); other features include fever, cardiorenal disease, serositis, hepatomegaly and splenomegaly, blood dyscrasias, anaemia, neutropenia, thrombocytopenia, haemolytic anaemia; wide variety of immunological disorders include positive antinuclear anti• bodies, raised DNA-binding, LE cells in peripheral blood Systemic sclerosis Connective tissue disorder characterized by thickened skin and subcutaneous tissues due to increase in dermal collagen and atrophy of epidermia; skin shiny, thick, later ulcerated, occasionally telangiectatic; finger due to dermal fibrosis, subcutaneous calcinOSis; arthritis (seropositive or seronegative) of small joints is common and often difficult to distinguish from coexistent rheumatoid arthritis; dysphagia due to oesophageal fibrosis (shown by barium swallow) is characteristic; occasional features: myopathy, malabsorption due to gut involvement, pulmon-

149 Problems in arthritis and rheumatism

ary fibrosis, cardiac conduction defects, renal involvement causing malignant hypertension

Takayusu's disease See: Pulseless disease Tennis elbow Non-specific inflammation of common extensor origin at the lateral epicondyle of the humerus (enthesopathy); com• monest cause of pain in the elbow Tenosynovitis Non-specific inflammation of a tendon sheath (primary or secondary to inflammatory polyarthritis) Tietze's syndrome Attacks of pain, tenderness and swelling of costosternal joints; often self-limiting, subsiding within a year Traumatic arthritis Synovitis or arthralgia following trauma to joint; sudden onset of monarticular swelling of a normal or previously arthritic joint Tuberculous arthritis Monarticular arthritis due to infection by Mycobacterium tuberculosis; joint pain with marked wasting of adjacent muscles and swelling, with shiny, bluish overlying skin; back pain and subsequent deformities due to vertebral involvement; cold abscesses (paravertebral, for example).

Ulcerative colitis, arthritis with See: Enteropathic arthritis

Wegener's granulomatosus Necrotizing lesion of nasal cartilages together with wide• spread polyarteritis Whipple's disease Probably bacterial infection of intestinal mucosa and fat, causing malabsorption, lymphadenopathy and a form of episodic seronegative spondarthritis Wilson's disease Hepatolenticular degeneration due to copper accumulation in tissues, the various manifestations relating principally to liver and nervous system disorder; Kayser-Fleischer rings in cornea; premature osteoarthritis and joint hyper• mobility in some patients

150 Further reading

General textbooks of Scott, J. (ed.)(1980). Copeman's Textbook of the Rheumatic Diseases, 6th Ed. (Edinburgh: Churchill Livingstone). A large, comprehensive text, for selected rather than general reading Mason, and Currey, (1980). An Introduction to Clinical Rheumatology, 3rd Ed. (London: Pitman). A small, compact book written for medical students, inclined to be theoretical rather than practical in its outlook Golding, D., (19-). Synopsis of the Rheumatic Diseases, 4th Ed. (Bristol: J. Wright &: Sons) (In preparation). A small, condensed text

Boob related to management Golding, D. (ed.) (1979). Concise Management of the Common Rheumatic Disorders (Bristol: J. Wright &: Sons). Companion to Synopsis, emphasizing practical treatment Hart, (ed.) (1978). Drug Treatment of the Rheumatic Diseases (Sydney: Adis Press). Useful information about all aspects of drug therapy Hollingsworth, (1978). Management of Rheumatoid Arthritis and its Complications (Year Book Medical Publishers, Inc.) Detailed up-to• date management of all aspects of the disease

151 Index

Achilles tendinitis 135, 139 anaemia 34,38,54 acupuncture 80,81,122,126 in rheumatoid arthritis 38, 93, techniques 69 95 theories 69 analgesics 57-9 adverse reactions classification 57 aspirin 58,80,61 ankle pain 135 azathioprine 66 ankylosing hyperostOSis, senile chloroquine 100 120, 139 codeine 58 ankylosing spondylitis 15, 101, cyclophosphamide 66 139 dihydrocodeine 59 advanced, features 106 elderly 101 clinical features 105, 106 gold 43, 100, 101 complications 20 hyperuricaemia 112 counselling 107 indomethacin 62, 101 early diagnosis 23 non-steroidal anti-inflammatory eye disorders 33, 34 drugs 24,61-4 general practice management paracetamol 57 107 penicillamine 43, 100, 101 and HLA-B27 97,104,139 pethidine 59 inheritance 18 phenylbutazone 63, 64 pain relief 107 systemic steroids 32, 65 prognosis 20 age respiratory disorders 34 and arthritis 100-2 spinal exercise 55 and prognosis 18 X-ray changes 37 albuminuria, significance of 34 X-ray therapy 103 alclofenac 61 anti-inflammatory drugs see also allopurinol 21, 110 non-steroidal anti• effects in gout 113 inflammatory drugs timing 25,112 classification 59 amitriptyline 49, 52 antinuclear antibody 40 amyloid disease 34, 43, 139 antistreptolysin 0 titre 41 in rheumatoid arthritis 95 aortic arch syndrome 140

