A 64-year-old man with Crohn's disease presented with recurrent painful swelling of both knees. His knees were aspirated and injected twice without relief of symptoms. His Crohn's disease symptoms improved when his azathioprine dose was increased.
Christopher Columbus may have suffered from and died of Reiter's arthritis. Reiter's arthritis is a painful inflammatory arthritis that develops after certain bacterial or viral infections, often in the genitourinary or gastrointestinal tracts. Symptoms include joint pain and swelling, eye inflammation, and genital lesions. Treatment focuses on treating underlying infections, reducing pain and inflammation, and managing joint symptoms.
This document summarizes various inflammatory mediators including cytokines, chemokines, lipid mediators, and neuropeptides. It describes the sources and functions of different cytokines such as IL-1, TNF-α, IFN-γ, and chemokines such as IL-8 and RANTES. It also discusses the roles of lipid mediators like leukotrienes and prostaglandins in inflammation.
This document discusses the evaluation and differential diagnosis of fever in rheumatic diseases. It covers the hypothalamic control of fever and endogenous pyrogens. Prolonged unexplained fever (PUO) is evaluated, considering infections, neoplasms, and immunogenic inflammation. Specific rheumatic diseases associated with fever are discussed, including rheumatoid arthritis, systemic lupus erythematosus, vasculitis, and childhood conditions like rheumatic fever and familial Mediterranean fever. A basic approach to investigating PUO and vasculitis is outlined.
This audit summarizes the current practice of zoledronic acid therapy at NNUH. It found that 73% of patients received zoledronic acid for osteoporosis. Most patients had previously tried other osteoporosis therapies. While most patients received information and supplements, some did not have information fully explained or receive calcium and vitamin D. All patients had creatinine clearance and calcium levels checked. Most were told to drink water before and observed after the infusion, though a few were not. The audit concluded areas of current practice that could be improved.
1) Vertebroplasty involves injecting PMMA into compressed vertebrae to relieve pain and strengthen bone by increasing load bearing and stiffness.
2) It was first performed in 1984 and widely used in the 1990s in the US to treat painful osteoporotic fractures.
3) Indications include painful new or progressive osteoporotic fractures refractory to medical therapy, after conservative treatment fails, and for certain high risk cases.
4) Clinical outcomes data from observational studies shows moderate to marked pain relief in 75-95% with long term efficacy supported.
Respiratory Complication Of Rheumatic Diseasedrmomusa
This document discusses respiratory complications of rheumatic diseases. It covers causes of diffuse parenchymal lung disease including infections, drugs, and connective tissue diseases. Clinical evaluation involves assessing symptoms, signs, imaging like HRCT, lung function tests, and biopsies. Specific lung manifestations are discussed for diseases like rheumatoid arthritis, SLE, and scleroderma. Drugs that can cause interstitial lung disease or other pulmonary complications are also outlined. Future areas of research are mentioned.
Christopher Columbus may have suffered from and died of Reiter's arthritis. Reiter's arthritis is a painful inflammatory arthritis that develops after certain bacterial or viral infections, often in the genitourinary or gastrointestinal tracts. Symptoms include joint pain and swelling, eye inflammation, and genital lesions. Treatment focuses on treating underlying infections, reducing pain and inflammation, and managing joint symptoms.
This document summarizes various inflammatory mediators including cytokines, chemokines, lipid mediators, and neuropeptides. It describes the sources and functions of different cytokines such as IL-1, TNF-α, IFN-γ, and chemokines such as IL-8 and RANTES. It also discusses the roles of lipid mediators like leukotrienes and prostaglandins in inflammation.
This document discusses the evaluation and differential diagnosis of fever in rheumatic diseases. It covers the hypothalamic control of fever and endogenous pyrogens. Prolonged unexplained fever (PUO) is evaluated, considering infections, neoplasms, and immunogenic inflammation. Specific rheumatic diseases associated with fever are discussed, including rheumatoid arthritis, systemic lupus erythematosus, vasculitis, and childhood conditions like rheumatic fever and familial Mediterranean fever. A basic approach to investigating PUO and vasculitis is outlined.
