Rheumatology

Chapter 31 gives an overview of rheumatology, the study of rheumatic conditions which can involve the joints, soft tissues, and bones and also comprises connective tissue disorders, vasculitides, and a number of autoimmune conditions. The chapter outlines patterns of rheumatological disease (e.g. mono-, oligo-, and polyarthropathies), symmetrical versus asymmetrical presentations of disease, and explains how to try and differentiate between inflammatory and non-inflammatory disorders. The chapter provides information on common drug treatments, including dangerous side effects from improperly prescribed methotrexate. Advice is given on history taking and detailed hand examination, with clinical signs of rheumatoid arthritis: Swan neck deformity, Boutonniere’s deformity, Z deformity of thumb, Bouchard’s nodes (proximal interphalangeal joint), Heberden’s nodes (distal interphalangeal joint, first metacarpophalangeal joint), finger ulnar deviation (metacarpophalangeal joint), and wrist radial deviation and subluxation. The most common rheumatological disorders are discussed, including rheumatoid arthritis, spondyloarthropathy, ankylosing spondylitis, psoriatic arthritis, gout, and osteoporosis (including the ‘MESSAGE’ mnemonic for osteoporosis risk factors). The Chapel Hill classification for vasculitides is also covered.