دانلود کتاب Skills in Rheumatology

فهرست مطالب :

Introduction
How to Use This Book?
Acknowledgement
Contents
About the Editors
Part I: Basics in Rheumatology
1: History-Taking Skills in Rheumatology
1.1 Introduction
1.1.1 Objectives
1.2 Approach to History Taking in Rheumatology
1.3 Historical Correlation
1.4 Physical Examination
1.5 How to Present your Case
1.5.1 Impression
1.5.2 Problem List
1.6 Follow-Up Patient
1.7 The 2011 ACR/EULAR Definitions of Remission in Rheumatoid Arthritis Clinical Trials
1.7.1 Boolean-Based Definition [2]
1.7.2 Index-Based Definition
References
2: Approach to Musculoskeletal Examination
2.1 Introduction
2.1.1 Objectives
2.2 Epidemiology of Rheumatic Diseases
2.3 Current Status of MSK Examination
2.4 General Approach to MSK Examination
2.5 Musculoskeletal Examination of Upper Limb Joints (Fig. 2.1)
2.5.1 The Hand and Wrist Joints
2.5.1.1 First Step: The Anatomy
Anatomy of the Hand Joints (Fig. 2.1)
Approach to Hand Pain
2.5.1.2 Second Step: The Approach
Inspection
Screening Exam
Palpation
Range of motion
Special tests
2.5.2 The Elbow Joint
2.5.2.1 First Step: The Anatomy (Figs. 2.7 and 2.8)
Approach to Elbow Pain
Differential Diagnosis
2.5.2.2 Second Step: The Approach
Inspection
Screening Exam
Palpation
Range of Motion
Special Tests
Golfer’s Elbow Test
Tennis Elbow Test
Elbow Flexion Test (Ulnar Nerve)
2.5.3 The Shoulder Joint
2.5.3.1 First Step: The Anatomy (Fig. 2.15)
Approach to Shoulder Pain
2.5.3.2 Second Step: The Approach
Inspection
Screening Exam
Palpation
Range of Motion
Special Tests
For RCT
Infraspinatus and Teres Minor
Left off Test
Hawkins Impingement Sign
Drop Arm Test (Fig. 2.22)
For AC joint:
2.6 Musculoskeletal Examination of the Lower Limb Joints
2.6.1 Ankle Joint
2.6.1.1 First Step: The Anatomy
Approach to Ankle Pain
2.6.1.2 Second Step: The Approach
Inspection
Screening Exam
Palpation
Range of Motion (Fig. 2.30)
Special Tests
2.6.2 Musculoskeletal Examination of the Knee Joint
2.6.2.1 First Step: The Anatomy (Fig. 2.35)
Approach to Knee Pain
2.6.2.2 Second Step: The Approach
Inspection
Screening Exam
Palpation
Range of Motion
Special Tests
2.6.3 Musculoskeletal Examination of the Hip Joint
2.6.3.1 First Step: The Anatomy (Fig. 2.39)
Approach to Hip Pain
2.6.3.2 Second Step: The Approach
Inspection
Screening Exam
Palpation
Range of Motion
Special Tests
2.7 Back Examination
2.7.1 First Step: The Anatomy
2.7.2 Second Step: The Approach
2.7.2.1 Inspection
2.7.2.2 Screening/Gait Assessment
2.7.2.3 Palpation
2.7.2.4 Range of Motion
2.7.2.5 Special Tests
Straight Leg Raising Test (SLRT) (Fig. 2.54)
Slump Test (Fig. 2.56)
Sacroilliac Joints Exam
Modified Schober’s Test
Neurological Exam
References
3: Laboratory Interpretation of Rheumatic Diseases
3.1 Introduction
3.1.1 Objectives
3.2 Acute Phase Reactants
3.3 Rheumatoid Factor (RF) and Anti-citrullinated Protein Antibody (ACPA)
3.3.1 Definition
3.4 Antinuclear Antibodies (ANAs)
3.4.1 Definition
3.4.2 Methods of Measurement
3.5 ANA Profile
3.5.1 Definition
3.6 Other Disease-Specific Antinuclear Antibodies and Cytoplasmic Antibodies
3.7 Circulatory Complement Components
3.7.1 Mechanism of Acquired Complement Deficiencies
3.8 Synovial Fluid Analysis
3.9 Key Notes
3.9.1 Gram Stain
3.9.2 Synovial Fluid Culture
3.9.3 Diagnostic Approach
3.9.4 Crystal Search Using Polarized Light Microscopy
3.10 Summary
References
4: Pharmacotherapy in Systemic Rheumatic Diseases
4.1 Introduction
4.2 Learning Objectives
4.3 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
4.4 Synthetic Disease-Modifying Anti-Rheumatic Drugs (sDMARDs)
4.4.1 Methotrexate
4.4.2 Leflunomide
4.4.3 Azathioprine
4.4.4 Hydroxychloroquine
4.4.5 Sulfasalazine
4.4.6 Mycophenolate Mofetil
4.4.7 Cyclophosphamide
4.4.8 Tofacitinib
4.4.9 Apremilast
4.5 Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs)
4.5.1 TNF-α Blockers
4.5.2 Rituximab
4.5.3 Abatacept
4.5.4 Tocilizumab
4.5.5 Ustekinumab
4.5.6 Secukinumab
4.6 Glucocorticoids
4.7 Anti-Resorptive Drugs
4.7.1 Bisphosphonates
4.7.2 Raloxifene
4.7.3 Teriparatide
4.7.4 Denosumab
4.8 Drugs Used in Crystal Arthropathy
4.8.1 Colchicine
