DOCSLIB.ORG

Rheumatology Vs Ortho: How Do You Tell?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Rheumatology Vs Ortho: How Do You Tell? Disclosures • None Rheumatology vs Ortho: How Do You Tell? Andrew J. Gross, MD Rheumatology Clinic Chief Associate Clinical Professor University of California, San Francisco Objectives Clinical Case #1 • Recognize the key features of polymyalgia • A 66 year old man comes to see you rheumatica complaining of shoulder pain. The pain came on suddenly about 3 weeks ago, • Recognize inflammatory back pain initially affecting his right shoulder and • Know the differential diagnosis of subacute then the left. The pain radiates down monoarticular arthritis into the upper arms and somewhat across his upper back and is • Know the hallmarks of fibromyalgia. exacerbated by shoulder abduction. • Distinguish rheumatoid arthritis from • He also complains of new onset lower osteoarthritis by hand joint involvement back and hip discomfort. 1 All of the following symptoms tipped you off Clinical Case #1 - Question to the diagnosis of PMR EXCEPT: You diagnose him with Polymyalgia Rheumatica (PMR). All of the following symptoms tipped you off to the 67% diagnosis of PMR EXCEPT: a. Morning stiffness lasting >45 minutes a. AM stiffness >45 min b. Hand numbness b. Hand numbness c. Pain & stiffness affects the lower back and pelvic c. lower back stiffness girdle 19% d. Pain & stiffness improves with activity d. Better w/ activity 9% 3% 2% e. ESR >40 mm/hr e. ESR >40 mm/hr i n s s h r m e e s s 5 b n f n t i v i t y m / m u m s t i f 0 n c k w / a c a > 4 n d b SR H a r E w e B e t t e r o A M stiffness >4 l Dasgupta B, et al, Ann Rheum Dis 2012, EULAR/ACR Classification Criteria Clinical Case #1 - Question Some Tips about PMR You diagnose him with Polymyalgia Rheumatica (PMR). • Typical distribution of All of the following symptoms tipped you off to the PMR symptoms… diagnosis of PMR EXCEPT: • Subdeltoid bursitis & a. Morning stiffness lasting >45 minutes biceps tenosynovitis are b. Hand numbness common in one or both c. Pain & stiffness affects the lower back and pelvic shoulders girdle • Patients may develop d. Pain & stiffness improves with activity adhesive capsulitis e. ESR >40 mm/hr Dasgupta B, et al, Ann Rheum Dis 2012, EULAR/ACR Classification Criteria Salvarani, C, et al, Nat Rev Rheumatol, 2012, PMID 22825731 2 Some more Tips about PMR Some more Tips about PMR • PMR is uncommon in patients < 60 years old • PMR is uncommon in patients < 60 years old 97 cases of PMR identified during a 10 year study from • ESR is helpful - but it is <40 mm/hr in 10-20% of patients Olmstead County, Minnesota – CRP can be helpful when ESR is <40 0-49 years 1 in a million 50-59 years 1 in 5,000 • 15% will have Giant Cell Arteritis (new onset head pain) 60-69 years 1 in 2,000 – New onset head pain 70-79 years 1 in 900 – Scalp tenderness – Jaw claudication when chewing – Sudden vision loss or diplopia Chuang TY, et al, Ann Intern Med 1983, PMID 6982645 Dasgupta B, et al, Ann Rheum Dis 2012, EULAR/ACR Classification Criteria Things patients with PMR often tell me When To Refer PMR to a rheumatologist • “I feel like I am 100 years old!” • Rheumatologists are generally pleased to see cases • “I need to crawl out of bed in of PMR the morning” • Partial response to treatment with prednisone – • “I feel okay as long as I keep should have fully response to 15-20 mg/d. moving, but I stiffen up as • Difficulty tapering prednisone soon as I sit down – like the • Symptoms of Giant Cell Arteritis tin man” • “That prednisone is a miracle” 3 Clinical Case #2 Clinical Case #2 • A 26 year old man comes to see you • The shoulder exam is notable