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    Rheumatology: A Clinical Handbook
    Rheumatology: A Clinical Handbook
    Rheumatology: A Clinical Handbook
    Ebook191 pages2 hours

    Rheumatology: A Clinical Handbook

    By Ahmad Al-Sukaini, Mohsin Azam and Ash Samanta

    4.5/5

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    About this ebook

    Rheumatology: A clinical handbook is an essential resource for medical students who need an introduction, understanding and overview of the subject.

    Most competing texts either burden medical students with information they do not require, or cover rheumatology alongside orthopaedics and as a result compromise fundamentals of rheumatology.

    This book is different:
    • It provides all the information students need during their rheumatology placement
    • Further information resources are signposted for those who want to take their studies further
    • A definition and brief pathophysiology for each condition is provided, which is linked to the respective clinical features.
    • The book covers the core elements of diagnosis and treatment based on the latest national guidelines to swiftly bring students and junior doctors in training up-to-date.
    • Self-assessment questions and an OSCE chapter provide a way of checking that users have understood and grasped the core material, as well as enabling students to be well equipped for their written and OSCE examinations.
    Written by two medical students and an experienced consultant rheumatologist, the book combines a reader-friendly writing style with coverage of the material through clinical experience of a professional in the field.

    Printed in full colour throughout, with an attractive design, a clear and concise writing style as well as a range of pedagogical features including an array of mnemonics, pictures and diagrams, Rheumatology: A clinical handbook is exactly the sort of book medical students and newly qualified doctors would benefit from.
    LanguageEnglish
    PublisherScion Publishing
    Release dateApr 17, 2014
    ISBN9781907904462
    Rheumatology: A Clinical Handbook

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    • 4/5
      simple-practical-well written-good book to review
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      One of the best books I have read in rheumatology

    Book preview

    Rheumatology - Ahmad Al-Sukaini

    Rheumatology

    A Clinical Handbook

    For more details see www.scionpublishing.com

    © Scion Publishing Limited, 2014

    First published 2014

    All rights reserved. No part of this book may be reproduced or transmitted, in any form or by any means, without permission.

    A CIP catalogue record for this book is available from the British Library.

    ISBN 978 1 907904 26 4

    Scion Publishing Limited

    The Old Hayloft, Vantage Business Park, Bloxham Road, Banbury OX16 9UX, UK

    www.scionpublishing.com

    Important Note from the Publisher

    The information contained within this book was obtained by Scion Publishing Ltd from sources believed by us to be reliable. However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the authors or publishers.

    Readers are reminded that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications and practices are based on current indications, there may be specific practices which differ between communities. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practising.

    Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be pleased to acknowledge in subsequent reprints or editions any omissions brought to our attention.

    Registered names, trademarks, etc. used in this book, even when not marked as such, are not to be considered unprotected by law.

    Line artwork by Hilary Strickland Illustration, Bath, UK

    Typeset by Medlar Publishing Solutions Pvt Ltd, India

    Printed in the UK

    Contents

    Preface

    Acknowledgments

    Abbreviations

    1 Introduction

    2 Specific conditions

    2.1 Rheumatoid arthritis

    2.2 Osteoarthritis

    2.3 Septic arthritis

    Introduction to spondyloarthropathies

    2.4 Psoriatic arthritis

    2.5 Ankylosing spondylitis

    2.6 Reactive arthritis

    2.7 Gout

    2.8 Calcium pyrophosphate disease

    2.9 Vasculitis

    2.10 Giant cell arteritis

    2.11 Polymyalgia rheumatica

    2.12 Systemic lupus erythematosus

    2.13 Polymyositis and dermatomyositis

    2.14 Sjögren’s syndrome

    2.15 Scleroderma

    2.16 Fibromyalgia

    2.17 Osteoporosis

    2.18 Paget’s disease

    3 Paediatric rheumatology conditions

    3.1 Vitamin D deficiency

    3.2 Juvenile idiopathic arthritis

    4 Investigations

    4.1 Blood tests

    4.2 Immunological tests

    4.3 Synovial fluid analysis

    4.4 Imaging

    5 Pharmacology

    5.1 Analgesia

    5.2 Corticosteroids

    5.3 Osteoporosis drugs

    5.4 DMARDs and biological agents

    6 OSCEs

    6.1 History taking

    6.2 Examination

    6.3 Differential diagnosis

    Appendix A Answers to self-assessment questions

    Appendix B Photograph acknowledgments

    Index

    Additional self-assessment questions are available in one of two ways:

    Visit www.scionpublishing.com/rheumatologyQandA

    Visit www.dotmedic.com/students/rheumatology/free.html

    Preface

    In my experience of teaching rheumatology at undergraduate (and postgraduate) level for over thirty years, there is one consistent response that I have come across from medical students. This is a general fear of rheumatology. The reason many students regard rheumatology as mysterious and arcane is because of a lack of understanding about what rheumatology covers, as well as a somewhat fuzzy knowledge of the various conditions that are encompassed within rheumatology.

