Synopsis of Rheumatic Diseases (eBook)

Font Cover 1
A Synopsis of Rheumatic Diseases 4
Copyright Page 5
Table of Contents 10
Preface to the Fifth Edition 6
Preface to the First Edition 8
Section 1: General Aspects of Rheumatology 12
Chapter 1. BIOLOGY OF SYNOVIAL JOINTS AND CONNECTIVE TISSUE 12
Structure of Synovial Joints 12
Blood Supply of Joints 14
Joint Lubrication 15
Synovial Fluid 15
Structure of Connective Tissue 16
Further Reading 17
Chapter 2. IMMUNOLOGICAL PRINCIPLES OF RHEUMATIC DISORDERS 17
Reference 22
Further Reading 22
Chapter 3. PATHOLOGY OF THE INFLAMMATORY REACTION 23
Acute inflammatory response 23
Chemical mediators 23
Chronic Inflammation 24
Persistence of Inflammation 24
Fibrosis 24
Chapter 4. LABORATORY INVESTIGATIONS AND IMAGING IN RHEUMATIC DISORDERS 25
Blood Count 25
Erythrocyte Sedimentation Rate 25
Serum Chemistry 26
Urine Analysis 27
Immunological Investigations 27
Synovial Fluid Analysis 28
Biopsy 29
Arthroscopy 29
Radiology in Arthritis 30
Imaging in Arthritis and Bone Disease 30
Inflammatory Arthritis: Principal Investigations 30
References 31
Chapter 5. EXAMINATION OF THE LOCOMOTOR SYSTEM 31
History-taking 32
Examination of Locomotor System: General Scheme 34
References 35
Chapter 6. ANALGESIC DRUGS IN RHEUMATIC DISORDERS 35
Further Reading 36
Chapter 7. ANTI-INFLAMMATORY DRUGS IN RHEUMATIC DISORDERS 36
Experimental Testing of Anti-Inflammatory Drugs 36
Classification of Antiinflammatory Drugs 37
Systemic Steroids and Corticotrophin (ACTH) 41
Antirheumatic Drugs in Special Situations 43
Further Reading 44
Chapter 8. PHYSIOTHERAPY IN RHEUMATIC DISORDERS 44
Heat Therapy 45
Cold Therapy 47
Exercise Therapy and Manipulation 47
Massage 48
Electrotherapy 48
Hydrotherapy 49
Spinal Traction 50
Physiotherapy Trials 50
References 50
Chapter 9. REHABILITATION IN CHRONIC ARTHRITIS 50
Assessment 50
Scope of Rehabilitation 51
Occupational Therapy in Rheumatology 51
Splints and Appliances 53
Wheelchairs 54
Social Help and Welfare 54
Resettlement 54
Further Reading 55
Chapter 10. CLASSIFICATION OF RHEUMATIC DISORDERS 56
I. Diffuse Connective Tissue Diseases 56
II. Arthritis Associated with Spondylitis (i.e. Spondarthritis) 57
III. OSTEOARTHRITIS 57
IV. Rheumatic Syndromes Associated with Infectious Agents 57
V. Metabolic and Endocrine Diseases Associated with Rheumatic States 58
VI. Neoplasms 59
VII. Neurovascular Disorders 59
VIII. Bone and Cartilage Disorders 59
IX. Extra-articular Disorders (Soft-tissue Rheumatism) 59
X. Miscellaneous Disorders Associated with Articular Manifestations 59
Section 2: The Major Rheumatic Diseases 62
Chapter 11. RHEUMATOID ARTHRITIS: AETIOLOGY AND PATHOLOGY 62
Definition 62
Aetiology 62
Pathogenesis of Rheumatoid Disease 64
Pathology of Rheumatoid Disease 65
References 74
Further Reading 74
Chapter 12. RHEUMATOID ARTHRITIS: CLINICAL FEATURES, COMPLICATIONS, DIAGNOSIS AND PROGNOSIS 74
Clinical Features 74
Extra-articular Manifestations and Complications 81
Laboratory Investigations 86
Synovial Biopsy 87
Radiology 87
Diagnosis and Differential Diagnosis 88
References 92
Chapter 13. MANAGEMENT OF RHEUMATOID ARTHRITIS 93
Splinting 94
Physiotherapy in Rheumatoid Arthritis 94
Orthopaedic Appliances 94
Intra-articular Corticosteroid Injections 95
Intra-articular Radiocolloids 96
Analgesics, First-line Antirheumatic drugs 96
Second-line Antirheumatic Drugs 96
Gold 96
Antimalarials 97
D-Penicillamine 98
Sulphasalazine (Salazopyrin) 99
Systemic Steroids 99
Immunosupressive Drugs in Rheumatoid Arthritis 99
Surgical Treatment in Rheumatoid Arthritis 99
Other Miscellaneous Treatments for Rheumatoid Disease 101
Treatment of Extra-Articular Manifestations and Complications 101
Crico-arytenoid Arthritis Causing Laryngeal Obstruction 101