This audit summarizes the current practice of zoledronic acid therapy at NNUH. It found that 73% of patients received zoledronic acid for osteoporosis. Most patients had previously tried other osteoporosis therapies. While most patients received information and supplements, some did not have information fully explained or receive calcium and vitamin D. All patients had creatinine clearance and calcium levels checked. Most were told to drink water before and observed after the infusion, though a few were not. The audit concluded areas of current practice that could be improved.
1) Vertebroplasty involves injecting PMMA into compressed vertebrae to relieve pain and strengthen bone by increasing load bearing and stiffness.
2) It was first performed in 1984 and widely used in the 1990s in the US to treat painful osteoporotic fractures.
3) Indications include painful new or progressive osteoporotic fractures refractory to medical therapy, after conservative treatment fails, and for certain high risk cases.
4) Clinical outcomes data from observational studies shows moderate to marked pain relief in 75-95% with long term efficacy supported.
Respiratory Complication Of Rheumatic Diseasedrmomusa
This document discusses respiratory complications of rheumatic diseases. It covers causes of diffuse parenchymal lung disease including infections, drugs, and connective tissue diseases. Clinical evaluation involves assessing symptoms, signs, imaging like HRCT, lung function tests, and biopsies. Specific lung manifestations are discussed for diseases like rheumatoid arthritis, SLE, and scleroderma. Drugs that can cause interstitial lung disease or other pulmonary complications are also outlined. Future areas of research are mentioned.
Osteoarthritis is a common form of arthritis that damages joints through wear and tear. While there is no cure, physiotherapy can help manage osteoarthritis symptoms by reducing pain, improving movement and posture, and strengthening muscles. Physiotherapy treatments for osteoarthritis include exercises tailored to each individual, as recent research shows exercise is effective for managing knee osteoarthritis. Exercises help maintain movement, improve joint nutrition and strength, and support general fitness.
Ankle sprains occur when the ligaments in the ankle are overstretched or torn from the ankle rolling during physical activity. Physiotherapists can assess the severity of the sprain and provide treatments like exercises and manual techniques to reduce swelling and pain to allow for healing and prevent long-term issues. Early physiotherapy along with resting, icing, compressing and elevating the ankle (RICE method) leads to quicker recovery compared to leaving it untreated and continuing strenuous activity. Returning to work or sport too early can delay healing, so physiotherapists can provide guidance on rehabilitation and taping or bracing to allow a safe return to activity.
Trigger digits, also known as stenosing tenosynovitis, is a common condition where the tendons in the fingers get inflamed and swollen, making it difficult or impossible to flex and extend the finger smoothly. There are two main types - nodular, where a distinct nodule is felt, and diffuse, where the swelling is less defined. Treatment depends on the type and duration of symptoms. For early nodular cases or diffuse cases of less than 6 months, non-invasive treatments like splinting, NSAIDs, massage and steroid injections are usually effective. For longstanding or severe cases, surgical release of the tendon sheath may be necessary if conservative treatments fail.
This document summarizes nonoperative treatment options for carpal tunnel syndrome (CTS). It discusses how CTS is a common compression neuropathy that can be costly and cause lost work time. Conservative treatments include medications like NSAIDs and steroids, splinting, modalities like ultrasound and iontophoresis, and addressing ergonomic risk factors. Studies show these approaches can provide relief for mild-moderate CTS and potentially avoid surgery, though outcomes vary. Nonoperative treatment is a viable first-line option when symptoms are early and mild.
1. Giant cell arteritis (GCA) and Takayasu's arteritis are two forms of large vessel vasculitis that predominantly affect elderly and younger populations respectively.
2. GCA most commonly involves branches of the carotid artery and causes headaches, jaw claudication, and vision loss. Takayasu's arteritis mainly affects the aorta and its primary branches and can lead to hypertension, aneurysms, and strokes.