for complaining of shoulder pain. The pain limitation in shoulder ROM (abduction, came on about 3 weeks ago, initially internal & external rotation) without affecting his right shoulder and then weakness in the rotator cuff muscles. the left. The pain does not radiate. There is some tenderness over the Range of motion of motion of both glenohumeral joint. No effusion. shoulders is limited. • Cervical spine flexion & rotation as • He also notices pain and stiffness in well as lumbar spine flexion are his neck and lower back. This is somewhat limited. Straight leg raise is worse recently, but has been present unremarkable. on an off for the past couple of years. • Hip rotation is also somewhat limited. • He complains of a hour of morning • The remainder of the joint exam is stiffness in his shoulders and low unremarkable. back. Which of the following conditions is the most likely Clinical Case #2 cause of this man’s shoulder, neck and lower back pain: Which of the following conditions is the most likely cause of this man’s shoulder, neck and 82% lower back pain: a. AS a. Ankylosing Spondylitis b. PMR b. Polymyalgia Rheumatica c. RA c. Rheumatoid Arthritis d. SLE d. Systemic Lupus Erythematosus e. CPPD e. Calcium Pyrophosphate Dihydrate Disease 10% (CPPD) 4% 1% 1% R A D AS R LE P M S P P C 4 Clinical Case #2 Typical distribution of involved joints in Which of the following conditions are a likely rheumatoid arthritis cause of this 26 y.o. man’s shoulder, neck and (and lupus) lower back pain: a. Ankylosing Spondylitis b. Polymyalgia Rheumatica (age >50) c. Rheumatoid Arthritis d. Systemic Lupus Erythematosus e. Calcium Pyrophosphate Dihydrate Disease (CPPD) (usually older people, typically spares lumbar spine) www.studyblue.com Rheumatoid Psoriatic Ankylosing Osteoarthritis Ankylosing Spondylitis Arthritis Arthritis Spondylitis https://dundeemedstudentnotes.wordpress.com/2014/06/16/polyarthritis/ 5 Ankylosing Spondylitis - sacroiliitis AS – “bamboo spine” Ankylosing Spondylitis Clinical Case #2 All of the following symptoms are associated with DIAGNOSIS inflammation of the spine (spondylitis) EXCEPT: Non-radiographic stage Radiographic stage a. Pain & stiffness improve with exercise. b. Onset of back pain was insidious Back pain Back pain Back pain c. Back pain & stiffness gets worse at night Sacroiliitis on Radiographic Syndesmophytes MRI sacroiliitis d. Burning pain in the thighs with standing e. Symptoms began before age 40 Time (years) Rudwaliet M, et al. Arthritis Rheum . 2005;52(4):1000-1008. 6 All of the following symptoms are associated with inflammation of the spine (spondylitis) EXCEPT: Clinical Case #2 All of the following symptoms are associated with inflammation of the spine (spondylitis) EXCEPT: 62% a. Improves w/ exercise a. Pain & stiffness improve with exercise. b. Insidious onset b. Onset of back pain was insidious c. Pain worse at night c. Back pain & stiffness gets worse at night d. Burning pain in thighs d. Burning pain in the thighs with standing e. Symptoms <40 y.o. 14% 14% e. Symptoms began before age 40 7% 4% t t s . s e o n 0 y . o s t h i g h 4 e x e r c i s e u < o n s w / d i r s e a t n i g h m s s i o I n y m p t p r o v e S m P a i n w o I Burning pain i Inflammatory Back Pain: NHANES 2009-2010 Hallmark Features Feature Odds Ratios Insidious onset 12.7 • 19.2% of US Adults age 20-69 years old reported chronic axial pain Pain at night (with improvement upon getting up) 20.4 • In patients with chronic axial pain, 28% to 35.5% Age at onset <40 years 9.9 had Inflammatory Back Pain Improvement with exercise 23.1 • US prevalence of IBP: 5% to 6% No improvement with rest 7.7 Sensitivity 79.6% & Specificity 72.4% Positive LR = 79.6/(100-72.4) = 2.9 ~ Probability = 14% • Self-reported prevalence of ankylosing spondylitis = 0.55 LR=likelihood ratio Sieper J, et al, Ann Rheum Dis 2009, PMID 19147614 Reveille JD, et al. Arthritis Care & Res . 