Occupational Therapy and Rehabilitation 102
Management of Important Emergencies in Rheumatoid Disease 103
Research and Patient Organizations in UK 103
References 104
Chapter 14. VARIANTS OF RHEUMATOID ARTHRITIS 104
Felty's Syndrome 104
Sjogren's Syndrome 105
Palindromic Rheumatism 107
References 108
Further Reading 108
Chapter 15. ARTHRITIS IN CHILDREN 109
Juvenile Chronic Arthritis (JCA) 109
References 113
Further Reading 113
Chapter 16. ANKYLOSING SPONDYLITIS AND SERONEGATIVE SPONDARTHRITIS 113
Seronegative Spondarthritis 113
Ankylosing Spondylitis 114
References 125
Further Reading 125
Chapter 17. REACTIVE ARTHRITIS 125
Rheumatic Fever 126
Reiter's Disease 128
Yersinia Arthritis 132
References 132
Further Reading 132
Chapter 18. SYSTEMIC CONNECTIVE-TISSUE DISORDERS 132
Systemic Lupus Erythematosus 132
Systemic Sclerosis (PSS: Progressive Systemic Sclerosis) 140
Polymyositis and Dermatomyositis 144
Mixed Connective-tissue Disease (MCTD) 146
References 147
Further Reading 147
Chapter 19. DISORDERS DUE TO VASCULITIS 147
Polyarteritis (Polyarteritis Nodosa) 148
Giant-cell Arteritis (Cranial or Temporal Arteritis) 152
Polymyalgia Rheumatica 154
Takayusu's Arteritis (Aortic Arch Syndrome: Pulseless Disease) 155
Wegener's Granulomatosis (Midline Granuloma) 156
Kawasaki's Disease (Mucocutaneous Lymph-node Syndrome) 156
Small Vessel (Hypersensitivity) Arteritis 156
Churg-Strauss Syndrome (Allergic Angiitis) 157
References 158
Further Reading 158
Chapter 20. OSTEOARTHRITIS (OSTEOARTHROSIS) 158
Classification 158
Aetiology 159
Pathology 160
Clinical Features 162
Radiology 164
Laboratory Investigations 164
General Principles of Management 164
Clinical Features and Treatment of Individual Joints 166
Reference 170
Further Reading 170
Chapter 21. ARTHRITIS DUE TO OR ASSOCIATED WITH METABOLIC AND ENDOCRINE DISORDERS 170
Gout (Podagra) 171
Calcinosis 180
Pyrophosphate Arthropathy (Calcium Pyrophosphate Deposition Disease) 181
Hydroxyapatite Deposition Disease 183
Ochronosis 184
Rheumatic Features of Hyperlipoproteinaemias 184
Whipple's Disease 186
Gaucher's Disease (Glycogen Storage Disease) 187
Amyloidosis 187
Periodic Fever 188
Acromegaly 188
Hyperthyroidism 189
Hypothyroidism 189
Rheumatic Features Associated with Diabetes Mellitus 190
References 190
Section 3: Less Common Forms of Arthritis 192
Chapter 22. INFECTIVE ARTHRITIS 192
Bacterial Infections 192
Acute Septic Arthritis 192
Tuberculous Arthritis 194
Gonococcal Arthritis 195
Syphilitic Arthritis 195
Lyme Arthritis2 196
Meningococcal Arthritis 196
Arthritis with Brucellosis 196
Arthritis with Enteric Fever 197
Reactive Arthritis with Enteric Infections 197
Musculoskeletal Features in Leprosy 197
Arthritis Following Virus Infections 198
Mycotic Infections 199
References 200
Further Reading 200
Chapter 23. ARTHRITIS ASSOCIATED WITH SKIN DISORDERS 200
Erythema Nodosum 200
Erythema Multiforme 201
Psoriatic Arthritis 201
Livido Reticularis 205
Behcet's Syndrome 205
Acne Arthralgia 207
Pustulotic Arthro-osteitis 207
Chapter 24. ARTHRITIS ASSOCIATED WITH OTHER SYSTEMIC DISORDERS 208
Arthritis Associated with Intestinal Disorders (Enteropathic Arthritis) 208
Arthritis Associated with Blood Disorders 209
Arthritis with Neurological Disorders: Neuropathic Arthritis 213
Arthritis and Rheumatism in Malignant Disease 213
Eye Involvement in Rheumatic Disorders 214
References 215
Further Reading 215
Chapter 25. OTHER ARTHRITIC DISORDERS OF UNCERTAIN CAUSE 215
Hypertrophic Osteoarthropathy 215
Jaccoud's Syndrome (Chronic Secondary Polyarthritis) 217
Musculoskeletal Features of Sarcoid 217
Intermittent Hydrarthrosis 218
Relapsing (Atrophic) Polychondritis 218
Arthralgia with Carcinoid Syndrome 218