153 Problems in arthritis and rheumatism aortic incompetance 105 chronic, management 122, arteritis 33 123 temporal 26,142 exercises 123 arthritis investigation of 120, 121 acromegalic 139 treatment 121-3 acromioclavicular 139 BehQet's disease 33,140 active and inactive 54 bicipital tendinitis 140 acute septic 97,143 biopsy, joint 36 agammaglobulinaemia 139 Bonchard's nodes 87 atypical, features of 16, 17 brachial neuralgia 125, 126, brucella 140 140, 144 classification 15-17 British Rheumatism and Arthritis crystal deposition 109-11 see Association, patient help 26 also gout Buerger's disease 136 degenerative 15 bursitis 77,82, 140 endocrine 16 enteropathic 104, 141 calcium apatite 87 haemophilic 140 Caplan's syndrome 140 HLA B27-associated 97, 101 capsulitis 77,83, 140 see also 15 frozen shoulder inflammatory 15, 16 stages and treatment 128 joint pain 29, 30 carpal tunnel syndrome 24, 92, leukaemic 144 140 management 51-74 causes 129,130 metabolic 16 cauda equina lesions 122 neuropathic 145 cervical spondylitis and sciatica reactive 16, 97 37 rubella 148 Charcot's joints 141 sarcoid 148 chlorambucil 66 secondary 15 chloroquine 99,100 and systemic disorders 14 potency 100 traumatic 15, 150 chondrocalcinosis (pseudogout) tuberculous 150 44, 109, 141 Arthritis and Rheumatism Council, and chronic arthritis 111 patient help 26 laboratory tests 113 arthrodesis 56 treatment 113 arthroplasty 56 varieties 110 arthroscopy 36 chondromalacia patellae 140 aspiration, joint effusions 107, coccygodynia 84 112 codeine 58 technique 67 corsets 122 aspirin 52,57, 58, 99 see steroids atlanto-axial subluxation 26 Crohn's disease 104 atrophic polychondritis 140 cyclophosphamide 66 Australia antigen 146 azapropazone 61 deformity 31,32 azathioprine 66 correction in osteoarthritis 88,89 back pain 24, 117-23 correction in rheumatoid acute, management scheme arthritis 99 121, 122 depression 35 aggravation 118 overlay 49

154 Index dermatomyositis 32, 141 foot dextropropoxyphene 58 flat see pes planus diazepam 48, 52 pain 25, 135, 136 diclofenac 61 vascular disorders 136 diflunisal 58 frozen shoulder (capsulitis) 19, dihydrocodeine 52,59 27, 142 dipipanone 59 causes 127 disc lesions 118, 140, 141, 144 limitation of movement 31 disease activity 54 assessment 54 genu valgum 19 quantitative comparison 54, gold 43, 55, 65, 99 55 administration 100 reduction of 55 effects 99 DNA binding 40 in elderly 101 dothiepin 52 monitoring 100 drooping shoulder girdles 126 golfers elbow (epicondylitis) 129, 142 elderly, arthritis and drug gonococcal complement fixation reactions 101, 102 test 40,41 enthesopathy 77,83 gout 142 epicondylitis see also golfers and and alcohol 112 tennis elbow atypical 110 erythema nodosum 141, 142 chronic tophaceous 110 and diagnosis 33 classical acute 110 erythrocyte sedimentation rate diet 113 19,20,54 drugs 25 in ankylosing spondylitis 104, incidence 18 105 patient investigations 111 rheumatoid arthritis 93 prognosis 21 rheumatologists yardstick 38 rheumatoid arthritis usefulness 26 differentiation 97 Westergren method 38 serum uric acid (SUA) 26,41, ethoheptazine 52 42, 110 exercises for low back pain 122, treatment 112, 113 123 varieties 109, 110 eye disorders X-ray changes 37 and dia.gnosis 34 in rheumatoid arthritis 95 haemarthrosis 142 Heberden's nodes 87, 96 fasciitis 77-9 heel pain 135 plantar 78 Henoch-Sch6nlein purpura 142, treatment 78, 79 143 X-ray spurs 78, 79 hip Felty's syndrome 15, 38, 142 congenital dislocation 85, 86 lymph nodes 35 pain 25,134 fenclofenac 61 replacement 88,107 fenoprofen 61 HLA antigens, B27 significance feprazone 61 41,97,104,139 fibrositis 77,80,81, 142 hydrarthrosis 143 syndrome 81 hydrotherapy 70 flufenamic acid 61,62 hypermobility syndrome 17,143 flurbiprofen 62 hyperparathyroidism 143

