Presents information in a clinically oriented and practically relevant format
Highlights and addresses day to day management issues
Presents information in a compact, concise, evidence based, and practical manner
Single authorship ensures style consistency and uniformity throughout the book
Clinical Rheumatology is a book written by a clinician for clinicians. It covers all the essential clinical aspects of Rheumatology in an engaging, clear, and concise manner, thereby fulfilling an unmet need. The focus of this book is to cover clinically pertinent and practically relevant issues while pruning unnecessary detail. Patient photographs, tables, and boxes enhance readability. The bedside clinical and investigative approach is discussed in a lucid fashion illustrated by clinical photographs, flowcharts, and algorithms. The evidence-based treatment is spelt out in an easy to comprehend fashion. Key messages have been listed at the beginning of each chapter.
The book is intended for undergraduate and postgraduate medical students, residents, fellows, and clinicians who want to gain practical knowledge and clinical insight into rheumatic diseases. The book is likely to appeal to internists, rheumatologists, physiatrists, physiotherapists, occupational therapists, as well as orthopaedic surgeons. They will find their day to day questions answered in a knowledge format that can be applied straight away. Senior clinicians will find it a ready reckoner and a handy manual to refresh and update their knowledge. Basic scientists will find it useful to gain clinical insight into the rheumatic diseases they research without being intimidated by the size of the text. Teachers will find it full of helpful teaching messages. Clinical Rheumatology is a must-have book for all those who deal with rheumatic musculoskeletal diseases.
Author(s): Rohini Handa
Edition: 1
Publisher: Springer
Year: 2021
Language: English
Tags: Clinical Rheumatology; Orthopedics; Rheumatic Diseases; Musculoskeletal Diseases; Immunology
Preface
Acknowledgments
Contents
About the Author
1: Bedside Approach to Musculoskeletal Complaints
1.1 Introduction
1.2 Bedside Approach
1.2.1 Origin of Pain (Articular or Nonarticular)
1.2.2 Inflammatory or Noninflammatory?
1.2.3 Pattern Recognition
1.2.3.1 Chronology
1.2.3.2 Number of Joints Affected
1.2.3.3 Symmetry
1.2.3.4 Upper Limb Versus Lower Limb Joint Involvement
1.2.3.5 Type of Joints Affected
1.2.3.6 Sequence or Pattern of Involvement
1.2.3.7 Extra-Articular Features
1.3 Conclusions
Suggested Reading
2: Laboratory Investigations in Rheumatology
2.1 Introduction
2.2 Acute Phase Reactants (APRs)
2.2.1 Erythrocyte Sedimentation Rate (ESR)
2.2.2 C-Reactive Protein (CRP)
2.2.3 Other Acute Phase Reactants
2.3 Autoantibodies
2.3.1 Rheumatoid Factor (RF)
2.3.2 Antibodies to Cyclic Citrullinated Peptide (Anti-CCP Antibodies)
2.3.3 Antinuclear Antibodies (ANA)
2.3.4 ANA or Anti-cellular Antibodies (ACA)?
2.3.5 Antibodies to ENA (Extractable Nuclear Antigens)
2.3.6 Antibodies to Double Stranded Deoxyribonucleic Acid (dsDNA)
2.3.7 Other Autoantibodies
2.3.8 Antibody Subsets in Systemic Sclerosis (SSc)
2.3.9 Antiphospholipid Antibodies (aPL)
2.3.10 Antineutrophil Cytoplasmic Antibodies (ANCA)
2.4 Serum Uric Acid (SUA)
2.5 Antistreptolysin O (ASO)
2.6 Complement
2.7 Synovial Fluid
2.8 HLA-B27
2.9 Other Investigations
2.10 Conclusions
Suggested Reading
3: Low Back Pain
3.1 Introduction
3.2 Causes and Natural History
3.3 Clinical Approach to a Patient with Low Back Pain
3.4 Pain Assessment
3.5 Investigations
3.6 Treatment
3.6.1 Acute Low Back Pain
3.6.2 Subacute and Chronic Low Back Pain
3.7 Conclusions
Suggested Reading
4: Osteoarthritis
4.1 Introduction
4.2 Classification of OA
4.3 Clinical Features, Investigations, and Diagnosis
4.4 Treatment
4.4.1 Nonpharmacologic Treatment Modalities in OA
4.4.2 Pharmacologic Therapy
4.4.2.1 Symptom Relieving Drugs in OA
4.4.2.2 Symptomatic Slow Acting Drugs for OA (SYSADOA)
4.4.2.3 Structure/Disease-Modifying Osteoarthritis Drugs (SMOADS/DMOADS)
4.4.2.4 Intra-articular Treatments for OA
4.4.3 Surgery
4.5 Conclusions
Suggested Reading
5: Gout and Other Crystal Arthritides
5.1 Introduction
5.2 Gout
5.2.1 Gouty Arthritis
5.2.2 Renal Disease in Gout
5.2.3 Investigations in Gout
5.2.4 Treatment of Gout
5.3 Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease
5.4 Basic Calcium Phosphate and Calcium Oxalate Crystal Disease
5.5 Conclusions
Suggested Reading
6: Rheumatoid Arthritis
6.1 Introduction
6.2 Clinical Recognition
6.3 Classification Criteria for Rheumatoid Arthritis
6.4 Current Treatment Paradigm of RA
6.5 How to Monitor Treatment in RA (Aligning Treatment to Targets)
6.6 Treatment Modalities for RA
6.6.1 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
6.6.2 Disease-Modifying Antirheumatic Drugs (DMARDs)
6.6.2.1 Conventional Synthetic (cs) DMARDs
6.6.2.2 Combination Therapy with csDMARDs
6.6.2.3 Biologics
When to Initiate Biologics in RA?