Tietze's Syndrome 218
Joint Disorders in Immunodeficiency 218
Arthritis Mutilans 219
Arthritis Associated with Drug Therapy 220
Arthritis with Haemochromatosis 220
Musculoskeletal Disorders in Wilson9s Disease 221
Musculoskeletal Disorders Following Renal Transplantation or Dialysis 221
Arthralgia with Atrial Myxoma 221
Arthritis and Liver Disease 221
Malignancy and Rheumatic Disorders 222
Arthritis with Cystic Fibrosis 223
Pancreatic Arthritis Syndrome 223
Arthritis with Coeliac Disease 223
References 223
Further Reading 223
Chapter 26. NEOPLASMS OF SYNOVIAL MEMBRANE AND TENDON SHEATHS 224
Benign Tumours 224
Malignant Tumours 224
Further Reading 224
Section 4: Rheumatism due to Extra-articular Causes ('Soft-tissue Rheumatism) 226
Chapter 27. SOFT-TISSUE (NON-ARTICULAR) RHEUMATISM 226
Generalized Rheumatic Pain due to Systemic Disorders 226
Tendinitis and Tenosynovitis 227
Enthesopathies 228
Bursitis 228
Capsulitis (Pericapsulitis or Periarthritis of Shoulder) 229
Myositis and Myopathy 231
Muscles Cramps 232
Fasciitis 233
Fibrositis ('Fibromyalgia Syndrome9) 234
Panniculitis 235
Neuritis 235
Soft-tissue (Athletic) Injuries 236
References 237
Further Reading 237
Chapter 28. RHEUMATISM ASSOCIATED WITH BONE AND CARTILAGE DISORDERS 237
Osteoporosis 238
Osteomalacia 241
Renal Bone Disease 244
Hyperparathyroidism 244
Osteomyelitis 246
Benign Bone Tumours 246
Malignant Bone Tumours 247
Hereditary Disorders of Bone and Cartilage 247
Paget's Disease of Bone 248
Avascular Necrosis of Bone (Aseptic Necrosis Osteonecrosis
References 253
Chapter 29. HEREDITARY CONNECTIVE-TISSUE DISORDERS 253
Marfan's Syndrome 253
Marfanoid Hypermobility Syndrome (Type I Mucopolysaccharidosis) 254
Ehlers-Danlos Syndrome 255
Osteogenesis Imperfecta (Fragilitas Ossium) 255
Hypermobility Syndrome 256
Arthrogryposis Multiplex Congenita 258
Morquio-Brailsford's Disease (Type IV Mucopolysaccharidosis) 258
Hereditary Progressive Arthro-ophthalmopathy 258
Chapter 30. PSYCHOGENIC RHEUMATISM 259
Definition 259
Aetiology 259
Clinical Features 259
Diagnosis 259
Treatment 260
Section 5: Vertebral Pain Syndromes 262
Chapter 31. CERVICAL PAIN AND BRACHIAL NEURALGIA 262
Cervical Disc Lesions and Spondylosis 263
Whiplash Injuries 267
Thoracic Outlet Syndromes 267
Coronary Artery Disease 269
Spasmodic Torticollis 269
Facial Pain 269
Chronic Headache 269
Chapter 32. LOW BACK PAIN AND SCIATICA 270
Lumbar Disc Lesions 273
Lumbar Spondylosis 278
Spondylolisthesis 279
Spinal Stenosis 279
Infections of the Spine 280
Neoplasms of Spine 280
Spinal Tumours 280
Back Pain in Women 281
References 281
Chapter 33. PAIN IN THE THORACIC SPINE 281
Osteochondritis of Spine 283
Anterior Chest Pain 284
Reference 284
Further Reading 284
Section 6: Limb Pain Syndromes 286
Chapter 34. SHOULDER PAIN 286
Rotator Cuff Lesions 288
Milwaukee Shoulder2 291
Bicipital Tendinitis 291
Algodystrophy (Reflex Sympathetic Dystrophy) 292
Shoulder-hand Syndrome 292
Neuralgic Amyotrophy (Shoulder-girdle Neuritis) 293
References 294
Further Reading 294
Chapter 35. ELBOW PAIN 294
Epicondylitis 294
References 296
Further Reading 296
Chapter 36. PAIN AND PARAESTHESIA IN THE HANDS 296
Flexion Contractures of Fingers 299
Acroparaesthesia 299
References 302
Further Reading 302
Chapter 37. PAIN IN THE HIP 302
Protrusio Acetabulae 304
References 304
Chapter 38. PAIN IN THE KNEE AND LEG 304
References 308
Further Reading 308
Chapter 39. PAIN IN THE HEEL, FOOT AND ANKLE 309
References 314
Section 7: Appendices 316
1. SELECTION OF MULTIPLE-CHOICE QUESTIONS ON RHEUMATOLOGY AND RELATED TOPICS SET IN THE MRCP (LONDON) EXAMINATION 316
2. NOTES ON ANSWERING THE MULTIPLE-CHOICE QUESTIONS 319
3. USEFUL LABORATORY INFORMATION IN RHEUMATOLOGY: NORMAL VALUES 321
Index 322