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ABC of Rheumatology
Ade Adebajo, Lisa Dunkley
Verlag BMJ Books, 2018
ISBN 9781118793183 , 224 Seiten
5. Auflage
Format PDF, OL
Kopierschutz DRM
Geräte
Title Page
3
Copyright Page
6
Contents
7
Preface
9
Contributors
11
List of Abbreviations
15
Chapter 1 Delivering Musculoskeletal Care Across Boundaries
17
Introduction
17
Rheumatology in the community: the impact on primary care
17
Who should be referred to secondary care?
17
Musculoskeletal interface services
19
Further management
19
Conclusion
19
References
19
Chapter 2 Pain in the Wrist and Hand
21
Functional anatomy
21
Tendon problems
21
Flexor tenosynovitis
21
Finger flexor tendonosis and trigger finger
22
De Quervain’s tenosynovitis
22
Extensor tenosynovitis
23
Mallet finger
23
Dupuytren’s contracture
23
Peripheral nerve entrapment syndromes
24
Carpal tunnel syndrome
24
Cubital tunnel syndrome
24
Osteoarthritis
25
Nodal osteoarthritis
25
First carpometacarpal osteoarthritis
25
Systemic disorders causing hand pain
25
Inflammatory arthritis
25
Acute pseudogout and chondrocalcinosis of the wrist
25
Acute gout and chronic tophaceous gout
26
Diabetic stiff hand (cheiroarthropathy – limited joint mobility syndrome)
26
Raynaud’s phenomenon
26
Other disorders
26
Ganglion
26
Chronic (work-related) upper limb pain
26
Osteonecrosis (rare)
27
Scaphoid bone fracture
27
Writer’s cramp
27
Septic arthritis
27
Complex regional pain syndrome
27
Local corticosteroid injection technique
27
References
27
Further reading
27
Chapter 3 Pain in the Neck, Shoulder and Arm????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
29
Anatomy and function of the neck and shoulder joint
29
Clinical evaluation
29
Neck pain
30
Investigation of neck pain
31
Treatment of neck pain
31
Shoulder pain
32
Rotator cuff disease
33
Adhesive capsulitis
34
Other shoulder disorders
35
Elbow and forearm pain
36
Lateral and medial epicondylitis
36
Other elbow disorders
37
Reference
37
Further reading
37
Chapter 4 Low Back Pain??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
39
Causes of low back pain
39
Lumbar spondylosis
39
Disc herniation
40
Spondylolisthesis
41
Spinal stenosis
41
Idiopathic (non-specific) low back pain
42
Neoplasms
42
Infection
42
Assessment
42
History
42
Physical examination
42
Imaging studies
43
Treatment
44
Acute low back pain
44
Chronic low back pain
45
Nerve root compression syndromes
45
Further reading
45
Chapter 5 Pain in the Hip??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
47
Hip pain in children
47
Developmental dysplasia of the hip (DDH)
47
Perthes’ disease
47
Slipped upper femoral epiphysis (SUFE)
47
Septic arthritis
47
Transient synovitis/‘irritable hip’
47
Other arthritides
48
Hip pain in adults
48
Osteoarthritis
48
Other arthritides
49
Hip fracture
49
Paget’s disease
49
Avascular necrosis
49
Malignancy
49
Femoro-acetabular impingement (FAI)
49
Painful soft tissue conditions around the hip
50
Management of hip pain
50
Acknowledgement
51
Further reading
51
Chapter 6 Pain in the Knee????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
53
Traumatic causes of knee pain
53
Meniscus injury
53
Articular cartilage injury
55
Differentiation of cause
55
Knee pain in younger people and athletes
55
Patellar tendonopathy
55
Anterior knee pain syndrome
55
Pes anserine bursitis
56
Iliotibial band friction syndrome
56
Knee pain in older people
56
Knee pain in systemic disease
57
Other causes of knee pain
58
‘Red flags’
58
Further reading
58
Chapter 7 Pain in the Foot????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
59
Foot pain in children
59
Juvenile idiopathic arthritis
59
Pain in the forefoot (metatarsalgia)
60
Morton’s neuroma (interdigital neuroma)
60
Stress fracture (march fracture)
60
Acute synovitis
61
