Introduction to Rheumatology

Question 1

What is rheumatology?

Answer 1

The medical specialty dealing with diseases of the musculoskeletal system including:

Bones
Joints = where 2 bone meets
Muscles
Tendons = cords of strong fibrous collagen tissue attaching muscle to bone
Ligaments = flexible fibrous connective tissue which connect two bones

Question 2

What is the basic clinical approach for rheumatology?

Answer 2

speed of onset: acute, subacute, chronic

morning/ inactivity stiffness

pattern of joint involvement: Mon, oligo, poly

Size: large e.g., knee, small e.g., fingers

symmetry

peripheral joints or spine

systemic features (fever, weight loss, malaise)

Question 3

What is arthritis?

Answer 3

disease of the joints

Question 4

What are the 2 major divisions of arthritis?

Answer 4

Degenerative joint disease (Osteoarthritis)

Inflammatory joint disease

Question 5

What is inflammation?

Answer 5

a physiological response to deal with injury or infection

• However, excessive/inappropriate inflammatory reactions can damage the host tissues

Question 6

What does inflamamtion manifest as?

Answer 6

Red, pain, hot, swelling, loss of function

rubor, dolor, calor, tumour, loss of function

Question 7

What are the physiological, cellular and molecular changes of inflammation?

Answer 7

-Increased blood flow
-Migration of white blood cells (leukocytes) into the tissues
-Activation/differentiation of leukocytes
-Cytokine production E.g. TNF-alpha, IL1, IL6, IL17

Question 8

what are causes of joint inflammation?

Answer 8

Ifnection
Crystal arthritis
Immune-mediated (autoimmune)

Question 9

What are examples of immune mediated joint inflammation?

Answer 9

• Rheumatoid arthritis (main form)
• systemic lupus erythematosus (SLE)
• reactive arthritis

Question 10

How are the cause of joint inflammation described?

Answer 10

Secondary inflammation in response to a noxious insult/ primary inflammation

Non-sterile inflammation/ sterile inflammation

Infection and crystal gout= Secondary inflammation in response to a noxious insult

Immune-mediated= primary inflammation

Infection= non-sterile inflammation

Crystal arthritis and immune mediated= sterile inflammation

Question 11

What are all the arthritis you need to know?

Answer 11

osteoarthritis

Septic arthritis

Crystals (gout and pseudogout)

Rheumatoid

Seronegative
- Psoriatic arthritis, Reactive arthritis, Ankylosing spondylitis IBD-associated

Lupus