General Practice Guide to Rheumatology. Dr Helen Gabathuler MRCP, MRCGP General practitioner and clinical assistant in rheumatology . Aims. History and Examination Appropriate Investigations Management Common conditions in general practice Must Not Miss Diagnoses.
Dr Helen Gabathuler
General practitioner and clinical assistant in rheumatology
Important to diagnose and refer these conditions to rheumatologist EARLY.
– painful, swollen joint (usually big toe)
- hot, red, tender, swollen joint
Most important differential diagnosis is infection
? increased production purines
? reduced renal excretion uric acid
Reduces urate concentrations in urine and blood.
Do not start during acute attack
Always cover with nsaid or colchicine to prevent gout being precipitated for 3/12
Beware itchy rash – 2%
A chronic disorder characterized by softening and disintegration of articular cartilage, with reactive phenomena such as vascular congestion and osteoblastic activity in the subarticular bone, new growth of cartilage and bone (osteophytes) at the joint margins, and capsular fibrosis.
Osteoarthritis is not accompanied by any systemic illness, and although there are sometimes signs of inflammation, it is not primarily an inflammatory disorder.
Pathological findings in OA include cartilage loss and reactive bone formation.
Incidence increases with age, weight, in women>men over 50 yrs, positive family history, trauma to joint.
Can be idiopathic or secondary OA.
Commonest joints affected are hands, hips, knees and spine.
- consider co-prescribing PPI
including immunoglobulins, urinary bence jones protein, rheumatoid factor, thyroid function, CK, CXR
ulnar deviation fingers, z deformity thumb, swan neck and boutonnière deformities.
Leg weakness bilat
Sensory disturbance perineal – saddle anaesthesia
Urinary and faecal disturbance ,progressing to incontinence
Sensory loss perineal area, buttocks,
back of thighs
Loss of perianal tone - need PR !
She has no dry eyes, or dry mouth, nor symptoms of Raynaud’s; she has developed a dry cough last 6 weeks, but no pain nor shortness of breath. Weight stable. Non-smoker.
white – blue – red
ischaemia --- stasis ---hyperaemia
Birefringence, or double refraction, is the splitting of a ray of light into two rays when it passes through certain types of material, such as calcitecrystals. The two rays, called the ordinary ray and the extraordinary ray, travel at different speeds. Thus the material has two distinct indices of refraction, as measured from different directions.
If split ray of light is rotated clockwise is classified as positive birefringent.
If counterclockwise rotation is classifed as negatively birefringent