Rheumatic diseases

Chapter 3

Rheumatic diseases

20 topics

  1. 37Rheumatoid arthritisThe commonest inflammatory arthritis, a symmetrical autoimmune synovitis of the hands and feet that erodes bone within months and inflames the whole body; how it begins, how it is recognised and measured, and how methotrexate, steroids and then biologics or JAK inhibitors, aimed at remission, have changed its course.
  2. 38Ankylosing spondylitis (Bechterew’s disease)Ankylosing spondylitis is the radiographic end of axial spondyloarthritis, an HLA-B27-linked inflammation of the sacroiliac joints, spine and entheses in young adults. This page covers inflammatory back pain, the eye, gut and skin links, MRI and the ASAS criteria, disease activity scores, and treatment from exercise and NSAIDs to TNF, IL-17 and JAK inhibitors.
  3. 39Reactive arthritis – Rheumatic fever, Reiter’s syndrome, Lyme diseaseThe arthritis that follows an infection elsewhere in the body. Reactive arthritis after gut and genital infections (the old Reiter's syndrome), arthritis after a streptococcal throat, and Lyme disease, the tick-borne spirochaete that can reach the joints, heart and nerves; how each is told apart and treated.
  4. 40Rheumatic fever – diagnosis and treatmentRheumatic fever seen from the rheumatology clinic. How to approach a child or young adult with fever and arthritis, how the Jones criteria work in practice, the joints, chorea and skin in detail, how each manifestation is treated, and how to keep a patient on years of penicillin.
  5. 41Psoriatic arthritisThe inflammatory arthritis that comes with psoriasis, a spondyloarthritis of the joints, entheses, digits, nails and spine; how it is recognised and classified, what its X-rays show, and how treatment climbs from NSAIDs and methotrexate to biologics chosen for the skin, eye and gut.
  6. 42Systemic lupus erythematosusThe autoimmune disease of young women in which antibodies against the cell nucleus and their immune complexes can inflame almost any organ; how its pattern, its antibodies and its complement levels make the diagnosis, and how hydroxychloroquine, little steroid and targeted drugs now control it.
  7. 43Progressive systemic sclerosisAn autoimmune disease of small vessels and connective tissue that thickens the skin and scars the lungs, gut, heart and kidneys; how its two main forms and its antibodies predict what will happen, how organs are screened, and how each is treated, from Raynaud's phenomenon to scleroderma renal crisis.
  8. 44Polymyositis / DermatomyositisThe idiopathic inflammatory myopathies, autoimmune diseases that weaken the proximal muscles and can involve the skin, lungs, gut and heart; how dermatomyositis, polymyositis and their newer relatives are told apart by their signs, antibodies and biopsy, why each patient is screened for cancer and lung disease, and how they are treated.
  9. 45Vasculitis – classification and clinical featuresInflammation of the blood vessel wall, from the aorta to the capillaries; how the Chapel Hill nomenclature names the vasculitides by the size of vessel they hit, how vessel size predicts the clinical picture, the mimics to exclude, the work-up and the principles of treatment that the five topics after this one apply to each disease.
  10. 46Henoch-Schönlein purpuraIgA vasculitis, the disease long called Henoch-Schönlein purpura, is the commonest vasculitis of childhood. This page covers its tetrad of purpura, arthritis, abdominal pain and nephritis, why the urine is watched for months, and when glucocorticoids and immunosuppression help, in children and in adults, who fare worse.
  11. 47Polyarteritis nodosa (PAN)A necrotising vasculitis of medium-sized arteries that spares the glomeruli and the lungs and has no ANCA; how it infarcts nerves, skin, kidneys, gut and testes, how angiography and biopsy prove it, and how the Five-Factor Score and the cause, from hepatitis B to a gene, choose the treatment.
  12. 48ANCA associated vasculitisThe small-vessel vasculitides driven by antibodies against two neutrophil enzymes, proteinase 3 and myeloperoxidase; how granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis attack the airways, lungs, kidneys and nerves, how they are proven, and how glucocorticoids, rituximab or cyclophosphamide induce remission and keep it.
  13. 49Large vessel vasculitis – Horton disease, Takayasu’s arteriitis, Buerger diseaseThe two vasculitides of the aorta and its branches, giant cell arteritis in older people and Takayasu arteritis in young women, and Buerger disease, a smoker's inflammatory occlusion of the small arteries and veins of the limbs that the syllabus places beside them; how each presents, how imaging and biopsy prove it, and how it is treated, from same-day steroids for a threatened eye to stopping every cigarette.
  14. 50Antiphospholipid syndromeThe autoimmune disease in which persistent antibodies against phospholipid-binding proteins cause arterial and venous thrombosis and pregnancy loss; how the three laboratory tests are done and read, what the 2023 criteria count, and why warfarin, not a direct oral anticoagulant, is the treatment.
  15. 51Polymyalgia rheumatica and fibromyalgiaTwo common causes of aching muscles that could hardly be more different; polymyalgia rheumatica, an inflammatory disease of older people that stiffens the shoulders and hips, raises the ESR and melts away on low-dose prednisolone, and fibromyalgia, widespread pain from a sensitised nervous system with normal tests, treated with exercise, explanation and a few drugs, never steroids.
  16. 52GoutGout is an inflammatory arthritis caused by crystals of monosodium urate that form when the blood urate stays too high. This page covers where the urate comes from and why it builds up, the flare, tophi and the kidney, how crystals and imaging confirm the diagnosis, and treatment of the flare and the long-term lowering of urate to a target.
  17. 53OsteoarthritisOsteoarthritis is the commonest joint disease, a slow failure of the whole joint in which cartilage is lost and bone remodels. This page covers its risk factors, the patterns in the knee, hip and hand, how it is diagnosed without imaging and told from inflammatory arthritis, and treatment built on exercise and weight loss, with drugs, injections and joint replacement in their place.
  18. 54OsteoporosisThe silent loss of bone mass and structure that makes bones break after minor falls; how bone is remodelled and lost, who is at risk, how DXA and FRAX decide who is treated, and how bisphosphonates, denosumab and the anabolic drugs are chosen, started and safely stopped.
  19. 55Treatment of rheumatic diseases with biologic and biosimilar drugsThe engineered antibodies and proteins that block one cytokine, cell or signal of the immune response, and the JAK inhibitors that work inside the cell; what each is used for across the rheumatic diseases, how patients are screened, vaccinated and watched, and what biosimilars are and why Europe treats them as interchangeable.
  20. 56Humoral immunity changes in Rheumatic diseasesThe autoantibodies, immune complexes and complement of the rheumatic diseases; how each antibody is tested and read, which disease and organ it points to, what it predicts, and why a positive test in a healthy person means little.