4.8.2 Allopurinol
4.9 Symptom-Specific Drugs
References
5: Radiology in Rheumatology
5.1 Introduction
5.2 Learning Objectives
5.3 Infectious Arthritis
5.3.1 Septic Arthritis
5.3.1.1 Radiographs
5.3.1.2 Ultrasonography
5.3.1.3 CT Scan
5.3.1.4 MRI
5.3.1.5 Scintigraphy
5.3.2 Tuberculous Arthritis
5.3.2.1 Radiograph
5.3.2.2 Ultrasonography
5.3.2.3 CT Scan
5.3.2.4 MRI
5.3.3 Brucella Arthritis
5.3.3.1 Radiograph
5.3.3.2 Ultrasonography
5.3.3.3 CT Scan
5.3.3.4 MRI
5.3.3.5 Scintigraphy
5.4 Metabolic Arthritis
5.4.1 Gouty Arthritis
5.4.1.1 Radiographs
5.4.1.2 Ultrasonography
5.4.1.3 CT Scan
5.4.1.4 MRI
5.4.2 Calcium Pyrophosphate Dehydrate (CPPD) Deposition Disease or Pseudogout
5.4.2.1 Radiograph
5.4.2.2 Ultrasonography
5.4.2.3 CT Scan
5.4.2.4 MRI
5.4.2.5 Radiographs
5.4.2.6 Ultrasonography/Magnetic Resonance Imaging (MRI)
5.5 Summary
5.5.1 Active Inflammatory Findings
5.5.2 Chronic Inflammatory Findings
References
Part II: Diagnostic Approach to Common Medical Problems in Patients with Rheumatic Diseases
6: Low-Back Pain
6.1 Introduction
6.2 Learning Objectives
6.3 Definition
6.4 Prevalence
6.5 Differential Diagnosis
6.6 Approach to Diagnosis
6.7 Radiological Studies for LBP
6.8 Detection of Inflammatory Back Pain
6.9 Treatment of Low-Back Pain (Acute or Sub-Acute Pain) [17, 18]
6.10 Treatment of Inflammatory Back Pain (IBP)
6.11 Referral
References
7: Pulmonary Manifestations of Connective Tissue Diseases
7.1 Introduction
7.2 Chapter Objectives
7.3 About the Chapter
7.4 To Get the Most of the Chapter
7.5 Important Information about Pulmonary Manifestations of CTDs before Going through the Chapter
7.6 Pulmonary Manifestations According to each CTD
7.6.1 Systemic Sclerosis or Scleroderma (SSc)
7.6.1.1 Parenchymal Lung Diseases
Presentation
Diagnosis
Prognosis
Treatment
Aspiration Pneumonitis
7.6.1.2 Vascular Diseases
Introduction
Presentation
Screening
Diagnosis
Prognosis
Treatment
7.6.1.3 Airway Disease
Bronchiectasis
Pleural Involvement
Pleural Effusion
Spontaneous Pneumothorax
Respiratory Muscle Weakness
7.6.1.4 Systemic Lupus Erythematosus (SLE)
Background
Pulmonary Manifestations
Pleural Diseases
Pleural Effusion
Presentation
Diagnosis
Treatment
7.6.1.5 Parenchymal Lung Disease
Acute Lupus Pneumonitis (ALP)
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.6.1.6 Diffuse Alveolar Hemorrhage (DAH)
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.6.1.7 Chronic ILD
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.6.1.8 Pulmonary Vascular Diseases
Thromboembolic Disease
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.6.1.9 SLE-Associated Pulmonary Arterial Hypertension (SLE-PAH)
Background
Presentation
Screening
Treatment
Acute Reversible Hypoxia
7.6.1.10 Airway Disease
Upper Airway Involvement
Introduction
Presentation
Diagnosis
Treatment
Lower Airway Involvement
Bronchiectasis
Bronchiolitis Obliterans (BO)/Obliterative Bronchiolitis (OB)
7.6.1.11 Muscle Involvement
Shrinking Lung Syndrome (SLS)
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.6.1.12 Associated Lung Disorders
Adult Respiratory Distress Syndrome (ARDS)
Infectious Complications
Pneumocystis Pneumonia (PCP) Prophylaxis
Lung Cancer
Drug Reactions
7.7 Rheumatoid Arthritis (RA)
7.7.1 Introduction
7.7.1.1 Introduction
7.7.1.2 Presentation
7.7.1.3 Diagnosis
7.7.1.4 Treatment
7.7.1.5 Prognosis
7.7.2 Pleural Diseases
7.7.2.1 Pleural Effusion
Introduction
Presentation
Diagnosis
Treatment
Complications
7.7.3 Pulmonary Vascular Diseases
7.7.3.1 PAH
7.7.3.2 DAH
7.7.4 Airway Diseases: Upper Airway Diseases
7.7.4.1 Cricoarytenoid Arthritis
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.7.4.2 Vocal Cord Rheumatoid Nodule
7.7.5 Airway Diseases: Lower Airway Diseases
7.7.5.1 Bronchiectasis
7.7.6 Airway Obstruction and Bronchial Hyperreactivity
7.7.6.1 Bronchiolitis Obliterans (BO)
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.7.6.2 Follicular Bronchiolitis
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.7.7 Rheumatoid Nodule and its Complications: (Necrobiotic Nodule)
7.7.7.1 Rheumatoid Nodule
Introduction
Presentation
Diagnosis
Treatment
Rheumatoid Nodulosis
