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Rheumatology and Conditions of the Musculoskeletal System (inc Trauma)

The nMRCGP Curriculum. Rheumatology and Conditions of the Musculoskeletal System (inc Trauma). Dr Andrew Jackson GP Trainer GPwSI MSK Dr George Eskander ST3 Airedale VTS. Why is MSK important? RCGP KEY CURRICULUM MESSAGES.

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Rheumatology and Conditions of the Musculoskeletal System (inc Trauma)

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  1. The nMRCGP Curriculum Rheumatology and Conditions of the Musculoskeletal System (inc Trauma) Dr Andrew Jackson GP Trainer GPwSI MSK Dr George Eskander ST3 Airedale VTS

  2. Why is MSK important?RCGP KEY CURRICULUM MESSAGES Each year 20% of the general population consult a GP with an MSK problem-huge burden for NHS and society. Taking an effective history and making a broad simple, focused examination in General Practice is likely to be more important than imaging and serology, which on their own may be falsely reassuring. Early diagnosis and treatment of IJD (within 3m) has a major impact on long term outcome and urgent referral to rheumatology is indicated where there is a high suspicion of IJD.

  3. Needs Assessment • How to take a focused history. • How to perform a relevant clinical examination. • Role of investigations e.g. Bloods/imaging • When/where/who to refer. • QOF.

  4. Patients present to us with symptoms rather than diseases and it often takes time for MSK problems to evolve into a recognisable form but early diagnosis of IJD crucial.

  5. MSK Groupings • Red Flag conditions • Non MSK cause e.g. statins, hypermobility, metabolic causes, infections • Inflammatory joint disease (e.g. RA, PA, PMR, gout, CT disorders) • Orthopaedic Conditions (e.g. OA) • Pain amplification syndromes How do I tell the difference?

  6. The purpose of our history, examination and appropriate tests is to determine which group the patient belongs to and to treat (and refer) them accordingly!

  7. TASKS Group 1 Identify the features in the history that suggest a patient presenting with joint pains has a ‘red flag’ condition.

  8. Group 2 • You are working in an outreach hospital in Africa. There is no lab. You see a 45 year old female with 6 children and no husband with what you think is new onset RA. The nearest rheumatologist is a 2 day transport which needs to be organised at great expense and requires authorisation by the consultant. You have to convince him over the phone to do this. • What features in the history and examination would you use to convince him to do this?

  9. Group 3 • What are the similarities and differences on history and examination between a patient with early RA and a patient with fibromyalgia?

  10. What are the important history points? • Morning stiffness (>30 mins) NOT ‘gelling’ • Reported joint swelling • Distribution of joints involved • FH • Positive response to nsaids • Systemic symptoms • Skin/nail disorders

  11. What are the important findings on examination? • Joint Swelling • Nodules (rheumatoid, OA, gout)

  12. Swelling • Can we see/feel it? What joints can you see fluid/effusion? • If we can’t see/feel it can we find evidence it is there (by restriction of movement)?

  13. How do we examine for swelling? • GALS Examination • What is it? • Why GALS? • How do we do it?

  14. What is the role of investigations? • Bloods (NB false positives and negatives) • X-rays • Ultrasound

  15. Referral pathways • IJD to rheumatology ASAP • Fibromyalgia ?who • MSK services (some deal with IJD some don’t) • Role of orthopaedics, pain services, physiotherapy, OT etc

  16. Any Questions?

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