How to Initiate Biologics in RA?
What Do Biologics Achieve in RA?
Place of Biologics in the Treatment Matrix of RA
Efficacy of Biologics
Switching of Biologics
Which Biologic for Whom?
Biologics and Safety Issues
Biologics in Pregnancy and Breastfeeding
6.6.2.4 Biosimilars
6.6.2.5 Targeted Synthetic (ts) DMARDS
6.6.3 Corticosteroids
6.7 Conclusions
Suggested Reading
7: Spondyloarthritides
7.1 Introduction
7.2 Clinical Recognition and Investigations
7.3 Ankylosing Spondylitis (AS)
7.3.1 What Constitutes Active Sacroiliitis on MRI
7.3.2 Classification Criteria for AS
7.3.3 Radiographic and Non-radiographic SpA
7.3.4 The Concept of Peripheral SpA
7.3.5 Disease Assessment of AS
7.4 PostStreptococcal Reactive Arthritis (PSReA)
7.5 Arthritis Associated with Inflammatory Bowel Disease (Enteropathic SpA)
7.6 Juvenile Spondyloarthritis
7.7 Undifferentiated Spondyloarthritis (USpA)
7.8 Management
7.8.1 General Measures and Pain Relief
7.8.2 DMARDs
7.8.3 Biologic Agents
7.8.3.1 Indications for Biologics
7.8.3.2 Sequence/Choice of Biologics
7.8.3.3 When to Stop Biologics
7.8.3.4 Does the Treatment of Radiographic SpA Differ from Non-radiographic SpA?
7.8.4 Corticosteroids
7.8.5 Surgery
7.9 Conclusions
Suggested Reading
8: Psoriatic Arthritis
8.1 Introduction
8.2 Clinical Recognition
8.3 Management
8.4 Conclusions
Suggested Reading
9: Reactive Arthritis
9.1 Introduction
9.2 Clinical Recognition and Investigations
9.3 Management
9.4 Conclusions
Suggested Reading
10: Seronegative Arthritis
10.1 Introduction
10.2 Approach to Seronegative Arthritis
10.3 Conclusions
Suggested Reading
11: Adult Still’s Disease
11.1 Introduction
11.2 Clinical Features
11.3 Classification Criteria
11.4 Investigations
11.5 Diagnosis
11.6 Treatment
11.7 Conclusions
Suggested Reading
12: Juvenile Idiopathic Arthritis
12.1 Introduction
12.2 Classification
12.2.1 Systemic Arthritis
12.2.2 Oligoarthritis
12.2.3 Rheumatoid Factor-Positive Polyarthritis
12.2.4 Rheumatoid Factor-Negative Polyarthritis
12.2.5 Enthesitis-Related Arthritis
12.2.6 Juvenile Psoriatic Arthritis
12.2.7 Undifferentiated Arthritis
12.3 Management
12.4 Conclusions
Suggested Reading
13: Connective Tissue Diseases: The Concept and Approach
13.1 Introduction
13.2 Clinical Approach to CTD
13.3 How to Recognize CTD?
13.4 Type of CTD
13.5 Criteria and Classification of CTDs
13.6 Implications for a Clinician
13.7 Investigations in a Patient Suspected of Having CTD
13.8 Treatment Considerations in CTD
13.9 Assessing Disease Activity in CTD
13.10 Differentiating Disease Activity from Disease Damage
13.11 Conclusions
14: Systemic Lupus Erythematosus
14.1 Introduction
14.2 Clinical Recognition
14.3 Investigations
14.4 Classification Criteria for SLE
14.5 Assessing Disease Activity in SLE
14.6 Differentiating Disease Activity from Disease Damage
14.7 Treat to Target in SLE
14.8 General Measures
14.9 Infections and Immunization in SLE
14.10 Pregnancy and Contraception
14.11 Major and Minor Organ Involvement in SLE
14.12 Drugs Used to Treat SLE
14.12.1 NSAIDs
14.12.2 Antimalarials—The Anchor Drugs for Lupus
14.12.3 Corticosteroids
14.12.4 Immunosuppressives in SLE
14.13 Comorbidities
14.14 Conclusions
Suggested Reading
15: Sjogren’s Syndrome
15.1 Introduction
15.2 Clinical Recognition
15.3 Investigations
15.4 Treatment
15.5 Conclusions
Suggested Reading
16: Systemic Sclerosis
16.1 Introduction
16.2 Classification
16.3 Clinical Features and Investigations
16.4 Treatment
16.5 Course and Prognosis
16.6 Conclusions
Suggested Reading
17: Undifferentiated Connective Tissue Disease, Mixed Connective Tissue Disease, and the Overlap Syndromes