7.7.7.2 Caplan Syndrome (Rheumatoid Pneumoconiosis)
Introduction
Presentation
Diagnosis
Treatment
Prognosis
7.7.8 Infections
7.7.8.1 Background
7.7.8.2 Latent Tuberculosis Infection (LTBI) Screening [129]
7.7.8.3 Cancer
7.7.8.4 Myopathy and Muscle Weakness
Introduction
Diagnosis
7.7.8.5 Fibrobullous Disease
7.7.8.6 Amyloidosis
7.8 Sjogren Syndrome (SS)
7.8.1 Background
7.8.2 Epistaxis
7.8.3 Hoarseness of the Voice
7.8.4 Xerotrachea and Xerobronchitis
7.8.5 Lower Airway Disease
7.8.5.1 Follicular Bronchiolitis (FB)
Introduction
Investigation
Treatment
Prognosis
7.8.6 Chronic Obstructive Pulmonary Disease (COPD)
7.8.7 Lung Parenchyma
7.8.7.1 ILD
Introduction
Subtypes
NSIP
Lymphocytic interstitial pneumonia (LIP)
7.8.8 Pleural Involvement
7.8.8.1 Pleural Effusion
7.8.9 Pulmonary Vascular Disease
7.8.9.1 PAH
Introduction
7.8.10 Cancer
7.8.10.1 Lymphoma
Introduction
Presentation
Diagnosis
Pseudolymphoma
Amyloidosis
7.9 Mixed Connective Tissue Disease (MCTD)
7.9.1 Introduction
7.9.2 Pulmonary Manifestations
7.9.2.1 Lung Parenchyma
Interstitial Lung Disease (ILD)
Introduction
Presentations
Diagnosis
Treatment
Prognosis
Alveolar Hemorrhage
Pulmonary Vascular Disease
PAH
Pleural Diseases
Pleural Effusion
7.10 Polymyositis (PM)/Dermatomyositis (DM)
7.10.1 Introduction
7.10.2 Pulmonary Manifestations
7.10.2.1 Parenchymal Lung Disease
Interstitial Lung Disease (ILD)
Introduction
Presentations
Diagnosis
Treatment
Prognosis
7.10.2.2 Aspiration Pneumonia
7.10.2.3 Pulmonary Vascular Disease
PAH
7.10.3 Pneumothorax (PNX) and Pneumomediastinum and Subcutaneous Emphysema
7.10.3.1 Introduction
7.10.4 Respiratory Failure and Hypoventilation
7.10.4.1 Introduction
7.10.4.2 Diagnosis
7.10.4.3 Complications
7.10.4.4 Treatment
7.10.4.5 Lung Cancer
References
8: Nervous System and Rheumatology
8.1 Introduction
8.1.1 Specific Objectives
8.2 Systemic Lupus Erythematosus (SLE)
8.2.1 Headache
8.2.1.1 Approach
8.2.2 Stroke
8.2.3 Seizure
8.2.3.1 Tips in History
8.2.4 Myelopathy
8.3 Rheumatoid Arthritis
8.3.1 Atlantoaxial Subluxation
8.3.2 Neuropathy
8.4 Neuropathy with Skin Rash
8.4.1 Tips in History and Physical Examinations
8.4.2 Laboratory Investigations and Imaging Modalities
8.4.3 Treatment
References
9: Diagnostic Approach to Proximal Myopathy
9.1 Introduction
9.1.1 Objectives
9.2 Clinical Presentation of Proximal Myopathy
9.2.1 History
9.2.2 Physical Examination
9.3 Differential Diagnosis of Proximal Myopathy
9.3.1 Toxins- and Drug-Induced Myopathy
9.3.2 Endocrine Myopathy
9.3.3 Dystrophic Myopathies
9.3.4 Inflammatory Myopathies
9.3.5 Myopathy Due to Infectious Disease
9.4 Diagnostic Approach
9.4.1 Muscle Enzyme
9.4.2 Rhabdomyolysis
9.4.3 Other Tests
9.4.4 Electromyography (EMG)
9.4.5 Muscle Magnetic Resonance Imaging (MRI)
9.4.6 Muscle Biopsy
9.4.7 Screening for Malignancy
9.4.8 Genetic Testing
9.5 The Management of Myopathy
9.5.1 Inherited Myopathy
9.5.2 Acquired Myopathy
References
10: Bones and Rheumatology
10.1 Introduction
10.2 Objectives
10.3 Bone Structures
10.4 Bone Remodeling and Bone Cells
10.4.1 Bone Cells
10.4.2 The Remodeling Cycle
10.4.3 Factors Influencing Remodeling
10.4.4 RANK/RANKL/OPG System
10.5 Mediators of Bone Loss in Rheumatic Diseases
10.5.1 Effects of Systemic Inflammation
10.5.1.1 Role of pro-Inflammatory Cytokines
10.5.1.2 Role of Inflammatory Cells
10.5.1.3 Causes of Uncoupling Process
The Wnt Signaling and its Antagonist, DKK1
Alteration of Glucocorticoid Signaling
10.5.2 Effects of Immobility
10.5.3 Effects of Glucocorticoids
10.6 Common Bone Diseases Associated with Rheumatic Disease
10.6.1 Rheumatoid Arthritis and Bone Loss
10.6.1.1 Predisposing Factor of Osteoporosis in RA
10.6.1.2 Pathological Process
10.6.1.3 Management of Bone Loss in RA
10.6.2 Systemic Lupus Erythematosus and Bone Loss
10.6.2.1 Predisposing Factors of Bone Loss in SLE
10.6.2.2 Pathological Process
10.6.2.3 Management of Bone Loss in SLE
10.6.3 Ankylosing Spondylitis and Bone Loss
10.6.3.1 Fracture Risk in AS
10.6.3.2 Management of Bone Loss in AS
10.6.4 Glucocorticoid-Induced Osteoporosis (GIOP)
10.6.4.1 Impact of GIOP
10.6.4.2 Approaching Managements of Patients with GIOP