    Some years ago I thought it might be helpful for medical students (at the University of Leicester) if I put together what I termed ‘revision notes’ for rheumatology. I would often encourage students to offer any suggestions for change but the reality was that no-one ever did. A couple of years ago, two bright young medical students, Ahmad Al-Sukaini and Mohsin Azam (who are co-authors of this text) approached me after one of my lectures and came up with a number of ideas, and the revision notes were updated in due course. They also suggested putting together a short book that would be more comprehensive than just brief notes, and that would flag key issues in rheumatology for undergraduate medical students. Their enthusiasm, effort and assistance are to be strongly commended.

    According to surveys we carried out at the University of Leicester, students wholeheartedly agreed that a rheumatology ‘guide’ would be of benefit to them and to junior doctors. Their preference was to use bullet point formatting and an approach that would be succinct and highly focused, as opposed to the more conventional paragraphs and narrative writing. We have also used a wide range of pedagogic features, including summary tables, illustrations and mnemonics throughout. Furthermore, the size of the book was important – it had to be one that could be carried around easily. To test student knowledge and reinforce learning, questions were devised within the framework used by examiners. Single Best Answer (SBA) and Extended Matching Questions (EMQs) are increasingly being utilized by medical school examiners to explore understanding of a topic and it is essential that students familiarize themselves with these types of question. The questions, together with their answers, can be found online, as mentioned at the end of the Contents.

    We took up this challenge and have put together this text with the aim of covering rheumatology in a clear and concise manner. The content thoroughly encompasses the current medical school curriculum in the UK and we hope that this text will be highly beneficial to medical students for furthering their knowledge, as well as a revision guide for undergraduate examination purposes. We also hope that it will assist newly qualified junior doctors and serve as a quick reference guide for clinics and ward-based work. The concise and coherent format of this book is likely to appeal to other healthcare professionals who require a working knowledge of rheumatology.

    Finally, I would say that this text is not intended to replace any of the standard erudite text books in rheumatology that have already been published. It is designed to focus the mind, provide concise guidance, and encourage further exploration of rheumatology.

    Dr Ash Samanta

    Consultant Rheumatologist, University of Leicester

    January 2014

    Acknowledgments

    We are extremely grateful to the medical students of the University of Leicester who gave invaluable advice on the content and structure of the text. We are also very grateful to Dr Rebecca Neame for her help in conducting the student survey. Our deepest appreciation goes to Dr Parthajit Das, Dr Shireen Shaffu and Dr Kenny Sunmboye for their contribution to the SBA and EMQ questions. We would also like to sincerely thank our friend Adeel Qureshi for sharing his remarkable experience in market research with us.

    We would also like to place on record our sincere gratitude to the team at Scion Publishing Ltd, particularly Dr Jonathan Ray and Ms Clare Boomer, for their great support, encouragement and patience.

    Please refer to Appendix B for acknowledgment to the copyright holders of the many images in the book.

    Dedications

    To my parents and family for all the unconditional love and support they have for me. Thank you for your unfailing faith and enthusiasm.

    Special thanks go to my uncle, Sabah, for being a truly inspirational person to me. You have been my mentor and a great blessing.     A.A.

    To the memory of my loving grandparents who always believed in me. I will always treasure the priceless memories we shared together.

    My deepest appreciation goes to my parents and the rest of my family. Without your continued support and inspiration, none of this would have been possible.     M.A.

    For my ‘long-suffering’ family.     A.S.

    Abbreviations

    Chapter 1

    Introduction

    Rheumatology is a multidisciplinary branch of medicine that encompasses the investigation, diagnosis and management of patients with arthritis and other musculoskeletal conditions. This includes many disorders affecting joints, bones, muscles and soft tissues. A significant number of musculoskeletal conditions also affect other organ systems and occur as part of a systemic autoimmune disease. The main rheumatological disorders are summarized in Fig. 1.1 and will be covered in significant depth.

    The rheumatology multidisciplinary team (MDT) consists of a variety of disciplines that work together with the aim of providing optimal care to sufferers via a holistic approach (Fig. 1.2). The team consists of many healthcare professionals including consultant rheumatologists, general practitioners (GPs), occupational therapists, orthopaedic surgeons, physiotherapists, psychiatrists, special nurses and many more.

    Rheumatologists are specialists who deal with a wide range of rheumatic diseases. They assess overall function, including physical and mental wellbeing and level of independence. They also manage results of advanced imaging and lab tests, treatment options and the need for further assessment and management, such as referrals to other healthcare providers.

    Chapter 2

    For each condition the following will be covered:

    • Pathophysiology: the information surrounding the pathophysiology of rheumatology disorders is constantly evolving and there is still so much that remains to be understood. Up-to-date resources were used with the intention of keeping this section simple and concise and not overlooking the clinical aspects of rheumatology!

    • Epidemiology and risk factors: attention has been paid to the incidence / prevalence of the rheumatology disorders so that students are aware of the very common, less common and rare disorders. Where possible, risk factors are arranged in a descending order of importance via a simple to follow table, to highlight the most important risk factors for students to learn.

    • Clinical

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