2012;64(6):905-910.Weisman MH, et al . Ann Rheum Dis. Rudwaleit M, et al. Ann Rheum Dis . 2009; 68(6):777-83. Ozgocmen S, et al. J Rheumatol . 2010;37(9):1978. 2013;72(3):369-373. 7 When to refer a patient with back pain to a rheumatologist AS: Treatment • Inflammatory Back Pain • HLA-B27+ (present in 85-95% of patients with AS) • Elevated CRP Axial disease only • Sacroiliitis on imaging (x-rays or MR) • Family history of Ankylosing Spondylitis TNF NSAID NSAIDs sulfasalazine inhibitors Physical Therapy Poddubnyy D, van Tubergen A, Landewé R, et al. Ann Rheum Dis 2015;74:1483–1487 Braun J, et al.,, Ann Rheum Dis 2011; 70: 896-904; van der Heijde D, et al, Ann Rheum Dis 2011; 70:905-08 Clinical Case #3 Clinical Case #3 • 45 year old man comes to see you with left knee To identify the cause of the knee swelling, what is the swelling for the past 7 days. He has no other best next test to obtain: complaints. A. Aspirate Knee Fluid for cell count and crystal search • ROS is unremarkable. No fevers or rashes B. MRI of knee • Physical Exam: unremarkable except for swelling C. X-ray of knee and warmth of the left knee with limited ROM. D. CBC with Differential E. Rheumatoid factor & CCP antibody 8 To identify the cause of the knee swelling, what Differential Diagnosis of is the best next test to obtain Sub-Acute Monoarticular Arthritis Non-Inflammatory Inflammatory 59% • Cartilage or ACL tear • Infectious A. Aspirate Knee Fluid • Flare of osteoarthritis – Lyme Disease B. MRI of knee • Mimics of joint swelling – Gonococcus C.
Load more

Recommended publications
  • Rotator Cuff Tendon Ruptures and Degeneration As the First Manifestation of Polymyalgia Rheumatica Disease - a Case Report
    Open Access Austin Journal of Clinical Case Reports Case Report Rotator Cuff Tendon Ruptures and Degeneration as the First Manifestation of Polymyalgia Rheumatica Disease - A Case Report Bazoukis G1*, Michelongona P2, Papadatos SS1, Pagkalidou E1, Grigoropoulou P1, Fragkou A1 and Abstract Yalouris A1 Polymyalgia Rheumatica (PMR) is a common rheumatic disease of the 1Department of Internal Medicine, General Hospital of elderly. Although it is a well-established disease, its causes and pathophysiology Athens “Elpis”, Greece remain unclear. In our case report we present an 83-year-old female presented 2Department of Internal Medicine, General Hospital of at the emergency department because of fever and diarrhea. Her medical Korinthos, Greece history included a recent orthopedic surgery because of tendons rupture of the *Corresponding author: George Bazoukis, rotator cuff. Her blood exams showed increased inflammatory markers and a Department of Internal Medicine, General Hospital of three-digit ESR. The diagnosis of PMR was set after the exclusion of infectious Athens “Elpis”, Greece and other diseases that mimic PMR symptoms. To the best of our knowledge, it is the first time that rotator cuff tendons rupture and degeneration is the first Received: June 05, 2016; Accepted: August 02, 2016; manifestation of PMR disease. Clinicians should be aware of the degeneration Published: September 08, 2016 of the shoulder and hip extra-articular structures in PMR and they should keep in mind that it can be the first manifestation of the disease. Keywords: Polymyalgia rheumatica; Rotator cuff denegeration; Tendon rupture Introduction and infraspinatus muscles as well as significant tendinopathy of the subscapularis and long head of biceps muscles.