10.6.4.3 Recommendations for Fracture Risk Assessment and Reassessment of Patient with GIOP
10.6.4.4 Recommendations for Initial Treatment and Prevention of GIOP
10.6.4.5 Rationale of Pharmacotherapy of GIOP
10.6.4.6 Follow-up Treatment Recommendations
10.7 Summary
References
11: Fever and Rheumatology
11.1 Introduction
11.2 Fever of Unknown Origin (FUO)
11.2.1 Definition [28]
11.2.2 Epidemiology
11.2.3 General Principles in the Treatment of FUO (Table 11.2)
11.2.4 Tips in FUO
11.3 Fever and Rheumatology
11.3.1 Introduction
11.4 Fever in Rheumatology Patient
11.4.1 History
11.4.2 Physical Examination (Table 11.3)
11.5 Rheumatologic Manifestation of Infectious Diseases
11.5.1 Introduction
11.5.1.1 Hepatitis B Virus Arthritis [104]
11.5.1.2 Acute Hepatitis B and Arthritis
11.5.1.3 Chronic Active Hepatitis B
11.5.1.4 Polyarteritis Nodosa
11.5.1.5 Essential Mixed Cryoglobulinemia
11.5.2 Hepatitis C Virus Arthritis
11.5.3 Parvovirus B19 Arthropathy
11.5.4 Dengue Virus
11.5.5 Septic Arthritis
11.5.6 Poncet’s Disease (Reactive Arthritis Associated with Tuberculosis) [121]
11.6 Vaccination in Adult Patient with Autoimmune Inflammatory Rheumatic Diseases (AIIRD)
11.6.1 Introduction
11.6.2 General Rules
References
12: Thrombosis in Rheumatological Diseases
12.1 Introduction
12.2 Pathophysiology of Thrombosis in Rheumatic Disorders
12.2.1 SLE and Thrombosis
12.2.1.1 Risk Factor and Etiology of Thrombosis in SLE
Inflammation and Disease Activity
Antiphospholipid (aPL) Antibodies
Protein C and S and Antithrombin Deficiencies
Factor V Leiden
Hyperhomocysteinemia
Traditional Risk Factors
12.2.1.2 Medication and Thrombosis in SLE
12.2.2 RA and Thrombosis
12.2.2.1 Risk Factor and Etiology of Thrombosis in RA
Lifestyle in RA
Inflammation
High Disease Activity and High Levels of Inflammatory Markers
Hospitalization
aPL Antibodies
TNF-α
Fibrinogen, VWF, Tissue Plasminogen Activator (t-PA) Antigen, and D-Dimer
Leukocytosis, Thrombocytosis, Increasing Platelet Activity, and Low Serum Albumin
High Systolic Blood Pressure (SBP) and Low Levels of High Density Lipoprotein (HDL)
Rheumatoid Factor (RF)
Prothrombotic Condition in RA
12.2.2.2 Medications and Thrombosis in RA
12.2.3 Vasculitis and Thrombosis
12.2.3.1 Large Vessel Vasculitis
12.2.3.2 Medium Vessel Vasculitis
12.2.3.3 Small Vessel Vasculitis
12.2.3.4 Risk Factors for Thrombosis in Vasculitis
Changes in Endothelial Function and Hypercoagulability
Hypercoagulability
Hypereosinophilia in Churg-Strauss
aPL Autoantibodies
12.2.3.5 Medications and Thrombosis in Vasculitis
12.2.4 Behçet’s Disease (BD)
12.2.4.1 Risk Factors for Thrombosis in BD
Endothelial Cell Dysfunction
Low Protein C
Activated Platelets and Microparticles (MP)
Vascular Endothelial Growth Factor (VEGF)
HLA-B51 and HLA-B35 Positivity
12.2.4.2 Medications and Thrombosis in BD
12.2.5 Antiphospholipid Syndrome (APS) and Thrombosis
12.2.5.1 Risk Factors for Thrombosis in APS
aPL Autoantibodies
The Effects of aPL Antibodies on Endothelial Cells
Hypercoagulable Effect of aPL Antibodies
Platelet Activation and Aggregation by aPL
β2GPI Binding with Platelet Factor 4 (PF4)
Activation of Monocytes by aPL Antibodies
Other Risk Factors for Thrombosis in APS
12.3 Approach and Diagnosis of Thrombosis in Rheumatic Diseases
12.3.1 History Taking
12.3.2 Physical Examination
12.3.3 Clinical Pretest Probability (CPTP) for VTE
12.3.4 Laboratory and Radiology Workup
12.4 Management of Thrombosis in Rheumatic Diseases, Prophylaxis, and Secondary Prevention of Thrombosis
12.4.1 Management of Thrombosis in Rheumatic Diseases
12.4.1.1 Special Consideration for Thrombosis in Rheumatic Disorders
12.4.2 Prophylaxis and Secondary Thrombosis Prevention in Rheumatic Disorders
12.4.2.1 Primary Prophylaxis in SLE Patients
12.4.2.2 Primary Prophylaxis in APS Patients
12.4.2.3 Primary Prophylaxis in High-Risk Situations
12.4.2.4 Secondary Prophylaxis in Patients with Positive aPL Antibodies
12.4.2.5 Refractory and Difficult Situations in aPL-Positive Patients
12.4.2.6 Statin Role for the Prophylaxis against Thrombosis in Rheumatic Diseases
References