155 Problems in arthritis and rheumatism

hypertrophic pulmonary diagnosis and treatment 134, osteoarthropathy 15,143 135 hypogammaglobulinaemia 40, lymphadenopathy 35 139, 143 hypothyroidism 143 manipulation, back 24,53 hysterical-conversion reactions contraindications 68 49 indications 68 62 lumbar 122 imipramine 52 andpain 53 immunoglobulins, polyclonal technique 68 increase 40 Marfan's syndrome 18 immunological tests 38-41 mefanemic acid 63 basic profile 41 mixed connective tissue disease immunostimulant drugs 67 144 immunosuppressive drugs 66 mobility improvement 55, 56,88, indomethacin 25, 62, 63 99,107 at night 62 and surgery 56 intervertebral joint derangement Morton's metatarsalgia 136, 26 144 iridocyclitis (anterior uveitis) and movement limitation 31 ankylosing spondylitis 33, and shoulder pain diagnosis 34 127 iritis 105 multiple sclerosis 32 muscle wasting, causes 32 Jaccoud syndrome 143, 147 myelography 122 juvenile chronic arthritis 144 myelomatosis 40,144 incidence 18 myocrisin 100 varieties 101 myopathy and halogenated steroids 32 ketoprofen 63, 99 myositis 77,81 see also I

156 Index

properties and composition muscle relaxants 52 61-4 non-steroidal anti-inflammatory response 24 drugs 24,52,98 uses 59,60 osteoarthritis 87, 88 physiotherapy 53 occupational therapy 72-4 reduction of disease activity patient assessment for 72 54-6 ochronotic arthropathy 145 rheumatoid arthritis 98-101 osteitis condensans ilii 145 specific anti-rheumatics 99 osteoarthritis 18,85-9,145 steroid injections 52, 53, 99 aetiology 85,86 panndculitis 77,79,80,86,146 aggrevating factors 85, 86 fat lady's knee 79, 80 articular cartilage 86 paracetamol 24,57 differentiation from paraesthesiae rheumatoid arthritis 96 arms 24 hip 134 and nerve root compression hospital management 88 30,32 ligament inflammation 30 source 32 management in family practice penicillamine 55, 65, 99 87,88 dose 99 pain and stiffness 87 effects 99 predisposing factors 85 in elderly 101 presentation 87 monitoring 100 prognosis 19,20 pentazocine 59 prosthesis 19 peptic ulcer and NSA1Ds 24 radiology 18 pes planus, treatment 136 secondary hip dislocation 85, pethidine 59 86 phenylbutazone 25, 63 surgery 25 ankylosing spondylitis 107 X-ray changes 37 gout 112 X-ray lippings 86 uses 64 osteochondritis 145 physiotherapy 45, 53, 69-72 osteomalacia, useful tests 42 faradic stimulation 71 osteotomy 56 home exercises 71,72 information needed for 70 Paget's disease 88, 145 pseudogout 113 pain see also back, upper and techniques 71 lower limbs usefulness 69 arms 24 piroxicam 64 burning and stabbing 30 135, 146 and inflammation 30 plasma protein and joint in arthritis 29 electrophoresis 42, 43 mechanical 30 polyarteritis nodosa 33, 146 neck and back, causes 117, polychondritis, relapsing 147 118 polymyalgia rheumatica 17,81, referred 17, 25, 30 82,127,146 at rest 30 and endocarditis 82 pain relief 51-74 incidence 18 analgesics 57-9,98 misdiagnosis in elderly 101 anti-inflammatory drugs nature of 82 57-67, 99, 107 see also picture of 81 aspirin recognition 26 heat and cold 51 syndrome 81 157 Problems in arthritis and rheumatism