    [Show full text]
  • James Albers, MD Phd Kirsten Gruis, MD Revised 10/2010
    James Albers, MD PhD Kirsten Gruis, MD Revised 10/2010 RADICULOPATHY I. Focal Radiculopathy A. Definitions: 1. Pathological process affecting dorsal (sensory) and/or ventral (motor) spinal roots 2. Clinically includes roots, DRG (dorsal root ganglion) and spinal nerves. B. Clinical Characteristics: 1. Pain may be out of proportion to objective deficit. 2. If chronic, radiculopathy can be asymptomatic. 3. Features favoring radiculopathy vs plexopathy/mononeuropathy a. Proximal pain (neck, low back) b. Pain with movement (tilting neck, lumbar extension) c. Pain with cough, sneeze, Valsalva C. Variables in localization: 1. Nerve damage varies in severity 2. Dermatomal and Myotomal distributions overlap: a. Masks objective deficits b. Enlarges positive phenomena (pain) 3. Pain may also be referred. 4. Involvement of multiple roots may confuse localization. 5. Variable anatomy, especially motor 4. If pain reproduced by palpation then higher suspicion for musculoskeletal disorder mimicking radiculopathy (see Table 1 and 2). However, pain to palpation does not exclude a radiculopathy or abnormal EDX test. 5. 32% of patients referred for EMG lab for lumbosacral radiculopathy have a musculoskeletal disorder. Page 1 of 11 Table 1 Musculoskeletal conditions that commonly mimic cervical radiculopathy Condition Clinical symptoms/signs Fibromyalgia syndrome Pain all over, female predominance, often sleep problems, tender to palpation in multiple areas Polymyalgia rheumatica >50 years old, pain and stiffness in neck, shoulder and hips, high erythrocyte
    [Show full text]
  • Juvenile Spondyloarthropathies: Inflammation in Disguise
    PP.qxd:06/15-2 Ped Perspectives 7/25/08 10:49 AM Page 2 APEDIATRIC Volume 17, Number 2 2008 Juvenile Spondyloarthropathieserspective Inflammation in DisguiseP by Evren Akin, M.D. The spondyloarthropathies are a group of inflammatory conditions that involve the spine (sacroiliitis and spondylitis), joints (asymmetric peripheral Case Study arthropathy) and tendons (enthesopathy). The clinical subsets of spondyloarthropathies constitute a wide spectrum, including: • Ankylosing spondylitis What does spondyloarthropathy • Psoriatic arthritis look like in a child? • Reactive arthritis • Inflammatory bowel disease associated with arthritis A 12-year-old boy is actively involved in sports. • Undifferentiated sacroiliitis When his right toe starts to hurt, overuse injury is Depending on the subtype, extra-articular manifestations might involve the eyes, thought to be the cause. The right toe eventually skin, lungs, gastrointestinal tract and heart. The most commonly accepted swells up, and he is referred to a rheumatologist to classification criteria for spondyloarthropathies are from the European evaluate for possible gout. Over the next few Spondyloarthropathy Study Group (ESSG). See Table 1. weeks, his right knee begins hurting as well. At the rheumatologist’s office, arthritis of the right second The juvenile spondyloarthropathies — which are the focus of this article — toe and the right knee is noted. Family history is might be defined as any spondyloarthropathy subtype that is diagnosed before remarkable for back stiffness in the father, which is age 17. It should be noted, however, that adult and juvenile spondyloar- reported as “due to sports participation.” thropathies exist on a continuum. In other words, many children diagnosed with a type of juvenile spondyloarthropathy will eventually fulfill criteria for Antinuclear antibody (ANA) and rheumatoid factor adult spondyloarthropathy.
    [Show full text]
  • Atraumatic Bilateral Achilles Tendon Rupture: an Association of Systemic
    378 Kotnis, Halstead, Hormbrey Acute compartment syndrome may be a of the body of gastrocnemius has been result of any trauma to the limb. The trauma is reported in athletes.7 8 This, however, is the J Accid Emerg Med: first published as 10.1136/emj.16.5.378 on 1 September 1999. Downloaded from usually a result of an open or closed fracture of first reported case of acute compartment the bones, or a crush injury to the limb. Other syndrome caused by a gastrocnemius muscle causes include haematoma, gun shot or stab rupture in a non-athlete. wounds, animal or insect bites, post-ischaemic swelling, vascular damage, electrical injuries, burns, prolonged tourniquet times, etc. Other Conclusion causes of compartment syndrome are genetic, Soft tissue injuries and muscle tears occur fre- iatrogenic, or acquired coagulopathies, infec- quently in athletes. Most injuries result from tion, nephrotic syndrome or any cause of direct trauma. Indirect trauma resulting in decreased tissue osmolarity and capillary per- muscle tears and ruptures can cause acute meability. compartment syndrome in athletes. It is also Chronic compartment syndrome is most important to keep in mind the possibility of typically an exercise induced condition charac- similar injuries in a non-athlete as well. More terised by a relative inadequacy of musculofas- research is needed to define optimal manage- cial compartment size producing chronic or ment patterns and potential strategies for recurring pain and/or disability. It is seen in injury prevention. athletes, who often have recurring leg pain that Conflict of interest: none. starts after they have been exercising for some Funding: none.