13: The Blood in Rheumatology
13.1 Introduction
13.2 Objectives
13.3 Hematological Manifestations of Rheumatoid Arthritis (RA)
13.3.1 Introduction
13.3.1.1 Anemia
Anemia of Chronic Disease (ACD)
Iron Deficiency Anemia (IDA)
Macrocytic Anemia
Hemolytic Anemia
Bone Marrow Hypoplasia with Anemia
Pure Red Cell Aplasia
Treatment of Anemia in RA
13.3.1.2 White Blood Cell (WBC) Count Abnormalities
Neutropenia and Felty’s Syndrome
Leukocytosis
Eosinophilia
13.3.1.3 Platelet Abnormalities
13.3.1.4 Hematological Malignancies in RA
13.4 Hematological Manifestations of Systemic Lupus Erythematosus (SLE)
13.4.1 Introduction
13.4.1.1 Anemia
Anemia of Chronic Disease
13.4.2 Treatment
13.4.2.1 Iron Deficiency Anemia (IDA)
13.4.2.2 Autoimmune Hemolytic Anemia (AIHA)
13.4.2.3 Red Cell Aplasia
13.4.2.4 Microangiopathic Hemolytic Anemia (MAHA)
13.4.3 WBC Abnormalities
13.4.3.1 Leucopenia and Neutropenia
13.4.3.2 Lymphocytopenia
13.4.3.3 Decreased Eosinophils and Basophils
13.4.3.4 Treatment of Leukopenia
13.4.3.5 Leukocytosis
13.4.4 Platelet Abnormalities
13.4.4.1 Thrombocytosis
13.4.5 Pancytopenia
13.4.6 Lymphadenopathy and Splenomegaly
13.4.7 Antibodies to Clotting Factor and Phospholipids
13.5 Macrophage Activation Syndrome (MAS)
13.5.1 Introduction
13.5.1.1 Pancytopenia
13.5.1.2 Hepatosplenomegaly
13.5.1.3 Hyperferritinemia
13.5.1.4 Coagulopathy
13.5.2 Treatment
References
14: Renal System and Rheumatology
14.1 Introduction
14.2 Objectives
14.3 Proteinuria
14.4 Hematuria
14.5 Renal Involvement in Different Rheumatic Diseases
14.6 Lupus Nephritis (LN)
14.6.1 Diagnostic Criteria
14.6.2 Treatment
14.6.3 Adjunctive Treatments
14.7 Sjögren’s Syndrome
14.8 Cryoglobulinemic Syndrome (CG)
14.9 Scleroderma
14.9.1 Rheumatoid Arthritis (RA)
14.9.2 Renal Involvement in Vasculitis
14.9.2.1 Polyarteritis Nodosa (PAN)
14.9.3 Eosinophilic Granulomatosis with Polyangiitis EGPA (Churg-Strauss)
14.9.4 Granulomatosis with Polyangiitis GPA (Wegener’s) and Microscopic Polyangiitis (MPA)
14.9.5 Henoch-Schönlein Purpura (HSP) (IgA Vasculitis)
14.9.6 Renal Side Effects of DMARDs and NSAIDs
References
15: Skin Manifestations of Rheumatological Diseases
15.1 Introduction
15.2 Objectives
15.3 Polyarthritis with Skin: (Diagram 15.1)
15.3.1 Rheumatoid Arthritis (RA)
15.3.2 Pyoderma Gangrenosum
15.3.3 Rheumatoid Vasculitis
15.3.4 Rheumatoid Nodule
15.3.5 Skin Ulceration
15.3.6 Systemic Lupus Erythematosus (SLE)
15.3.7 ACLE (Localized)
15.3.7.1 Malar Rash
15.3.7.2 Disseminated (Generalized) ACLE
15.3.7.3 SCLE
15.3.7.4 CCLE
15.3.8 Others
15.3.8.1 Photosensitivity
15.3.8.2 Discoid Rash
15.3.8.3 Alopecia
15.3.8.4 Oral Ulcer
15.3.8.5 Systemic Sclerosis “Scleroderma”
15.3.8.6 Raynaud Phenomenon
15.3.9 Telangiectasia
15.3.10 Sclerodactyly
15.3.11 Cutaneous Sclerosis
15.3.12 Digital Ulcers
15.3.13 Calcinosis Cutis
15.4 Psoriasis
15.4.1 Scales (Fig. 15.9)
15.4.1.1 Nail Involvement
15.4.1.2 Erythroderma
15.4.1.3 Guttate Lesion
15.4.1.4 Psoriatic Arthritis
15.4.2 Dermatomyositis (DM)
15.4.2.1 Gottron’s Papules
15.4.2.2 Heliotrope Eruption
15.4.3 Facial Erythema
15.4.4 Photodistributed Poikiloderma
15.4.5 Periungual Abnormalities
15.4.6 Psoriasiform Changes in Scalp
15.4.7 Calcinosis Cutis
15.4.8 Reactive Arthritis
15.4.8.1 Circinate Balanitis
15.4.8.2 Keratoderma
15.4.9 Hepatitis C Virus (HCV)
15.4.9.1 Porphyria Cutanea Tarda
15.4.9.2 Leukocytoclastic Vasculitis
15.4.10 Lichen Planus
15.4.11 Necrolytic Acral Erythema
15.4.12 Polyarteritis Nodosa
15.4.12.1 Livedo Reticularis
15.4.12.2 Ulcerations
15.4.13 Digital Ischemia
15.5 Sarcoidosis
15.5.1 Erythema Nodosum
15.5.2 Papular Sarcoidosis
15.5.3 Nodular Sarcoidosis
15.5.4 Maculopapular Sarcoidosis
15.5.5 Plaque Sarcoidosis
15.5.6 Lupus Pernio
15.5.7 Hypopigmented Sarcoidosis
15.5.8 Atrophic and Ulcerative Sarcoidosis
15.6 Rheumatic Fever
15.6.1 Arthritis
15.6.2 Erythema Marginatum
15.6.3 Subcutaneous Nodules
15.7 Behçet’s Disease
15.7.1 Erythema Nodosum-like Lesion
15.7.2 Acneiform Lesion
15.7.3 Folliculitis-like Rash
15.7.4 Papulopustular Eruptions
15.7.5 Erythema Multiforme-like Lesions
15.7.6 Superficial Thrombophlebitis
15.7.7 Ulcers (Oral, Genital)