systemic steroids in 64 rheumatism, spft.tissue 17, treatment 82 77-84 polymyositis 14,81,146 classification 77 muscle wasting 32 definition 77 steroid dose 81 prognosis 19 prednisolone 82 psychogenic 84 prostate carcinoma 42 rheumatoid arthritis 18, 147, prosthesis 134 148 Charnley 88 aetiology 91 proteinuria 43 childhood 100, 101 pseudogout 111,146 complications 94-6 psoriatic arthritis 104, 146 deformities 32,92-4,Q9 psychological factors 47-50 96, 97 psychological overlay early diagnosis 91, 92 assessment 47,48 early management 97 categories 47 elderly 101, 102 pulseless disease 147 foot pain 25 hospital management 98-100 quadriceps muscle wasting 32 incidence 18 de Quervain's disease 147 laboratory investigations 35-44 rash, butterfly 33 management 98 referral 44 palmar erythema 92 letter, information needed 45 presenting features 92 rheumatoid arthritis 93 prognosis 20 and surgery 44 early 27 Reiter's disease 33, 104, 139, factors affecting 18, 19 147 referral 93 renal failure and diagnosis 34 specific drugs 65, 99, 100 rest 55 ulnar deviation 95 effects of 122 X-ray changes 37 low back pain 121, 122 rheumatoid factor rheumatic disorders incidence 39 diagnosis and symptoms nature 39 29-35 and rheumatoid arthritis frequency in practice 17, 18 prognosis 19 investigations 36-44 tests for 39, 40, 93 pain 29,30 usefulness 26,39 work days lost 18 rheumatoid nodules 93 rheumatic fever 147 rheumatology rheumatism in general practice 13 classification 17 rotator cuff lesions 27,127,148 criteria for psychogenic 49, treatment 128 50 generalized 83 sacroiliitis 104, 148 inherited disorders 18 investigations 104 management 51-74 sciatica 24,148 non-articular 13 definition 133 palindromic 145 management 121-3 psychogenic 47,49,50 neurogenic claudication 134 psychosomatic 14, 15 scleroderma 148 see also and referred pain 17 systemic sclerosis and systemic disorders 14 scoliosis 32 158 Index seronegative spondarthritis 39, tennis elbow (epicondylitis) 14, 103 see also ankylosing 31, 150 spondylitis causes 129 definition 103 incidence 18 HLAB27 104 steroid injections 27 sacroiliitis 104 tenosynovitis 77,82,83,129, varieties of 104 147,150 shoulder pain 17, 18, 27, 127 treatment 83 causes 127 Tietze's syndrome 150 diagnosis 127 tolmetin 64 treatment 128 tophi 111 shoulder-hand syndrome 148 torticollis 32 Sjogren's syndrome 148 traction, lumbar 122 spondylolisthesis, X-ray 120 treatment spondylosis 148, 149 ankylosing spondylitis 20, 107 steroid injections 52,53,55,136 bursitis 83 local in osteoarthritis 87 fasciitis 78, 79 steroids, systemic 99 gout 21, 112, 113 doses 64 neck pain 119 precautions 65 osteoarthritis 87-9 prescription 64 polymyalgia rheumatica 82 side-effects 65 polymyositis 81 stiffness pseudogout 113 apparent 30 psychogenic rheumatism 50 joint and muscle 30, 87 rheumatoid arthritis 20, rheumatoid arthritis 94 98-102 Still's disease 149 tennis elbow 14, 27 lymph nodes 35 tenosynovitis 83 symptoms and signs 101 triamcinolone and muscle wasting sulindac 64 32 supraspinatus tendinitis 149 surgery ulnar nerve entrapment 87 osteoarthritis 89,134 upper limb problems 125-31 tennis elbow 129 examination, investigations and swelling, cardinal sign of arthritis treatment scheme 130 30,31 multilevel case 131 symptoms and signs of rheumatic pain causes 125-7 disorders shoulder pain 127 significance 29-35 uric acid synovectomy, medical with drugs affecting 21 yttrium 99 serum (SUA), usefulness 26, synovial fluid analysis 44 41,42 synovitis 31,32 systemic lupus erythematosus vasculitis 94, 96 34,38,84,96,144,149 virus polyarthritis 96 immunological tests 40 systemic sclerosis 81,96,149 Wegener's granulomatosis 150 Whipple's disease 104,150 Takayusu's disease 147, 150 Wilson's disease 150 tarsal tunnel syndrome 136 wrist pain 129 tenderness joint 31 X-ray referred 31 ankylosing spondylitis 23, 106 159 Problems in arthritis and rheumatism arthrograms 37 osteoarthritis 86, 88 backpain 37 pseudogout 111 bone erosions in rheumatoid reasons for 36 arthritis 27 and rheumatic disease cervical spine pain 119 diagnosis 36, 37 hippain 25 rheumatoid arthritis 93 myelograms 37

160