Rheumatology

Overview

Rheumatology and nonoperative (office) orthopedics deal with the prevention, diagnosis, and

management of crystalline diseases, systemic rheumatic diseases, spondyloarthropathies,

vasculitis, inflammatory muscle disease, osteoporosis, osteoarthritis, recreational and sports injury,

and soft-tissue diseases and trauma. The goal of rheumatology is early diagnosis and treatment of

these conditions to prevent disability and death.

The general internist needs to have competency in the initial diagnosis and management of acute

arthritis and musculoskeletal disorders and in the long-term care of systemic disorders. He or she

must also be proficient in monitoring the effects of anti-inflammatory, immunosuppressive, and

cytotoxic drugs.

Common Clinical Presentations

· Joint pain and/or swelling (acute or chronic, monoarticular or polyarticular)

· Muscle aches (localized or diffuse)

· Musculoskeletal weakness

· Nonarticular signs and symptoms of rheumatologic disease, such as Raynaud’s

phenomenon and skin rash

· Regional pain of the neck, shoulder, lower back, hip, knee, hands, or wrists

· Traumatic joint

Procedure Skills

· Therapeutic injection of corticosteroid and arthrocentesis for the knee joint.

· Therapeutic injection of corticosteroid to the periarticular structures (bursal) of the

shoulder, knee, elbow, and foot

· Arthrocentesis of other joints (optional)

Primary Interpretation of Tests

· Analysis of synovial fluid.

· Plain bone radiographs of joints and spine

Ordering and Understanding Tests

· Anti-DNA, anti-Sm, anti-RNP, and anti-SS-A antibodies

· Antineutrophil cytoplasmic antibody (ANCA)

· Complement level

· Erythrocyte sedimentation rate

· Fluorescent antinuclear antibody (ANA)

· Rheumatoid factor

· Synovial analysis for crystals