17.1 Introduction
17.2 Nomenclature (UCTD or MCTD or Overlap Syndrome)
17.3 Treatment
17.4 Conclusions
Suggested Reading
18: Antiphospholipid Syndrome
18.1 Introduction
18.2 Clinical Recognition
18.3 Management
18.3.1 Primary Thromboprophylaxis
18.3.2 Treatment of Thrombotic APS
18.3.3 Treatment of Obstetric APS
18.3.4 Treatment of Catastrophic APS
18.4 Conclusions
Suggested Reading
19: Inflammatory Muscle Diseases
19.1 Introduction
19.2 Dermatomyositis
19.3 Polymyositis
19.4 Necrotizing Autoimmune Myositis
19.5 Sporadic Inclusion-Body Myositis
19.6 Overlap Myositis
19.7 Investigations
19.8 Treatment of IIM
19.9 Conclusions
Suggested Reading
20: Vasculitis
20.1 Introduction
20.2 Clinical Approach
20.3 Disease Activity and Damage Assessment in Vasculitis
20.4 Pseudovasculitis Syndromes/Mimics
20.5 Granulomatosis with Polyangiitis (GPA)- Wegener’s Granulomatosis
20.6 Microscopic Polyangiitis (MPA)
20.7 Eosinophilic Granulomatosis with Polyangiitis (EGPA)-Churg–Strauss Syndrome
20.8 Treatment of ANCA-Associated Vasculitis (GPA, MPA, EGPA)
20.9 Polyarteritis Nodosa
20.10 Takayasu’s Arteritis
20.11 Temporal Arteritis or Giant Cell Arteritis
20.12 Henoch–Schonlein Purpura
20.13 Conclusions
Suggested Reading
21: Osteoporosis
21.1 Introduction
21.2 Definition
21.3 Clinical Approach
21.3.1 Who Should Be Screened for Osteoporosis?
21.3.2 How Should Screening Be Done?
21.3.2.1 DXA (Dual-Energy X-Ray Absorptiometry)
21.3.2.2 Osteoporosis Screening Intervals
21.3.2.3 Biochemical Markers of Bone Turnover
21.4 Fracture Risk Assessment
21.5 Management
21.5.1 When to Intervene?
21.5.2 How to Intervene- Which Drug for Whom?
21.5.3 Drug Holiday with Bisphosphonates
21.5.4 Drugs other than Bisphosphonates
21.6 Conclusions
Suggested Reading
22: Behcet’s Syndrome
22.1 Introduction
22.2 Clinical Recognition
22.3 Treatment
22.4 Conclusions
Suggested Reading
23: Soft Tissue Rheumatism and Regional Pain Syndromes
23.1 Introduction
23.2 Clinical Approach
23.3 Management
23.4 Conclusions
Suggested Reading
24: Fibromyalgia
24.1 Introduction
24.2 Clinical Recognition
24.3 Classification and Diagnostic Criteria for FMS
24.4 Management
24.5 Conclusions
Suggested Reading
25: Complex Regional Pain Syndrome
25.1 Introduction
25.2 Clinical Recognition
25.3 Treatment
25.4 Conclusions
Suggested Reading
26: Benign Joint Hypermobility Syndrome
26.1 Introduction
26.2 Clinical Recognition
26.3 Management
26.4 Conclusions
Suggested Reading
27: Tuberculous and Septic Arthritis
27.1 Introduction
27.2 Musculoskeletal Tuberculosis (MSK TB)
27.2.1 Clinical Recognition of MSK TB
27.2.2 Diagnosis of MSK TB
27.2.3 Treatment of MSK TB
27.3 Septic Arthritis
27.3.1 Clinical Approach
27.3.2 Management of Septic Arthritis
27.4 Conclusions
Suggested Reading
28: Viral Arthritis
28.1 Introduction
28.2 Chikungunya Arthritis
28.2.1 Clinical Features of Chikungunya
28.2.2 Rheumatologic Spectrum of Chikungunya
28.2.3 Diagnosis
28.2.4 Differential Diagnosis
28.2.5 Treatment
28.3 Dengue Arthritis
28.4 Other Viral Arthritides
28.5 Conclusions
Suggested Reading
29: Sarcoidosis: Rheumatological Considerations
29.1 Introduction
29.2 Clinical Recognition
29.3 Diagnosis
29.4 Treatment
29.4.1 Who to Treat?
29.4.2 How to Treat?
29.4.3 Who not to Treat?
29.5 Conclusions
Suggested Reading
30: Emergencies in Rheumatology