    [Show full text]
  • Rheumatism and the Thyroid
    130 Journal of the Royal Society of Medicine Volume 86 March 1993 Rheumatism and the thyroid D N Golding MA MD FRCPI The Old Forge, Woodside Green, Bishop's Stortford, Herts CM22 7UL Keywords: thyrotoxicosis; rheumatism; hypothyroidism; Hashimoto's disease Muscle weakness and myopathy are well-known Paradoxically the serum muscle enzymes (such as Presidential features of thyrotoxicosis. It is less well-known that creatine kinase) are more likely to be elevated in the Address muscle weakness, pain and even swelling of small mild myopathy associated with hypothyroidism than given to joints are not uncommon in hypothyroidism. Recently in the clinically more severe thyrotoxic myopathy6. Section of it has become apparent that a seronegative poly- Capsulitis of the shoulders is seen in some hypo- Rheumatology & arthritis of small joints may occur in patients with thyroid patients, though is commoner in thyrotoxicosis. Rehabilitation, Hashimoto's disease (even when euthyroid), and that A bilateral case has been described in a myxoedem- 13 May 1992 this condition may be responsible for other rheumatic atous patient with proximal myopathy and an acute features, such as neck and chest pain. phase response7. In hypothyroidism muscular pain is often associated with marked fatigue (the 'after tennis Historical note feeling') and prolonged morning stiffness (thought That rheumatic features can be associated with thyroid to be due to deficiency of alpha-glucosidase in this disorders has been known for some time: for example, condition), which may give a mistaken diagnosis in 1873 Sir William Gull described two cases of 'A of polymyalgia rheumatica. It must however be cretinoidal state supervening in Adult Women', remembered that polymyalgia rheumatica may coexist describing neck stiffness and joint pain; and early with hypothyroidism8- and indeed the prevalence of British reports were described in a recent paper by hypothyroidism in patients with polymyalgia is about in 5%, significantly greater than in controls.
    [Show full text]
  • Conditions Related to Inflammatory Arthritis
    Conditions Related to Inflammatory Arthritis There are many conditions related to inflammatory arthritis. Some exhibit symptoms similar to those of inflammatory arthritis, some are autoimmune disorders that result from inflammatory arthritis, and some occur in conjunction with inflammatory arthritis. Related conditions are listed for information purposes only. • Adhesive capsulitis – also known as “frozen shoulder,” the connective tissue surrounding the joint becomes stiff and inflamed causing extreme pain and greatly restricting movement. • Adult onset Still’s disease – a form of arthritis characterized by high spiking fevers and a salmon- colored rash. Still’s disease is more common in children. • Caplan’s syndrome – an inflammation and scarring of the lungs in people with rheumatoid arthritis who have exposure to coal dust, as in a mine. • Celiac disease – an autoimmune disorder of the small intestine that causes malabsorption of nutrients and can eventually cause osteopenia or osteoporosis. • Dermatomyositis – a connective tissue disease characterized by inflammation of the muscles and the skin. The condition is believed to be caused either by viral infection or an autoimmune reaction. • Diabetic finger sclerosis – a complication of diabetes, causing a hardening of the skin and connective tissue in the fingers, thus causing stiffness. • Duchenne muscular dystrophy – one of the most prevalent types of muscular dystrophy, characterized by rapid muscle degeneration. • Dupuytren’s contracture – an abnormal thickening of tissues in the palm and fingers that can cause the fingers to curl. • Eosinophilic fasciitis (Shulman’s syndrome) – a condition in which the muscle tissue underneath the skin becomes swollen and thick. People with eosinophilic fasciitis have a buildup of eosinophils—a type of white blood cell—in the affected tissue.