3. Treatment for both involves high-dose glucocorticoids, with additional immunosuppressants sometimes used for refractory or relapsing disease. Careful monitoring is needed due to risks of treatment complications like osteoporosis and fractures.
This document provides an introduction to research governance for NHS research. It defines research governance as a framework that requires approval from an NHS trust and ethics committee before research can begin. The key components of research governance are outlined, including peer review, obtaining ethics committee approval, ensuring data protection, employing researchers with proper contracts, indemnity, financial accountability, and disseminating results. Researchers must obtain both ethics approval and approval from their trust's research and development office before beginning a study.
The document discusses various types of joint and bone infections, including bacterial, viral, fungal and parasitic infections. It covers topics such as septic arthritis, osteomyelitis, Lyme disease and treatments including antibiotics and joint drainage. Prognosis depends on factors like speed of treatment, prior joint damage and virulence of the infecting organism.
The document discusses outcomes in rheumatoid arthritis (RA) including disease activity, disability, damage, and mortality. Specific factors related to poor outcomes include severe disease, involvement of many joints, rheumatoid factor positivity, and high inflammatory markers. Disease activity states refer to when RA is active with inflammation or inactive without it. Treatment goals aim to reduce severity, improve disability, stop joint damage, and avoid adverse events. Clinical measures, patient reports, laboratory tests, and radiological assessments are used to evaluate disease activity and outcomes.
This document provides an overview of the immune system and how it responds to microbial infections. It discusses both the innate and adaptive immune responses. The innate response involves inflammation, complement activation, NK cells, and activation of antigen presenting cells. The adaptive response involves activation of naive T lymphocytes, polarization of T cells into Th1 and Th2 subsets, roles of Th1 and Th2 cells, and roles of memory B and T cells in providing long-term protective immunity. The document also briefly discusses some methods microbes use to evade the immune system.
This document presents two case studies of patients seen in rheumatology clinics with various musculoskeletal and gastrointestinal symptoms. Case 1 is a 54-year-old woman with back, hip and ankle pain who is found to have spondyloarthritis likely related to inflammatory bowel disease. Case 2 is a 29-year-old woman with neck stiffness, back pain, and diarrhea who is diagnosed with spondyloarthritis related to psoriasis or inflammatory bowel disease. Both patients undergo testing including imaging and are treated with medications.
This document discusses meta-analysis techniques for systematically reviewing and statistically combining results from multiple clinical trials. It covers the history of meta-analysis, methodology for combining test statistics and assessing heterogeneity, software for conducting meta-analyses, and current issues including how to handle different study designs. Examples are provided to illustrate meta-analysis of randomized controlled trials comparing treatments for stroke, myocardial infarction, and other conditions.
This patient has systemic sclerosis for 3.5 years with tight skin on hands and face, pain in knees and feet, and morning stiffness. He has multiple medical issues including renal failure and is wheelchair-bound. Examination found tight skin on hands and face. His current management includes physiotherapy, wax, and treatment for his other conditions. Further tests are needed to monitor his systemic sclerosis and complications.
Carpometacarpal (CMC) arthritis most commonly affects the thumb joint, causing pain and loss of motion. It involves wear and tearing of cartilage at the saddle joint between the thumb metacarpal and trapezium bones. Non-surgical treatments include splinting and injections, while surgical options range from joint preserving procedures like osteotomy to joint replacement or fusion depending on severity. Outcomes of different procedures include reduced pain and improved function.
Trochanteric bursitis refers to inflammation of fluid-filled sacs located around the greater trochanter bone on the outside of the hip. It commonly causes deep aching pain on the outside of the hip and thigh that increases with activity and is worse when lying on the affected side. Risk factors include trauma, hip arthritis, back problems, obesity, and other conditions that alter gait or hip movement. Treatment focuses on rest, NSAIDs, physiotherapy, steroid injections, or occasionally surgery.
