Monday, 22 February 2010

Rheumatology in new station 5

examples from recent exams:
-RA on methotrexate presented with SOB.
-RA back from long journey presented with swallon calf.
-RA C/O gritty eyes.

quick enquiry about the RA, how long, how active , current Rx, regular F/U.
now assess the presenting problem.
what is the link with RA?
SOB (pul fibrosis, pnuemonitis as s/e of MTX)
swallon calf (repture backer's cyst)
gritty eyes (Sogren's syndrome)

review medication and PMHx

quickly assess RA, ? active ?sinovitis
examine the system of the complain (chest, calf, eyes)

explore what the patient main concern and reasure
epxplain what investigation and wahy.

hopefully you will be done by 6 min and able to present to the examiner.

any other thoughts?


  1. i have a case of RA with c/o weak hands=carpal tunel syndrome.
    thyrotoxicosis under going surgery=treated graves
    disease assess any other concern.
    DVT 55 years male job tailer .

  2. headache in 42 old obese female = PSEUDOTUMOR CEREBRI FUNDUS PAPILLODEMA

  3. The diagnosis of AS is made according to the modified New York criteria.
    Traditionally, treatment of AS has been directed to relieving pain and stiffness in an attempt to preserve mobility and maintain function. Regular physiotherapy and the use of non-steroidal anti-inflammatory agents (NSAIDs) form the mainstay of treatment.
    Two TNF-blocking agents are presently licensed in the UK for the treatment of AS: infliximab and etanercept.
    A definite diagnosis of ankylosing spondylitis requires the radiological criterion and at least one clinical criterion.
    Radiological criterion: Sacroiliitis at least grade 2 bilaterally or grade 3 or 4 unilaterally.
    Clinical criteria:
    1-Low back pain and stiffness for more than 3 months that improves with exercise but is not relieved by rest.
    2-Limitation of motion of the lumbar spine in both the sagittal and the frontal plane.

    Limitation of chest expansion relative to normal values correlated for age and sex.