15.7.8 Pyoderma Gangrenosum
15.7.9 Positive Pathergy Reaction at Injection Site
15.7.10 Arthritis
15.8 Inflammatory Bowel Disease
15.8.1 Erythema Nodosum (EN)
15.8.2 Pyoderma Gangrenosum
15.8.3 Oral Ulcer
15.8.4 Musculoskeletal Manifestations
15.8.5 Arthritis
15.9 Severe and Life-Threatening Conditions (Fig. 15.21)
15.10 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
15.10.1 Rash
15.10.2 Bullous Lesions
15.10.3 Urticarial Lesions (Not Pruritic)
15.10.4 Erythema
15.10.5 Palpable Purpura
15.10.6 Edema (Face, Tongue)
15.10.6.1 Sloughing of Skin
15.11 Erythroderma Exfoliation
15.11.1 Erythema
15.11.1.1 Exfoliation and Scales (2–6 Days after Erythema)
15.11.2 Pruritus
15.11.3 Pain
15.11.4 Dyspigmentation
15.11.5 Palmoplantar Keratoderma
15.11.6 Nail Changes
15.11.7 Diffuse Non-scarring Alopecia
15.11.8 Systemic Manifestation
15.11.9 Complications
15.12 Gonococcal Arthritis
References
16: Cardiovascular Diseases and Rheumatology
16.1 Introduction
16.2 Cardiovascular Manifestations in the Rheumatic Diseases
16.2.1 Rheumatoid Arthritis (RA)
16.2.1.1 Pericarditis
16.2.1.2 Myocardial Involvement
Antimalarials-Induced Cardiotoxicity
16.2.1.3 Heart Failure
16.2.1.4 Coronary Artery Disease (CAD)
16.2.1.5 Rheumatoid Nodule
16.2.2 SLE
16.2.2.1 Pericarditis
16.2.2.2 Myocarditis
16.2.2.3 Coronary Artery Disease (CAD)
16.2.2.4 Endocarditis (Libman–Sacks Endocarditis)
16.2.3 Systemic Sclerosis (SSc)
16.2.3.1 Myocardial Fibrosis
16.2.3.2 Myocardial Ischemia
16.2.3.3 Pericarditis
16.2.4 Antiphospholipid Syndrome
16.2.4.1 Aspirin and APS
16.2.5 Ankylosing Spondylitis (AS)
16.2.5.1 Aortic Involvement
16.2.5.2 Myocardial Involvement
16.2.5.3 Conduction Abnormalities
16.2.6 Psoriatic Arthritis
16.2.6.1 Arrhythmias
16.2.6.2 CAD:
16.2.7 Systemic Vasculitis
16.3 The Accelerated Atherosclerosis Effects on CAD in Rheumatologic Diseases
16.4 Metabolic Syndrome and Rheumatological Diseases
16.4.1 RA
16.4.2 SLE
16.4.3 AS
16.4.4 Psoriasis
16.4.5 Gout
16.5 The Various Medications that Are Being Used in the Management of Rheumatologic Disease that Have Variable Effects on CAD
16.5.1 NSAIDs
16.5.2 Glucocorticoids (GC)
16.5.3 Methotrexate
16.5.4 TNF Biologic DMARDs
16.5.5 Non-TNF Biologic DMARDs
Appendix 1
References
17: Gestational Rheumatology
17.1 Introduction
17.2 Objectives
17.3 Physiology of Pregnancy
17.3.1 Changes in Cardiovascular System
17.3.2 Hematological Changes
17.3.3 Changes in Coagulation System
17.3.4 Changes in the Maternal Immune System
17.3.5 Changes in the Endocrine Glands
17.4 Systemic Lupus Erythematosus
17.4.1 Introduction
17.4.2 Influence of Pregnancy on SLE
17.4.3 Lupus Flares
17.4.4 Lupus Nephritis (LN)
17.4.5 Influence of SLE on Pregnancy
17.4.6 Hypercoagulability in SLE
17.4.6.1 Platelet Activation
17.4.6.2 Lupus Platelets
17.4.6.3 Laboratory Workup
17.4.6.4 High-Risk Clinical Scenarios
17.4.6.5 Management of Lupus Pregnancy
A) Management Issues
B) Treatment of Active Lupus Activity
C) Delivery
D) Puerperium
17.5 Antiphospholipid Syndrome in Pregnancy
17.5.1 Introduction
17.5.2 Diagnostic Criteria
17.5.3 Pathogenesis of APS
17.5.3.1 Thrombosis (Thrombosis of Vessels and Placenta)
17.5.3.2 Defective Placentation
17.5.3.3 Inflammation
17.5.4 Treatment
17.5.4.1 Low-Dose ASA (LDA): Either Alone or Combined with Heparin
17.5.4.2 Aspirin/Heparin-Resistant APS (AHR-APS)
17.5.5 Conclusion
17.6 Neonatal Lupus Erythematosus
17.6.1 Introduction
17.6.2 Pathogenesis and Clinical Features
17.6.3 Treatment of Congenital Heart Block
17.6.4 Conclusion
17.7 Rheumatoid Arthritis (RA) and Pregnancy
17.7.1 Introduction
17.7.2 Effect of Pregnancy on RA
17.7.3 Effects of RA on Pregnancy
17.8 Sjogren’s Syndrome (SS) and Pregnancy
17.9 Systemic Sclerosis (SSc) and Pregnancy
17.10 Vasculitis and Pregnancy
17.10.1 Introduction
17.10.2 Large Vessel Vasculitis
17.10.2.1 Behcet’s Disease (BD)
17.10.2.2 Takayasu’s Arteritis
17.10.3 Medium Vessels Vasculitis
17.10.3.1 Polyarteritis Nodosa (PAN)
17.10.4 Small Vessels Vasculitis
17.10.4.1 Granulomatosis with Polyangiitis (GPA) (Wegner’s Granulomatosis)
17.10.4.2 Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)