The document discusses biologic therapies for rheumatological conditions. It provides information on TNF antagonists that are approved for treating diseases like rheumatoid arthritis, spondyloarthropathies, and psoriasis. It discusses the mechanisms of action, pharmacokinetics, administration, and safety monitoring of TNF inhibitors like infliximab, etanercept, and adalimumab. The document also summarizes clinical trial data on the effectiveness of TNF inhibitors for conditions like Crohn's disease and ankylosing spondylitis.
- Systemic Lupus Erythematosus (SLE) is an incurable, multisystemic autoimmune disease that predominantly affects women and has variable rates of median age of onset depending on ethnicity.
- SLE can affect many different body systems and has a variety of potential symptoms and complications, including renal, neurological, and hematological manifestations.
- Treatment involves managing symptoms with medications like hydroxychloroquine, corticosteroids, immunosuppressants, and emerging therapies targeting B cells and cytokines.
Muscle function and strength are vital for joint health and proper functioning. Muscle weakness and dysfunction may be an important factor in the development of joint damage in conditions like osteoarthritis. While the relationship between muscle and joint problems is complex, regular exercise and physical rehabilitation can help maintain muscle strength and proprioception, delaying or preventing further joint deterioration. Community- and home-based exercise programs are important for allowing patients to independently manage their condition long-term through regular physical activity.
Behçet's syndrome is a systemic vasculitis characterized by recurrent oral and genital ulcers, skin lesions, uveitis, and arterial, venous, or neurological involvement. It is most common along the ancient Silk Road trade route. Diagnosis requires recurrent oral ulcers plus two of the other main symptoms. Treatment involves immunosuppressants such as colchicine, azathioprine, and TNF-antagonists, which can help control symptoms but the underlying cause remains unknown. Prognosis is generally good if major vessel or neurological involvement can be prevented.
Clinical research methodology involves understanding different study types and choosing the appropriate one to investigate research questions. The main types are observational (cross-sectional, case-control) and interventional (cohort, randomized controlled trial). Observational studies can show associations but not causation due to limitations like bias and confounding. Interventional studies like randomized controlled trials can establish causation by minimizing biases through randomization and blinding. Well-designed clinical trials systematically plan the hypothesis, participants, interventions, outcomes, sample size, controls, analysis and interpretation of results to accurately assess interventions.
This document summarizes the modern management of gout. It discusses the pathophysiology of gout involving urate crystals activating the inflammasome and promoting inflammation. It reviews risk factors such as hyperuricaemia, diet, obesity, and metabolic syndrome. Guidelines for treatment include lifestyle changes, acute flare treatment with NSAIDs or colchicine, and chronic management with urate-lowering therapy such as allopurinol or febuxostat to reduce serum urate levels. New discoveries in urate transporters and their role in hyperuricaemia are also discussed.
Osteoarthritis is a common form of arthritis that damages joints through wear and tear. While there is no cure, physiotherapy can help manage osteoarthritis symptoms by reducing pain, improving movement and posture, and strengthening muscles. Physiotherapy treatments for osteoarthritis include exercises tailored to each individual, as recent research shows exercise is effective for managing knee osteoarthritis. Exercises help maintain movement, improve joint nutrition and strength, and support general fitness.
Ankle sprains occur when the ligaments in the ankle are overstretched or torn from the ankle rolling during physical activity. Physiotherapists can assess the severity of the sprain and provide treatments like exercises and manual techniques to reduce swelling and pain to allow for healing and prevent long-term issues. Early physiotherapy along with resting, icing, compressing and elevating the ankle (RICE method) leads to quicker recovery compared to leaving it untreated and continuing strenuous activity. Returning to work or sport too early can delay healing, so physiotherapists can provide guidance on rehabilitation and taping or bracing to allow a safe return to activity.