    [Show full text]
  • Polymyalgia Rheumatica Mimicking an Iliopsoas Abscess
    Central Annals of Orthopedics & Rheumatology Case Report *Corresponding author Lennart Dimberg, Department of Public Health and Community Medicine, the Sahlgrenska Academy, University of Gothenburg, Box 454, SE-405 30 Polymyalgia Rheumatica Gothenburg, Sweden, Email: [email protected] Submitted: 30 November 2020 Mimicking an Iliopsoas Abscess Accepted: 12 December 2020 Published: 15 December 2020 Lennart Dimberg1* and Fredrik Wennerberg2 Copyright 1Department of Public Health and Community Medicine, the Sahlgrenska Academy, © 2020 Dimberg L, et al. University of Gothenburg, Sweden OPEN ACCESS 2Radiology Resident Physician/MD, NU Hospital Group/NU-sjukvården, Sweden Keywords • Case report Abstract • Polymyalgia rheumatic Background: Polymyalgia Rheumatica (PMR) is a clinical condition characterized • Iliopsoas abscess by pain and stiffness of proximal muscles of shoulders and hips. We here present an unusual case initially believed to be an abscess of the iliopsoas muscle. Case presentation: An elderly man visited our clinic with symptoms of left hip pain and stiffness and an elevated erythrocyte sedimentation rate (ESR) at 96 mm/h, but no fever. An MRI of the left hip and proximal femur suggested an iliopsoas abscess, which was aspirated with clear yellow fluid and no bacteria. A few weeks later, additional pain and stiffness of the muscles of both shoulders made a diagnosis of PMR suspicious. A prompt response to high doses of Prednisolone confirmed the diagnosis. Conclusion: PMR may present with hip-pain due to a unilateral iliopsoas bursitis. BACKGROUND An iliopsoas abscess is a rare condition, often appearing with vague clinical features. In a review article by Lee et al, during 1988-1998 a major Taiwanese hospital registered about one case per year Lee et al, [1] The affected individual typically presents with fever, back-pain and limp.
    [Show full text]
  • Polymyalgia Rheumatica: an Autoinflammatory Disorder?
    Autoinflammatory disorders RMD Open: first published as 10.1136/rmdopen-2018-000694 on 4 June 2018. Downloaded from EDITORIAL Polymyalgia rheumatica: an autoinflammatory disorder? Alberto Floris,1 Matteo Piga,1 Alberto Cauli,1 Carlo Salvarani,2,3 Alessandro Mathieu1 To cite: Floris A, Piga M, Cauli A, Polymyalgia rheumatica (PMR) is an (figure 2A).6 Further, after low-dose gluco- et al. Polymyalgia rheumatica: elderly onset syndrome characterised by corticoid therapy initiation, patients with an autoinflammatory aching and stiffness in the shoulders and the PMR experience a rapid improvement of disorder?. RMD Open 2018;4:e000694. doi:10.1136/ pelvic girdle associated to increased levels symptoms, generally within 24–72 hours, and rmdopen-2018-000694 of acute phase reactants and rapid response more than 40% of them achieve complete to glucocorticoids.1 Although the cause of response within 3 weeks.1 Similarly, in rare ► Prepublication history for PMR remains unknown, most of the evidence monogenic AIDs, a rapid remission of symp- this paper is available online. suggest a multifactorial aetiology inducing an toms and significant reduction in frequency To view these files, please visit immunomediated pathogenesis.1 2 of inflammatory attacks is rapidly achieved the journal online (http:// dx. doi. org/ 10. 1136/ rmdopen- 2018- According to the ‘immunological with specific treatment, such as colchicine in 000694). continuum model’ proposed by McGonagle familial Mediterranean fever (FMF) and inter- in 2006, all immune-mediated diseases can
    [Show full text]
  • 20 Care of People with Musculoskeletal Problems
