The Rheumatology Handbook

by Margaret Callan

Overview

The Rheumatology Handbook is a unique resource for medical students and non-specialist doctors. It represents a collaborative effort between specialists from major teaching hospitals within the UK and Ireland, with each chapter being edited by a different consultant rheumatologist with the relevant subspecialty interest.Written clearly and concisely and well illustrated, the book provides readers with the basic scientific information that they require to understand current concepts about the pathogenesis of rheumatological disease, and draws on recent research studies to give up-to-date information about investigation and treatment. It covers the full range of rheumatological conditions, from local degenerative problems to systemic immune-mediated disease. It includes a useful section on soft-tissue disorders and a practical guide to performing soft-tissue and joint injections; at the other end of the clinical spectrum, the rationale for and efficacy of novel treatments targeted at individual components of the immune response are well explained.

Product Details

ISBN-13:	9781848163201
Publisher:	Imperial College Press
Publication date:	09/28/2011
Pages:	488
Product dimensions:	6.10(w) x 9.00(h) x 1.00(d)

Table of Contents

Preface V

Contributing Authors Xiii

Chapter 1 Basic Science for Rheumatology 1

1.1 Introduction 1

1.2 Anatomy of Bones and Joints 1

1.2.1 Bones 2

1.2.2 Joints 6

1.3 Biochemistry of Crystal Formation 12

1.3.1 Sodium Urate Crystals 12

1.3.2 Calcium Salt Crystals 12

1.4 Innate and Adaptive Immunity 13

1.4.1 Cells of the Innate Immune System 14

1.4.2 Soluble Factors in Innate Immunity 17

1.4.3 Cells of the Adaptive Immune System 19

1.4.4 Soluble Mediators of Adaptive Immunity 23

1.4.5 Autoimmunity 25

1.5 Inflammation 28

1.5.1 Angiogenesis 29

1.5.2 Leukocyte Trafficking 30

1.5.3 Cytokines and Chemokines 30

1.6 Genes and Proteins in Rheumatic Disease 33

1.6.1 Deoxyribonucleic Acid and Protein 33

1.6.2 Genetic Disease 35

Chapter 2 Clinical Assessment of Patients with Rheumatic Disease 39

2.1 Gait, Arms, Legs, Spine Screen 39

2.2 History 40

2.3 Examination 44

2.3.1 The Hand and Wrist 44

2.3.2 The Elbow 51

2.3.3 The Shoulder 53

2.3.4 The Hip 57

2.3.5 The Knee 60

2.3.6 The Ankle and Foot 63

2.3.7 The Neck 65

2.3.8 The Thoracic and Lumbar Spine 68

2.3.9 Gait 71

2.3.10 Extra-Articular Features of Rheumatic Disease 71

2.3.11 Miscellaneous Specific Examinations 72

2.4 Investigation of Rheumatic Disease 75

2.4.1 Laboratory Tests 75

2.4.2 Imaging Studies 85

2.4.3 Electrophysiological tests 90

Chapter 3 Arthritis 91

3.1 Rheumatoid Arthritis 91

3.2 Spondyloarthropathies 108

3.2.1 Ankylosing Spondylitis 110

3.2.2 Reactive Arthritis 118

3.2.3 Enteropathic Arthritis 120

3.2.4 Undifferentiated Spondyloarthropathy 121

3.3 Psoriatic Arthritis 122

3.4 Osteoarthritis 132

3.5 Crystal Associated Disease 143

3.5.1 Gout 144

3.5.2 Calcium Pyrophosphate Crystal Deposition 158

3.5.3 Basic Calcium Phosphate Deposition 162

3.6 Bacterial Infection and Arthritis 165

3.6.1 Septic Arthritis 165

3.6.2 Gonococcal Arthritis 169

3.6.3 Syphilitic Arthritis 171

3.6.4 Lyme Arthritis 171

3.6.5 Mycobacterial Arthritis 171

3.7 Viral Infection and Arthritis 172

3.7.1 Parvovirus B19 174

3.7.2 Rubella Infection 174

3.7.3 Arthropod-Borne Alphaviruses 175

3.7.4 Hepatitis B Virus 175

3.7.5 Hepatitis C Virus 176

Chapter 4 Connective Tissue Disease and Vasculitis 177

4.1 Connective Tissue Disease 177

4.1.1 Systemic Lupus Erythematosus 177

4.1.2 Anti-Phospholipid Antibody Syndrome 191

4.1.3 Sjogren's Syndrome 196

4.1.4 Systemic Sclerosis 201

4.1.5 Inflammatory Myopathies 212

4.1.6 Sarcoidosis 218

4.2 Vasculitis 225

4.2.1 Takayasu's Arteritis 225

4.2.2 Giant Cell Arteritis and Polymyalgia Rheumatica 229

4.2.3 Polyarteritis Nodosa 232

4.2.4 ANCA-Associated Vasculitis 236

4.2.5 Henoch-Schonlein Purpura 243

Chapter 5 Metabolic Bone Disease and Inherited Disorders of Bone and Connective Tissue 247