Trigger digits, also known as stenosing tenosynovitis, is a common condition where the tendons in the fingers get inflamed and swollen, making it difficult or impossible to flex and extend the finger smoothly. There are two main types - nodular, where a distinct nodule is felt, and diffuse, where the swelling is less defined. Treatment depends on the type and duration of symptoms. For early nodular cases or diffuse cases of less than 6 months, non-invasive treatments like splinting, NSAIDs, massage and steroid injections are usually effective. For longstanding or severe cases, surgical release of the tendon sheath may be necessary if conservative treatments fail.
This document summarizes nonoperative treatment options for carpal tunnel syndrome (CTS). It discusses how CTS is a common compression neuropathy that can be costly and cause lost work time. Conservative treatments include medications like NSAIDs and steroids, splinting, modalities like ultrasound and iontophoresis, and addressing ergonomic risk factors. Studies show these approaches can provide relief for mild-moderate CTS and potentially avoid surgery, though outcomes vary. Nonoperative treatment is a viable first-line option when symptoms are early and mild.
1. Giant cell arteritis (GCA) and Takayasu's arteritis are two forms of large vessel vasculitis that predominantly affect elderly and younger populations respectively.
2. GCA most commonly involves branches of the carotid artery and causes headaches, jaw claudication, and vision loss. Takayasu's arteritis mainly affects the aorta and its primary branches and can lead to hypertension, aneurysms, and strokes.
3. Treatment for both involves high-dose glucocorticoids, with additional immunosuppressants sometimes used for refractory or relapsing disease. Careful monitoring is needed due to risks of treatment complications like osteoporosis and fractures.
This document provides an introduction to research governance for NHS research. It defines research governance as a framework that requires approval from an NHS trust and ethics committee before research can begin. The key components of research governance are outlined, including peer review, obtaining ethics committee approval, ensuring data protection, employing researchers with proper contracts, indemnity, financial accountability, and disseminating results. Researchers must obtain both ethics approval and approval from their trust's research and development office before beginning a study.
The document discusses various types of joint and bone infections, including bacterial, viral, fungal and parasitic infections. It covers topics such as septic arthritis, osteomyelitis, Lyme disease and treatments including antibiotics and joint drainage. Prognosis depends on factors like speed of treatment, prior joint damage and virulence of the infecting organism.
The document discusses outcomes in rheumatoid arthritis (RA) including disease activity, disability, damage, and mortality. Specific factors related to poor outcomes include severe disease, involvement of many joints, rheumatoid factor positivity, and high inflammatory markers. Disease activity states refer to when RA is active with inflammation or inactive without it. Treatment goals aim to reduce severity, improve disability, stop joint damage, and avoid adverse events. Clinical measures, patient reports, laboratory tests, and radiological assessments are used to evaluate disease activity and outcomes.
This document provides an overview of the immune system and how it responds to microbial infections. It discusses both the innate and adaptive immune responses. The innate response involves inflammation, complement activation, NK cells, and activation of antigen presenting cells. The adaptive response involves activation of naive T lymphocytes, polarization of T cells into Th1 and Th2 subsets, roles of Th1 and Th2 cells, and roles of memory B and T cells in providing long-term protective immunity. The document also briefly discusses some methods microbes use to evade the immune system.
This document presents two case studies of patients seen in rheumatology clinics with various musculoskeletal and gastrointestinal symptoms. Case 1 is a 54-year-old woman with back, hip and ankle pain who is found to have spondyloarthritis likely related to inflammatory bowel disease. Case 2 is a 29-year-old woman with neck stiffness, back pain, and diarrhea who is diagnosed with spondyloarthritis related to psoriasis or inflammatory bowel disease. Both patients undergo testing including imaging and are treated with medications.
This document discusses meta-analysis techniques for systematically reviewing and statistically combining results from multiple clinical trials. It covers the history of meta-analysis, methodology for combining test statistics and assessing heterogeneity, software for conducting meta-analyses, and current issues including how to handle different study designs. Examples are provided to illustrate meta-analysis of randomized controlled trials comparing treatments for stroke, myocardial infarction, and other conditions.