Differential diagnosis: inflammation of anterior metatarsal soft tissue pad
62
Plantar metatarsal bursitis
62
Pain along the medial longitudinal arch
62
Painful heel (Box 7.4)
62
Sever’s disease (calcaneal apophysitis)
62
Plantar calcaneal bursitis
63
Chronic inflammation of the heel pad
63
Achilles tendon affections
63
Osteochondritis
63
Arthropathies that affect the foot
64
Osteoarthritis
64
Rheumatoid arthritis
64
Spondyloarthritis
64
Neuropathic joint disease
64
Complex regional pain syndrome, type 1
64
Gout
66
Management of rheumatic foot conditions
66
Tissue viability
66
Foot function and joint protection
66
Foot health promotion
66
Foot surgery
66
Further reading
66
Chapter 8 Fibromyalgia Syndrome and Chronic Widespread Pain??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
67
Diagnosis
67
Aetiology and symptoms
68
Investigations
68
Management
68
Education
68
Graded exercise
69
Pacing activities
69
Psychotherapeutic interventions
69
Sleep
69
Complementary/alternative medicine
69
Drug therapy
69
Conclusion
70
Further reading
70
Chapter 9 Osteoarthritis
71
Presentation
71
Symptoms
71
Examination
73
Investigations
73
Management
73
Patient education and information access
73
Exercise
74
Reducing adverse biomechanical factors
74
Pharmacological treatments
74
Surgery
74
Conclusion
76
References
76
Chapter 10 Gout, Hyperuricaemia and Crystal Arthritis
77
Gout and hyperuricaemia
77
Epidemiology
77
Risk factors for gout/hyperuricaemia
77
Relationship between gout and hyperuricaemia
79
Hyperuricaemia and cardiovascular disease
79
Clinical features
80
Acute gout
80
Chronic gout
80
Urate stones
80
Inherited metabolic disorders
80
Treatment
80
Acute gout
80
Intercritical and chronic gout
81
Pseudogout
81
Other crystal diseases
82
References
82
Further reading
82
Chapter 11 Osteoporosis and Metabolic Bone Disease????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
83
Normal physiology of bone
83
Osteoporosis
83
Assessment of osteoporosis
83
Reducing fracture risk
84
Pharmacological agents
85
Antiresorptive treatments
86
Anabolic treatments
86
In development
86
Pain relief and falls prevention
86
Monitoring of treatment
86
Osteomalacia
87
Paget’s disease of bone
87
Reference
88
Further reading
88
Chapter 12 Rheumatoid Arthritis: Clinical Features and Diagnosis????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
89
Pathogenesis
89
Clinical features
89
‘Red flags’
90
Diagnosis
91
History
91
Clinical examination
91
Laboratory tests
91
Imaging
91
Synovial fluid analysis
92
Differential diagnosis
92
Further reading
92
Chapter 13 Treatment of Rheumatoid Arthritis????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
93
Non-steroidal anti-inflammatory drugs
93
Corticosteroids
93
Conventional disease-modifying antirheumatic drugs (DMARDs)
93
Gold
93
Methotrexate
94
Sulfasalazine
94
Hydroxychloroquine
94
Leflunomide
94
Combination therapy
94
Biological response modifiers
94
Tumour antagonists
94
Interleukin-1 receptor antagonist
95
B-cell depletion
95
Abatacept
95
Tocilizumab
95
Biosimilars
95
New small molecule DMARDs
95
Identification of co-existing problems
96
Complementary therapy
96
Further reading
96
Chapter 14 Spondyloarthritides????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
97
Axial spondyloarthritis/ankylosing spondylitis
97
Assessment of ankylosing spondylitis
99
Psoriatic arthritis
99
Reactive arthritis
101
Enteropathic arthritis
102
Undifferentiated spondyloarthritis
102
Treatment
102
Sacroiliitis and spondylitis
102
Oligoarthritis and/or enthesitis
103
Reference
103
Further reading
103
Chapter 15 Juvenile Idiopathic Arthritis????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
105
Epidemiology
105
Classification
105
Etiology
105
Pathogenesis
106
Oligoarthritis
106
Persistent oligoarthritis
106
Clinical features
106