5.1 Osteoporosis 247

5.2 Osteomalacia and Parathyroid Disorders 261

5.2.1 Osteomalacia 261

5.2.2 Primary Hyperparathyroidism 266

5.2.3 Hypoparathyroidism and Conditions Associated with PTH Signalling Abnormalities 268

5.3 Paget's Disease of the Bone 268

5.4 Heritable Disorders of the Musculoskeletal System 272

5.4.1 Marfan Syndrome 275

5.4.2 Ehlers-Danlos Syndrome 275

5.4.3 Osteogenesis Imperfecta 285

5.4.4 Achondroplasia 288

5.4.5 Epiphyseal/Spondyloepiphyseal Dysplasias 290

5.4.6 Metaphyseal/Spondylometaphyseal Dysplasias 293

5.4.7 Diaphyseal Dysplasias 294

5.4.8 Disorders of Bone Density 295

Chapter 6 Regional Pain Problems 299

6.1 Shoulder Pain 299

6.2 Neck Pain 302

6.3 Mid and Low Back Pain 306

6.4 Nerve Entrapment Syndromes 311

6.4.1 Carpal Tunnel Syndrome 312

6.4.2 Ulnar Nerve Entrapment Syndrome 313

6.4.3 Tarsal Tunnel Syndrome 315

6.4.4 Meralgia Paraesthetica 316

6.5 Disorders of Tendons and their Sheaths 316

6.5.1 Lateral Elbow Tendinopathy 318

6.5.2 Medial Elbow Tendinopathy 319

6.5.3 Patella Tendinopathy 320

6.5.4 Achilles Tendinopathy 321

6.5.5 Posterior Tibial Tendinopathy 322

6.5.6 De Quervain's Disease 323

6.5.7 Trigger Digits 324

6.6 Plantar Fasciitis 325

6.7 Bursitis 326

6.7.1 Subacromial Bursitis 327

6.7.2 Olecranon Bursitis 327

6.7.3 Iliopsoas Bursitis 327

6.7.4 Trochanteric Bursitis 328

6.7.5 Ischial Bursitis 329

6.7.6 Prepatella, Infrapatella and Pes Anserine Bursitis 330

6.7.7 Calcaneal Bursitis 331

6.7.8 Intermetatarsal Bursitis 332

6.8 Morton's Neuroma 332

6.9 Ganglions 333

6.10 Overuse Syndromes 333

6.11 Fibromyalgia 335

Chapter 7 Paediatric Rheumatology 339

7.1 Approach to the Assessment and Management of Children with Rheumatic Disease 339

7.2 Juvenile Idiopathic Arthritis 344

7.2.1 Systemic Onset Juvenile Idiopathic Arthritis 346

7.2.2 Oligoarticular Juvenile Idiopathic Arthritis 349

7.2.3 Polyarticular Juvenile Idiopathic Arthritis 351

7.2.4 Juvenile Psoriatic Arthritis 353

7.2.5 Enthesitis Related Arthritis 355

7.3 Reactive Arthritis 356

7.3.1 HLA B27 Associated Reactive Arthritis 357

7.3.2 Post-Streptococcal Arthritis 357

7.3.3 Other Forms of Reactive Arthritis 357

7.4 Chronic Recurrent Multifocal Osteomyelitis 358

7.5 Multi-System Inflammatory Disorders in Childhood 359

7.5.1 Pyrexial Presentation of Multisystem Inflammatory Disorders 362

7.5.2 Skin Presentation of Multisystem Inflammatory Disorders 362

7.6 Non-Inflammatory Musculoskeletal Pain Disorders 364

7.6.1 Neoplasia 364

7.6.2 Back Pain 364

7.6.3 Limp 366

7.6.4 Non-Accidental Injury 366

7.6.5 Growing Pains 366

7.6.6 Sport Associated Limb Pain 367

7.6.7 Benign Joint Hypermobility 367

7.6.8 Chronic Pain or Pain Amplification Syndromes 368

7.7 Osteoporosis in Children and Adolescents 371

Chapter 8 Local Injections in Rheumatology Practice 373

8.1 Introduction 373

8.2 Procedural Checklist 377

8.3 Specific Injection Techniques 379

8.3.1 Glenohumeral Joint and Subacromial Space 379

8.3.2 Elbow Joint and Surrounding Tissues 381

8.3.3 Wrist 383

8.3.4 Small Joints of the Hand 384

8.3.5 Hip Joint and Surrounding Tissues 386

8.3.6 Knee Joint and Surrounding Tissue 387

8.3.7 Ankle Joint 388

8.3.8 Feet 390

8.4 Concluding Comments 391

Chapter 9 Drugs Used in Management of Rheumatic Disease 393

9.1 Introduction 393

9.2 Non-Steroidal Anti-Inflammatory Drags 393

9.3 Corticosteroids 396

9.4 Disease-Modifying Anti-Rheumatic Drugs 400

9.4.1 Methotrexate 400

9.4.2 Sulphasalazine 404

9.4.3 Leflunomide 405

9.4.4 Hydroxychloroquine 407

9.5 Drags with Cytotoxic and Anti-Proliferative Effects on Immune Cells 409

9.5.1 Cyclophosphamide 409

9.5.2 Azathioprine 410

9.5.3 Mycophenolate Mofetil 412

9.6 Drags Targeting the Cytokines TNF-α or IL-6 413

9.6.1 TNF-α Antagonists 413

9.6.2 Tocilizumab 415

9.7 Drags Targeting B Cells or T Cells 416

9.7.1 Rituximab 417

9.7.2 Abatacept 418

9.8 Drags Used in Management of Gout 419

9.8.1 Colchicine 419

9.8.2 Allopurinol 420

9.8.3 Febuxostat 422

9.8.4 Sulphinpyrazone 422

9.9 Drags Used in Management of Metabolic Bone Disease 423

9.9.1 Bisphosphonates 423

9.9.2 Raloxifene 425

9.9.3 Strontium Ranelate 426

9.9.4 Teriparatide and Human Recombinant Parathyroid Hormone 427

9.9.5 Denosumab 428

Chapter 10 Case Studies in Rheumatology 431

References for Diagnostic and Classification Criteria 455

Index 459