17.11 Polymyositis (PM)/Dermatomyositis (DM) and Pregnancy
17.12 Spondyloarthritis and Pregnancy
17.13 Conclusion
References
18: Perioperative Management of Patients with Rheumatic Diseases
18.1 Introduction
18.1.1 Objectives
18.2 The Preoperative Medical Evaluation
18.2.1 History Taking
18.2.2 Physical Examination
18.2.3 Investigations
18.2.4 Assessment of Specific Clinical Problems in Patients with RA
18.2.4.1 Cardiovascular
18.2.4.2 Pulmonary
18.2.4.3 Cricoarytenoid Arthritis
18.3 Perioperative Drug Management
18.3.1 Perioperative Management if Antirheumatic Drugs [12–16]
18.3.2 Perioperative Management of Other Systemic Medications [12–14, 16, 17]
18.3.3 DVT Prophylaxis
18.3.4 Prophylactic Antibiotics [20, 29]
18.4 Assessment of Specific Clinical Problems in Patients with SLE
18.5 Postoperative Follow-Up
18.6 Patient Education
18.7 Physical Activity and Rehabilitation
References
19: Eye and Rheumatology
19.1 Introduction
19.1.1 Objectives
19.2 Uveitis
19.2.1 Approach to Uveitis
19.2.1.1 History
19.2.1.2 Eye Examination
19.2.1.3 Treatment
19.3 Eye Dryness
19.3.1 Approach to Dry Eye
19.3.1.1 History
19.3.1.2 Eye Examination
19.3.1.3 Treatment
19.4 Corneal Ulcer
19.4.1 Approach to Corneal Ulcer
19.4.1.1 History
19.4.1.2 Eye Examination
19.4.1.3 Treatment
19.5 Scleritis
19.5.1 Approach to Scleritis
19.5.1.1 History
19.5.1.2 Eye Examination
19.5.1.3 Treatment
19.6 Episcleritis
19.6.1 Approach to Episcleritis
19.6.1.1 History
19.6.1.2 Eye Examination
19.6.1.3 Treatment
19.7 Cataract
19.7.1 Approach to Cataract
19.7.1.1 History
19.7.1.2 Eye Examination
19.7.1.3 Treatment
19.8 Glaucoma
19.8.1 Approach to Glaucoma
19.8.1.1 History
19.8.1.2 Eye Examination
19.8.1.3 Treatment
19.9 Ophthalmologic Side Effects of Rheumatic Medications [17]
19.10 Antimalarial-Related Retinopathy
19.10.1 Approach to Antimalarial-Related Retinopathy
19.10.1.1 History
19.10.1.2 Eye Examination
19.10.1.3 Treatment
References
20: Vasculitis and Rheumatology
20.1 Learning Objectives
20.1.1 Pathologic Mechanisms Underlying Vasculitis
20.1.2 Classification of Vasculitis
20.1.3 The 2012 Chapel Hill Consensus Conference (CHCC) on Nomenclature of Vasculitis
20.1.4 How to Approach a Patient with Vasculitis?
20.1.4.1 A Case Scenario
20.1.5 Major Forms of Vasculitis
20.1.5.1 Takayasu’s Arteritis (TA)
20.1.5.2 Giant Cell Arteritis (GCA)
20.1.5.3 Polyarteritis Nodosa (PAN)
20.1.5.4 Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA)
20.1.5.5 Eosinophilic Granulomatosis with Polyangiitis (EGPA)
20.1.5.6 IgA Vasculitis (IgAV)
20.1.5.7 Cutaneous Leukocytoclastic Angiitis
20.1.5.8 Behcet’s Disease (BD)
References
21: Diabetes and Rheumatology
21.1 Introduction
21.1.1 Objectives
21.2 Pathophysiology
21.2.1 Classification of Rheumatological Manifestations in Diabetic Patients
21.3 Carpal Tunnel Syndrome
21.3.1 Epidemiology
21.3.2 Approach to CTS
21.3.2.1 History
21.3.2.2 Physical Examination
21.3.2.3 Investigations
21.3.3 Treatment
21.4 Reflex Sympathetic Dystrophy
21.4.1 Pathogenesis
21.4.2 Epidemiology
21.4.3 Approach to RSD
21.4.3.1 History
21.4.3.2 Physical Examination
21.4.4 Diagnosis Criteria (Table. 21.2)
21.4.5 Treatment
21.5 Flexor Tenosynovitis
21.5.1 Pathogenesis
21.5.2 Epidemiology
21.5.3 Approach to Flexor Tenosynovitis
21.5.3.1 History
21.5.3.2 Physical Examination
21.5.3.3 Investigations
21.5.4 Treatment [17]
21.6 Diabetic Muscular Infarction
21.6.1 Pathophysiology
21.6.2 Epidemiology
21.6.3 Approach to DMI
21.6.3.1 History
21.6.3.2 Physical Examination
21.6.3.3 Imaging Studies
21.6.3.4 Muscle Biopsy (for Confirmation)
21.6.4 Treatment
21.7 Adhesive Capsulitis (Frozen Shoulder)
21.7.1 Pathogenesis
21.7.2 Epidemiology
21.7.3 Approach to Frozen Shoulder
21.7.3.1 History
21.7.3.2 Physical Examination
21.7.3.3 Imaging
21.7.4 Treatment
21.8 Neuropathic Osteoarthropathy (Charcot Joint)
21.8.1 Pathogenesis
21.8.2 Epidemiology
21.8.3 Approach to Charcot Joint
21.8.3.1 History
21.8.3.2 Physical Examination
21.8.4 Treatment
21.9 Diabetes and Osteoporosis
21.9.1 Pathogenesis
21.9.2 Challenges in Diagnosing and Treating Diabetes-Related Osteoporosis
21.9.3 Approach to Diabetes-Related Osteoporosis
21.9.3.1 History
21.9.3.2 Physical Exam
21.9.3.3 Diagnosis
21.9.3.4 Management of Osteoporosis on Diabetic Patients
References
22: Soft Tissue Rheumatic Disorders
22.1 Introduction
22.1.1 Learning Objectives
22.1.2 Classification of Soft Tissue Disorders
22.1.3 Bursitis
22.1.4 Tendinitis
22.1.5 Rotator Cuff Tendinitis and Rotator Cuff Tear
22.1.6 Enthesitis
22.1.7 Achilles Tendinitis
22.1.8 Epicondylitis [26, 27]
22.1.9 Fasciitis
22.1.10 Plantar Fasciitis
22.1.11 Palmar Fasciitis
22.1.12 Eosinophilic Fasciitis
References
23: Gastrointestinal Manifestations of Rheumatic Diseases
23.1 Objectives
23.2 Gastrointestinal Manifestations of Systemic Lupus Erythematosus (SLE)
23.2.1 Oral Cavity Manifestations of SLE
23.2.2 Esophageal Manifestations of SLE
23.2.3 Gastric Manifestations of SLE
23.2.4 Colonic and Small Bowel Manifestations of SLE
23.2.5 Pancreatic and Gallbladder Manifestations of SLE
23.2.6 Hepatic Manifestations of SLE
23.2.7 Gastrointestinal Malignancies in Systemic Lupus Erythematosus
23.3 Gastrointestinal Manifestations of Rheumatoid Arthritis (RA)
