1 / 15

Rheumatology for the GP

This plan covers the rheumatological history, key conditions, drugs, referrals, and important questions in managing rheumatic diseases. Learn about inflammatory arthritis, gout, giant cell arteritis, polymyalgia rheumatica, vasculitis, chronic pain/fibromyalgia, early inflammatory arthritis, Beighton score, antibodies, types of DMARDs, and drug monitoring. Referrals and common questions are also addressed. Ideal for GPs seeking to enhance their understanding of rheumatology.

thomasrebecca
Download Presentation

Rheumatology for the GP

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Rheumatology for the GP Abid Yusuf ST5 Rheumatology & GIM

  2. Plan • What we do • The rheumatological history • Key conditions • Drugs • Referrals • Questions

  3. History • Inflammatory arthritis • Early morning stiffness • Joint swelling • Distribution • Rashes • IBD • Preceding infection • Iritis • Character of pain • Connective Tissue Disease • Raynaud’s • Mouth ulcers • Dry mouth/eyes • Myalgia • Tight skin • Fatigue

  4. Gout • Acute • NSAIDs • Colchicine • Steroids • Chronic • 4 weekly follow up • Allopurinol • Febuxostat • Etc • Investigations • U&Es • Uric acid • X ray affected areas • Diet

  5. Giant Cell Arteritis Typical History Includes Eye symptoms? No Yes Admit IV Methylprednisolone for 3 days Ophthalmology referral Vascular surgery referral for TAB Consider Aspirin 75mg Consider bone protection Refer to Rheumatology Prednisolone 40-60mg Orally +Proton Pump Inhibitor Consider Aspirin 75mg Consider bone protection Refer to Rheumatology

  6. PMR • Onset • Shoulder and hip girdles • Myalgia • Key manoeuvres • Constitutional symptoms • Investigations • FBC • U&E • CK • RF, Anti-CCP • Ig’s • Serum electrophoresis • CXR • Management • Start prednisolone 15mg PO OD • Should have excellent response within 24-48 hours • Consider bone protection

  7. Early Inflammatory Arthritis • Swollen tender joints • Back pain • Inflammatory • Mechanical • Stiff • Fatigue • Investigations • FBC • U&E • CRP, ESR • Uric acid • RF, Anti-CCP • B27 (if SpA features) • X ray hands and feet • ?erosions • Treatment • Avoid steroids if possible • NSAIDs • Refer early!

  8. Vasculitis • Purpuric rash • Preceding infection • ENT • Haemoptysis • Asthma • Neuropathy • Inflammatory eye disease • Always do urine dip • Investigations • URINE DIP • Protein:Creatinine Ratio, red cell casts • FBC • U&E • LFT • ANA, dsDNA • ANCA • RF • CXR

  9. Chronic pain/Fibromyalgia • Generalised pain • Unrefreshing sleep • Low mood • IBS • Investigations • Beighton score • FBC, U&E, Ca, Vit D • TFT • 9am cortisol • CK • ANA, dsDNA • Myeloma screen in older people • Interventions • Believe them • Graded exercises • CBT • Pain management • Pacing

  10. Beighton Score

  11. Antibodies If inflammatory arthropathy suspected • Rheumatoid factor • Anti-CCP antibodies If connective tissue disease suspected • ANA • ENA • dsDNA If Vasculitis suspected • ANCA • ANA + dsDNA • Rheumatoid Factor/Cryoglobulins • Hepatitis Screen

  12. Types of DMARD • Targeted synthetic DMARD • JAK inhibitors • Baricitinib • Tafacitinib • Biologic DMARD • Anti-TNFa • Infliximab • Etanercept • Adalimumab • Golimumab • Certolizumab • Anti-IL6 • Tocilizumab • Sarilumab • Anti-CD20 • Rituximab Nonbiologic DMARD • Methotrexate • Sulfasalazine • Leflunomide • Hydroxychloroquine • Azathioprine • MycophenolateMofetil

  13. Drug monitoring • Local set up • FBC, LFT • Blood testing schedule when initiating DMARD • 2 weekly for 6 weeks • Monthly for 3 months • 3 monthly

  14. Referrals

  15. Questions?

More Related