This patient has systemic sclerosis for 3.5 years with tight skin on hands and face, pain in knees and feet, and morning stiffness. He has multiple medical issues including renal failure and is wheelchair-bound. Examination found tight skin on hands and face. His current management includes physiotherapy, wax, and treatment for his other conditions. Further tests are needed to monitor his systemic sclerosis and complications.
Carpometacarpal (CMC) arthritis most commonly affects the thumb joint, causing pain and loss of motion. It involves wear and tearing of cartilage at the saddle joint between the thumb metacarpal and trapezium bones. Non-surgical treatments include splinting and injections, while surgical options range from joint preserving procedures like osteotomy to joint replacement or fusion depending on severity. Outcomes of different procedures include reduced pain and improved function.
Trochanteric bursitis refers to inflammation of fluid-filled sacs located around the greater trochanter bone on the outside of the hip. It commonly causes deep aching pain on the outside of the hip and thigh that increases with activity and is worse when lying on the affected side. Risk factors include trauma, hip arthritis, back problems, obesity, and other conditions that alter gait or hip movement. Treatment focuses on rest, NSAIDs, physiotherapy, steroid injections, or occasionally surgery.
The document discusses biologic therapies for rheumatological conditions. It provides information on TNF antagonists that are approved for treating diseases like rheumatoid arthritis, spondyloarthropathies, and psoriasis. It discusses the mechanisms of action, pharmacokinetics, administration, and safety monitoring of TNF inhibitors like infliximab, etanercept, and adalimumab. The document also summarizes clinical trial data on the effectiveness of TNF inhibitors for conditions like Crohn's disease and ankylosing spondylitis.
- Systemic Lupus Erythematosus (SLE) is an incurable, multisystemic autoimmune disease that predominantly affects women and has variable rates of median age of onset depending on ethnicity.
- SLE can affect many different body systems and has a variety of potential symptoms and complications, including renal, neurological, and hematological manifestations.
- Treatment involves managing symptoms with medications like hydroxychloroquine, corticosteroids, immunosuppressants, and emerging therapies targeting B cells and cytokines.
Muscle function and strength are vital for joint health and proper functioning. Muscle weakness and dysfunction may be an important factor in the development of joint damage in conditions like osteoarthritis. While the relationship between muscle and joint problems is complex, regular exercise and physical rehabilitation can help maintain muscle strength and proprioception, delaying or preventing further joint deterioration. Community- and home-based exercise programs are important for allowing patients to independently manage their condition long-term through regular physical activity.
Behçet's syndrome is a systemic vasculitis characterized by recurrent oral and genital ulcers, skin lesions, uveitis, and arterial, venous, or neurological involvement. It is most common along the ancient Silk Road trade route. Diagnosis requires recurrent oral ulcers plus two of the other main symptoms. Treatment involves immunosuppressants such as colchicine, azathioprine, and TNF-antagonists, which can help control symptoms but the underlying cause remains unknown. Prognosis is generally good if major vessel or neurological involvement can be prevented.
Clinical research methodology involves understanding different study types and choosing the appropriate one to investigate research questions. The main types are observational (cross-sectional, case-control) and interventional (cohort, randomized controlled trial). Observational studies can show associations but not causation due to limitations like bias and confounding. Interventional studies like randomized controlled trials can establish causation by minimizing biases through randomization and blinding. Well-designed clinical trials systematically plan the hypothesis, participants, interventions, outcomes, sample size, controls, analysis and interpretation of results to accurately assess interventions.
This document summarizes the modern management of gout. It discusses the pathophysiology of gout involving urate crystals activating the inflammasome and promoting inflammation. It reviews risk factors such as hyperuricaemia, diet, obesity, and metabolic syndrome. Guidelines for treatment include lifestyle changes, acute flare treatment with NSAIDs or colchicine, and chronic management with urate-lowering therapy such as allopurinol or febuxostat to reduce serum urate levels. New discoveries in urate transporters and their role in hyperuricaemia are also discussed.