30.1 Introduction
30.2 Acute Low Back Pain
30.3 Acute Gout
30.4 Acute Arthritis
30.5 Lupus Flare
30.6 Systemic Vasculitides
30.7 Scleroderma Renal Crisis
30.8 Catastrophic Antiphospholipid Syndrome (CAPS)
30.9 Erythema Nodosum (EN)
30.10 Complex Regional Pain Syndrome (CRPS)
30.11 Conclusions
Suggested Reading
31: Joint Aspiration and Injection
31.1 Introduction
31.2 Joint Aspiration (Arthrocentesis)
31.2.1 Indications
31.2.2 Contraindications to Joint Aspiration
31.2.3 Synovial Fluid Analysis
31.3 Joint/Soft Tissue Injections
31.3.1 Indications for Joint/Soft Tissue Steroid Injections
31.3.2 Contraindications to Joint/Soft Tissue Steroid Injections
31.4 Practical Points
31.5 Procedure
31.6 Conclusions
32: Pregnancy, Lactation, Contraception, and Fatherhood in Rheumatic Diseases
32.1 Introduction
32.2 Risk Categories of Drugs
32.3 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
32.4 Corticosteroids
32.5 Disease-Modifying Antirheumatic Drugs (DMARDs)
32.6 Biologics and Targeted Synthetic DMARDs
32.7 Intravenous Immunoglobulin (IVIG)
32.8 Specific Rheumatic Diseases
32.8.1 Systemic Lupus Erythematosus (SLE)
32.8.2 Systemic Sclerosis (SSc)
32.9 Contraception
32.10 Fertility Preservation in Autoimmune Rheumatic Diseases
32.11 Male Fertility and Fatherhood Issues
32.12 Conclusions
Suggested Reading
33: Immunisation in Autoimmune Rheumatic Diseases
33.1 Introduction
33.2 Influenza Vaccine
33.3 Pneumococcal Vaccine
33.4 Zoster (Shingles) Vaccines
33.5 Hepatitis B Virus (HBV) Vaccine
33.6 Other Inactivated Vaccines
33.7 Postexposure Prophylaxis
33.8 Conclusions
Suggested Reading
34: Coronavirus Disease (COVID-19) and the Rheumatologist
34.1 Introduction
34.2 COVID-19 and Autoimmune Rheumatic Diseases
34.3 Antirheumatic Drugs During COVID-19
34.3.1 Treatment Continuation
34.3.2 Treatment Initiation
34.4 Patients with ARD Who Develop COVID-19
34.5 COVID-19 Testing Before Biologic Infusions
34.6 Musculoskeletal (MSK) Manifestations of COVID-19
34.7 SARS-CoV-2 Vaccination in Patients with Rheumatic Diseases
34.8 Conclusions
Suggested Reading
35: Web Resources in Rheumatology
35.1 Introduction
35.1.1 American College of Rheumatology (ACR)
35.1.2 European League against Rheumatism (EULAR)
35.1.3 Asia Pacific League of Associations for Rheumatology (APLAR)
35.1.4 British Society for Rheumatology
35.1.5 Indian Rheumatology Association
35.1.6 Osteoarthritis Research Society International (OARSI)
35.1.7 Disease Activity Score (DAS) Website
35.1.8 RheumaHelper
35.1.9 Assessment of SpondyloArthritis international Society (ASAS)
35.1.10 Spondyloarthritis Research and Treatment Network (SPARTAN)
35.1.11 Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA)
35.1.12 Pediatric Rheumatology INternational Trials Organisation (PRINTO)
35.1.13 Lupus Foundation of America
35.1.14 Antinuclear Antibody (ANA) Patterns
35.1.15 The Sjögren’s Foundation
35.1.16 Scleroderma Foundation
35.1.17 The Myositis Association
35.1.18 International Osteoporosis Foundation (IOF)
35.1.19 The Fracture Risk Assessment Tool (FRAX®)
35.1.20 The International Society of Clinical Densitometry (ISCD)
35.1.21 The Rare Diseases Clinical Research Network
35.1.22 The COVID-19 Global Rheumatology Alliance
35.1.23 UpToDate
35.1.24 Drugs and Lactation Database (LactMed)
35.1.25 Sex and U