    20 Care of people with musculoskeletal problems Applicable guidelines Relevant NICE guidelines and pathways: https://pathways.nice.org.uk/pathways/musculoskeletal- conditions SIGN guidelines (www.sign.ac.uk): 136 Management of chronic pain The British Institute of Musculoskeletal Medicine: www.bimm.org.uk The Primary Care Rheumatology Society: www.pcrsociety.org.uk Arthritis Research UK: www.arthritisresearchuk.org The British Association of Sport and Exercise Medicine: www.basem.co.uk/ The UK Anti-Doping website: https://ukad.org.uk/medications-and-substances/about-TUE/ The National Osteoporosis Society: www.nos.org.uk FRAX tool to evaluate fracture risk: www.shef.ac.uk/FRAX The Disabled Living Foundation: www.dlf.org.uk RCGP Inflammatory Arthritis Toolkit: www.rcgp.org.uk/clinical-and- research/resources/toolkits/inflammatory-arthritis-toolkit.aspx A resource to help GPs assess fitness for work: http://fitforwork.org Material for patient www.arthritisresearchuk.org has PILs available to download www.backcare.org.uk – charity for back health www.ccaa.org.uk – Children’s Chronic Arthritis Association www.bssa.uk.net – British Sjögren’s Syndrome Association CSA Cases Workbook for the MRCGP, 3e © 2019, Scion Publishing Ltd www.lupusuk.org.uk – lupus charity www.nass.co.uk – National Ankylosing Spondylitis Society www.nras.org.uk – National Rheumatoid Arthritis Society www.pmrandgca.org.uk – Polymyalgia Rheumatica and Giant Cell Arteritis Scotland www.sruk.co.uk – Scleroderma and Reynaud’s UK www.rsiaction.org.uk – national repetitive strain
    [Show full text]
  • Juvenile Spondyloarthritis / Enthesitis Related Arthritis (Spa-ERA) Version of 2016
    https://www.printo.it/pediatric-rheumatology/GB/intro Juvenile Spondyloarthritis / Enthesitis Related Arthritis (SpA-ERA) Version of 2016 1. WHAT IS JUVENILE SPONDYLOARTHRITIS/ENTHESITIS- RELATED ARTHRITIS (SpA-ERA) 1.1 What is it? Juvenile SpA-ERA constitutes a group of chronic inflammatory diseases of the joints (arthritis), as well as tendon and ligament attachments to certain bones (enthesitis) and affects predominantly the lower limbs and in some cases the pelvic and spinal joints (sacroiliitis - buttock pain and spondylitis - back pain). Juvenile SpA-ERA is significantly more common in people that have a positive blood test for the genetic factor HLA-B27. HLA-B27 is a protein located on the surface of immune cells. Remarkably, only a fraction of people with HLA-B27 ever develops arthritis. Thus, the presence of HLA-B27 is not enough to explain the development of the disease. To date, the exact role of HLA-B27 in the origin of the disease remains unknown. However, it is known that in very few cases the onset of arthritis is preceded by gastrointestinal or urogenital infection (known as reactive arthritis). Juvenile SpA-ERA is closely related to the spondyloarthritis with onset in adulthood and most researchers believe these diseases share the same origin and characteristics. Most children and adolescents with juvenile spondyloarthritis would be diagnosed as affected by ERA and even psoriatic arthritis. It is important that the names "juvenile spondyloarthritis", "enthesitis-related arthritis" and in some cases "psoriatic arthritis" may be the same from a clinical and therapeutic point of view. 1 / 12 1.2 What diseases are called juvenile SpA-ERA? As mentioned above, juvenile spondyloarthritis is the name for a group of diseases; the clinical features may overlap with each other, including axial and peripheral spondyloarthritis, ankylosing spondylitis, undifferentiated spondyloarthritis, psoriatic arthritis, reactive arthritis and arthritis associated with Crohn’s disease and ulcerative colitis.