23.3.1 Dysphagia and Other Esophageal Manifestations of Rheumatoid Arthritis
23.3.2 Gastric Manifestations of Rheumatoid Arthritis
23.3.3 Intestinal and Colonic Manifestations of Rheumatoid Arthritis
23.3.4 Hepatic Manifestations of Rheumatoid Arthritis
23.3.5 Other Gastrointestinal Manifestations of Rheumatoid Arthritis
23.4 Gastrointestinal Manifestations of Inflammatory Myositis
23.4.1 Symptomatology
23.4.2 Esophageal Manifestations of Inflammatory Myositis
23.4.3 Gastric Manifestations of Inflammatory Myositis
23.4.4 Intestinal Manifestations of Inflammatory Myositis
23.4.5 Hepatic Manifestations of Inflammatory Myositis
23.5 Gastrointestinal Manifestations of Systemic Sclerosis
23.5.1 Esophageal Manifestations of Systemic Sclerosis
23.5.2 Gastric Manifestations of Systemic Sclerosis (SSc)
23.5.3 Intestinal Manifestations of Systemic Sclerosis
23.5.4 Colonic and Anorectal Manifestations of Systemic Sclerosis
23.6 Gastrointestinal Manifestations of Behcet’s Disease (BD)
23.6.1 Esophageal Manifestations of Behçet’s Disease
23.6.2 Gastric Manifestations of Behçet’s Disease
23.6.3 Intestinal and Colonic Manifestations of Behcet’s Disease
23.6.4 Pancreatic Manifestations of Behcet’s Disease
23.6.5 Hepatic Manifestations of Behcet’s Disease
23.6.6 Visceral Arterial Involvement in Patients with Behcet’s Disease
23.7 Gastrointestinal Manifestations of Vasculitis
23.7.1 Polyarteritis Nodosa (PAN)
23.7.1.1 Gastrointestinal Manifestations of Polyarteritis Nodosa
23.7.1.2 Hepatic and Biliary Manifestations of Polyarteritis Nodosa
23.7.1.3 Pancreatic Manifestations of Polyarteritis Nodosa
Diagnostic Modalities of Polyarteritis Nodosa
Treatment
23.7.2 Granulomatosis with Polyangiitis—GPA (Formerly Named Wegener’s Granulomatosis)
23.7.3 Eosinophilic Granulomatosis with Polyangiitis—EGPA (Formerly Named Churg-Strauss Syndrome)
23.7.4 Henoch-Schonlein Purpura (HSP)
23.7.5 Behcet’s Disease
23.8 Gastrointestinal Manifestations of Spondyloarthropathies (SpA)
23.8.1 Ankylosing Spondylitis (AS)
23.8.2 Psoriatic Arthritis (PsA)
23.8.3 Reactive Arthritis
23.8.4 IBD-Associated SpA
23.9 Gastrointestinal Manifestations of Sjogren’s Syndrome (SS)
23.9.1 Oral Manifestations of Sjogren’s Syndrome
23.9.2 Esophageal Manifestations of Sjogren’s Syndrome
23.9.3 Gastric Manifestations of Sjogren’s Syndrome
23.9.4 Bowel and Colonic Manifestations of Sjogren’s Syndrome
23.9.5 Pancreatic Manifestations of Sjogren’s Syndrome
23.9.6 Hepatic Manifestations of Sjogren’s Syndrome
References
24: Pediatric Rheumatology
24.1 Introduction
24.2 Learning Objectives
24.3 Pediatric Rheumatic Diseases
24.4 Childhood Onset SLE
24.5 Juvenile Dermatomyositis
24.6 Juvenile Idiopathic Arthritis
24.7 Childhood Vasculitis
24.8 Kawasaki Disease
24.9 Autoinflammatory Syndromes
References
Part III: Classification Criteria and Guidelines
25: Classification Criteria and Clinical Practice Guidelines for Rheumatic Diseases
25.1 Introduction
25.2 Rheumatoid Arthritis Classification Criteria and Management Guidelines
25.2.1 Classification Criteria (Fig. 25.1)
25.2.2 Management Guidelines [2] (Fig. 25.2)
25.3 Systemic Lupus Erythematosus Classification Criteria and Management Guidelines
25.3.1 Classification Criteria of Systemic Lupus Erythematosus (Fig. 25.3)
25.3.2 Management Guidelines for Systemic Lupus Erythematosus
25.3.2.1 General Management Recommendations
25.3.2.2 Lupus Nephritis (LN)
25.3.2.3 Neuropsychiatric Lupus [10]
25.4 Antiphospholipid Syndrome Classification Criteria and Management Guidelines
25.4.1 Classification Criteria
25.4.2 Management Guidelines
25.5 Vasculitis Classification Criteria and Management Guidelines
25.5.1 Classification Criteria (Fig. 25.18)
25.5.2 Management Guidelines
25.5.3 Classification Criteria [18]
25.6 Spondyloarthritis Classification Criteria and Management Guidelines
25.6.1 Classification Criteria (Figs. 25.20, 25.21 and 25.22) (Table 25.3)
25.6.2 Management Guidelines
25.7 Psoriatic Arthritis Classification Criteria and Management Guidelines (Table 25.4) (Fig. 25.25)
25.7.1 Classification Criteria
25.7.2 Management Guidelines
25.8 Systemic Sclerosis Classification Criteria and Management Guidelines
25.8.1 Classification Criteria of Systemic Sclerosis (Tables 25.5, 25.6 and 25.7)
25.8.2 Management Guidelines of Systemic Sclerosis (Table 25.8)
25.8.3 Dermatomyositis and Polymyositis Classification Criteria and Management Guideline
25.8.4 Summary of Polymyositis and Dermatomyositis Classification Criteria [27] (Fig. 25.27)
25.8.5 Sjögren’s Syndrome Classification Criteria and Management Guidelines (Table 25.9)
25.8.6 Behcet’s Disease Classification Criteria and Management Guidelines
25.8.7 Diagnostic Criteria for Behcet’s Disease, International Study Group for Behcet’s Disease (1990) (Tables 25.10 and 25.11)
25.8.8 Gout Classification Criteria and Management Guidelines [31] (Box 25.2)
25.9 Osteoarthritis Classification Criteria and Management Guidelines
25.9.1 Classification Criteria (Fig. 25.28)
25.9.2 Osteoarthritis Management Guidelines [35] (Figs. 25.29, 25.30 and 25.31)
25.9.2.1 Osteoporosis Classification Criteria and Management Guidelines [36–41] (Table 25.12) (Box 25.3) (Fig. 25.32)
References