Diagnosis
107
Extended oligoarthritis
107
Genetics
107
Prognosis
107
Uveitis
108
Epidemiology
108
Insidious-onset (chronic) uveitis
108
Suddenonset (acute) uveitis
108
Management of JIA-associated uveitis
108
Systemic juvenile idiopathic arthritis
108
Pathogenesis
109
Extra-articular clinical features
109
Central nervous system disease
109
Musculoskeletal manifestations
110
Diagnosis and differential diagnosis
110
Features seen during the course of the disease
110
Systemic complications
110
Prognosis
111
Polyarticular juvenile idiopathic arthritis
111
Rheumatoid factor-negative polyarthritis
111
Rheumatoid factor-positive polyarthritis
112
Psoriatic arthritis
112
Pathogenesis
112
Clinical features
112
Laboratory examination
113
Prognosis
113
Enthesitis-related arthritis
113
Epidemiology and pathogenesis
114
Clinical features
114
Systemic features
114
Investigations (Box 15.9)
114
Prognosis
114
Undifferentiated arthritis
114
Treatment of juvenile idiopathic arthritis
115
Non-steroidal anti-inflammatory drugs
115
Corticosteroids
115
DMARDs
115
Biologic drugs
115
References
117
Further reading
117
Chapter 16 Musculoskeletal Disorders in Children and Adolescents????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
119
The ‘limping child’
119
Back pain
119
Mechanical pain
121
Neoplasia
122
Arthritis and infection
122
Chronic arthritis (JIA)
123
Connective tissue diseases
123
Systemic lupus erythematosus
123
Juvenile dermatomyositis
123
Sclerodermas
124
Vasculitis
125
Rare inflammatory syndromes
126
Inherited autoinflammatory syndromes
126
The role of the multidisciplinary team
126
References
127
Further reading
127
Chapter 17 Polymyalgia Rheumatica and Giant Cell Arteritis
129
Epidemiology
129
Clinical features and diagnosis
129
Making the diagnosis
131
Treatment of PMR and GCA
132
Monitoring PMR and GCA
133
References
133
Chapter 18 Systemic Lupus Erythematosus and Lupus-Like Syndromes????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
135
Causes
135
Epidemiology
136
Clinical presentations
136
Systemic lupus erythematosus
136
General features
137
Mucocutaneous manifestations
137
Musculoskeletal manifestations
137
Haematological manifestations
137
Renal manifestations
138
Nervous system manifestations
138
Pulmonary and cardiovascular manifestations
139
Gastrointestinal manifestations
139
Pregnancy and systemic lupus erythematosus
139
Neonatal lupus syndrome
139
Sjögren’s syndrome
139
Overlap syndromes and other lupus?like conditions
140
Polymyositis and dermatomyositis
140
Antiphospholipid syndrome
140
Thrombosis
140
Obstetric syndromes
140
Other manifestations
140
Catastrophic antiphospholipid syndrome
141
Outcome of systemic lupus erythematosus and antiphospholipid syndrome
141
Investigations
141
Investigations in systemic lupus erythematosus
141
Investigations in antiphospholipid syndrome
141
Management
141
General measures
141
Drug therapy in systemic lupus erythematosus (Bertsias et al., 2012; Mosca et al., 2010)
142
Biologic treatments currently used in lupus
143
Therapy in antiphospholipid antibody syndrome (Box 18.8)
143
Conclusion
143
References
143
Chapter 19 Raynaud’s Phenomenon and Scleroderma??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
145
Diagnosis, classification and epidemiology of scleroderma
145
Raynaud’s phenomenon and connective tissue disease
145
Systemic sclerosis
146
Diffuse cutaneous systemic sclerosis (dcSSc)
146
Limited cutaneous systemic sclerosis (lcSSc)
148
Aetiopathogenesis
148
Autoantibody profiles
148
Risk stratification in systemic sclerosis
149
Management of systemic sclerosis
149
Organ-based complications
150
Conclusion
152
Further reading
152
Resource
152
Chapter 20 Reflex Sympathetic Dystrophy
153
Introduction
153
What causes RSD?
153
How is RSD diagnosed?
154
How is RSD treated?