    [Show full text]
  • Rheumatology Consultation Referral Form
    CLINICAL HISTORY FORM TODAY’S DATE: NAME: DATE OF BIRTH: CHIEF COMPLAINT JOINT PAIN JOINT SWELLING FATIGUE WEAKNESS DECREASED MOBILITY RASHES STIFFNESS FEVER OTHER: WHERE? HOW LONG HAVE YOU HOW DOES IT FEEL? WORSE WITH: “ALL OVER” HAD THIS PROBLEM? ACHY SITTING ALL JOINTS BURNING STANDING MANY JOINTS IS THE PROBLEM: DULL WALKING ALL MUSCLES GRADUAL SHARP OVER EXERTION MANY MUSCLES INTERMITTENT SHOOTING STANDING UP JAWS SUDDEN THROBBING STRESS CHEST FREQUENT TINGLY PREMENSTRUAL PERIOD NECK CONSTANT NUMB COLD WEATHER MID BACK COME AND GO HOT WET WEATHER LOWER BACK TIMING? OTHER: OTHER: LT RT SHOULDERS MORNING LT RT ELBOWS AFTERNOON HOW LONG IS YOUR BETTER WITH: LT RT WRISTS EVENING MORNING STIFFNESS? HEAT LT RT HANDS NIGHT < 10MIN ICE LT RT FINGERS SEVERITY? > 15MIN REST LT RT HIPS MILD > 30MIN STRETCHING LT RT KNEES MODERATE > 60MIN SHOWER/BATH LT RT ANKLES SEVERE > 90MIN ACTIVITY LT RT FEET CHANGES IN INTENSITY > 2 HRS MASSAGE LT RT TOES OTHER: CURRENT PRESCRIPTION MEDICATIONS MEDICATION NAME STRENGTH QUANTITY TAKEN TIMES PER DAY (EXAMPLE) PREDNISONE 5 MG 2 TABLETS 3 TIMES PER DAY OVER THE COUNTER MEDICATIONS/NUTRITIONAL SUPPLEMENTS/VITAMINS MEDICATION NAME STRENGTH QUANTITY TAKEN TIMES PER DAY PAST MEDICAL HISTORY RESPIRATORY: OB/GYN & GENITOURINARY: ASTHMA PROSTATE DISEASE MUSCULOSKELETAL: EMPHYSEMA INFERTILITY ANKYLOSING SPONDYLITIS COPD POLYCYSTIC OVARIAN DISEASE SCOLIOSIS PNEUMONIA CHRONIC UTI SCIATICA SLEEP APNEA # OF PREGNANCIES: CERVICAL DISC DISEASE TB # OF MISCARRIAGES: LUMBAR DISC DISEASE SINUS/ALLERGIES # OF LIVING CHILDREN:
    [Show full text]
  • The Correlations Between Dimensions of the Normal Tendon And
    www.nature.com/scientificreports OPEN The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging Pawel Szaro 1,2,3* & Khaldun Ghali Gataa2 This comparative study aimed to investigate how tendinopathy-related lesions change correlations in the dimensions of the Achilles tendon. Our experimental group included 74 patients. The mean age was 52.9 ± 10.4 years. The control group included 81 patients with a mean age was 35.2 ± 13.6 years, p < .001. The most signifcant diference in correlation was the thickness of the tendon and the midportion’s width, which was more signifcant in the tendinopathy (r = .49 vs. r = .01, p < .001). The correlation was positive between width and length of the insertion but negative in normal tendons (r = .21 vs. r = − .23, p < .001). The correlation was between the midportions width in tendinopathy and the tendon’s length but negative in the normal tendon (r = .16 vs. r = − .23, p < .001). The average thickness of the midportion in tendinopathy was 11.2 ± 3.3 mm, and 4.9 ± 0.5 mm in the control group, p < .001. The average width of the midportion and insertion was more extensive in the experimental group, 17.2 ± 3.1 mm vs. 14.7 ± 1.8 mm for the midportion and 31.0 ± 3.9 mm vs. 25.7 ± 3.0 mm for insertion, respectively, p < .001. The tendon’s average length was longer in tendinopathy (83.5 ± 19.3 mm vs. 61.5 ± 14.4 mm, p < .001). The dimensions correlations in normal Achilles tendon and tendinopathic tendon difer signifcantly.
    [Show full text]