Rheumatology teaching Rheumatology teaching Pilot 4 sessions Pilot 4 sessions Consultant Rheumatologist/student Consultant Rheumatologist/student presentation presentation Based on Phase II objectives Based on Phase II objectives Polyarthritis, Monoarthritis, Back Polyarthritis, Monoarthritis, Back pain, Soft-tissue disorders pain, Soft-tissue disorders Ward 2 Rheumatology Ward 2 Rheumatology
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Rheumatology teaching Pilot 4 sessions Pilot 4 sessions Consultant Rheumatologist/student presentation Consultant Rheumatologist/student presentation Based.
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Rheumatology teachingRheumatology teaching
Pilot 4 sessionsPilot 4 sessions Consultant Rheumatologist/student Consultant Rheumatologist/student
presentationpresentation Based on Phase II objectivesBased on Phase II objectives Polyarthritis, Monoarthritis, Back pain, Polyarthritis, Monoarthritis, Back pain,
colitis, iritiscolitis, iritis Inflammatory or mechanical*Inflammatory or mechanical* Pattern of joint and symmetry eg RA Pattern of joint and symmetry eg RA
vs PsA vs OA*vs PsA vs OA* Multi-organ disease*Multi-organ disease* Fibromyalgia symptoms* Fibromyalgia symptoms*
How do you differentiateHow do you differentiate
between mechanical andbetween mechanical and
inflammatory symptoms?inflammatory symptoms?
Mechanical vs InflammatoryMechanical vs Inflammatory
Inflammatory Inflammatory MechanicalMechanical Immobility stiffness Immobility stiffness latter daylatter day EMS>30-60 minsEMS>30-60 mins EMS<30-60 minsEMS<30-60 mins Better with activity and NSAIDsBetter with activity and NSAIDs worse with worse with
o Arthralgias, arthritis – non deformingArthralgias, arthritis – non deforming
o Proximal myopathy – pain and weakness Proximal myopathy – pain and weakness (PMR pain and stiffness – think also (PMR pain and stiffness – think also GCA)GCA)
and feetand feet ? CTD/vasculitis - ANA, ENA, RF, DNA ? CTD/vasculitis - ANA, ENA, RF, DNA
binding, ANCA, complementbinding, ANCA, complement Urine dip and BPUrine dip and BP Organ based investigations Organ based investigations Diffuse symptoms – CK, Ca, ALP, TFTDiffuse symptoms – CK, Ca, ALP, TFT Viral – Parvovirus, LFT+Hepatitis Viral – Parvovirus, LFT+Hepatitis
What other conditions What other conditions presentpresent
RF <15 not significant unless associated with appropriate RF <15 not significant unless associated with appropriate clinical scenarioclinical scenario
What are the ANA and ENA?What are the ANA and ENA?
ANA and ENAANA and ENA
ANA 1/40 not significant unless associated ANA 1/40 not significant unless associated with appropriate clinical scenariowith appropriate clinical scenario
Also in RA, cirrhosis, ai liver disease, Also in RA, cirrhosis, ai liver disease, neoplasia, healthy populationneoplasia, healthy population
ENA – extractable nuclear antigensENA – extractable nuclear antigens Anti-Ro and anti-La - SjogrensAnti-Ro and anti-La - Sjogrens Scl 70 and anti-centromere – SclerodermaScl 70 and anti-centromere – Scleroderma Anti-RNP – mixed CTDAnti-RNP – mixed CTD Anti-Jo1 - myositis Anti-Jo1 - myositis
What is ANCA ?What is ANCA ?
ANCAANCA
Antibodies vs specific antigens in Antibodies vs specific antigens in cytoplasm of neutrophilscytoplasm of neutrophils
ANCA reactive to myeloperoxidase ANCA reactive to myeloperoxidase (MPO) – perinuclear pattern of (MPO) – perinuclear pattern of staining P-ANCA eg microscopic staining P-ANCA eg microscopic polyarteritispolyarteritis
ANCA reactive to proteinase 3 (PR3) ANCA reactive to proteinase 3 (PR3) – cytoplasmic pattern of staining C-– cytoplasmic pattern of staining C-ANCA eg Wegener’s granulomatosisANCA eg Wegener’s granulomatosis
What are the radiologicalWhat are the radiological
feature of OA, RA (and feature of OA, RA (and PsA) ?PsA) ?
Radiology - OA Radiology - OA
Four cardinal Four cardinal features:features: Joint space Joint space