155
Reference
156
Further reading
156
Chapter 21 Is It an Autoimmune Rheumatic Disease???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
157
Autoantibody profile in diagnosis
157
Which systemic autoimmune rheumatic disease?
158
Differential diagnosis
160
Drug-induced lupus
160
Other disorders of the skin
161
Fibromyalgia
162
Endocrine disorders
162
Is it infection?
163
Reference
163
Further reading
163
Chapter 22 Sport and Exercise Medicine????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
165
Sports injuries
165
‘Know the patient, know the sport, know the injury’
165
Assessment
165
Management (Box 22.1)
166
Common sports injuries – the acute injury
167
Common sports injuries – the chronic/overuse injury
168
Exercise prescription
169
Summary
169
Further reading
169
Chapter 23 Vasculitis and Related Rashes????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
171
Large-vessel vasculitis
172
Medium-vessel vasculitis
172
Polyarteritis nodosa
172
Kawasaki’s disease (mucocutaneous lymph node syndrome)
172
Medium- and small-vessel vasculitis
172
Granulomatosis with polyangiitis (Wegener’s)
172
Microscopic polyangiitis
173
Eosinophilic granulomatosis with polyangiitis (Churg–Strauss)
173
Small-vessel vasculitis
173
IgA vasculitis (Henoch–Schönlein purpura)
173
Behçet’s disease
173
Investigation
173
Urine analysis
174
Blood tests
174
Liver function tests
174
Immunology
174
Biopsy
174
Other investigations
174
Differential diagnosis
174
Livedo reticularis
174
Bacterial infections
174
Infective endocarditis
174
Cholesterol embolism
175
Atrial myxoma
175
Antiphospholipid antibody syndrome
175
Cocaine abuse
175
Prognosis
175
Treatment
175
Further reading
176
Chapter 24 Basic Immunology and the Biologic Era
177
Inflammation
177
Activation of the adaptive immune response
177
Cells of the immune system
177
T-cells
177
B-cells
178
Macrophages
179
Biologic therapies
179
Structure
181
Cytokine-based treatments
181
Cell depletion
182
Co-stimulation blockade
182
Efficacy
182
Safety
182
Anti-drug antibodies
184
Biosimilars
184
Janus kinase inhibition
184
Further reading
184
Chapter 25 Laboratory Tests
185
Haematology investigations
185
Anaemia
185
Platelet abnormalities
185
White blood cell abnormalities
186
Acute-phase response
186
Biochemical investigations
187
Hepatic function
187
Renal function
188
Bone biochemistry
188
Other biochemical tests
188
Immunological tests
188
Autoantibodies
188
Rheumatoid factors
189
Antibodies to cyclic citrullinated peptides
189
Antinuclear antibodies
189
Antibodies to DNA
189
Antibodies to extractable nuclear antigens
190
Antiphospholipid antibodies
191
Antineutrophil cytoplasmic antibodies
191
Immunoglobulins
191
Complement
192
Genetic associations
192
Microbiology
192
Further reading
192
Chapter 26 Musculoskeletal Radiology
193
Plain radiography (X-ray)
193
Ultrasound scanning
197
Magnetic resonance imaging
198
Computed tomography
198
Bone scintigraphy
199
Positron emission tomography
199
Dual energy X-ray absorptiometry
200
Further reading
200
Chapter 27 The Team Approach
201
The patient as a member of the multidisciplinary team
201
Effectiveness of multidisciplinary team working
202
Roles and responsibilities of members of the team
202
Consultant and medical staff
202
Rheumatology nurse specialist
202
Occupational therapist
202
Physiotherapist
203
Podiatrist
203
Other members of the MDT
203
Charity organizations
203
Further reading
204
Chapter 28 Epidemiology of the Rheumatic Diseases
205
Osteoarthritis
205
Musculoskeletal pain
205
Low back pain
205
Neck pain
207
Chronic widespread pain and fibromyalgia
207
Gout
207
Rheumatoid arthritis
207
Spondyloarthritis
208
Ankylosing spondylitis
208
Psoriatic arthritis
208
Connective tissue disease
209
Systemic lupus erythematosus
209
Scleroderma
209
Polymyalgia rheumatica and giant cell arteritis
209
Osteoporosis
209
Index
211
EULA
226
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