Rheumatology deals with musculoskeletal (MSK) disorders affecting joints, bones, muscles, and connective tissues, often causing pain, stiffness, swelling, and deformities.
Mnemonic: "R.H.E.U.M. =
Rheumatic Health Examines Underlying Muscles & Joints"
APPROACH TO A PATIENT WITH
MUSCULOSKELETAL (MSK) COMPLAINTS
- Step 1: Identify Origin of Pain → Articular (Joint) vs. Non-Articular (Muscle, Ligament, Tendon, Bursa).
- Step 2: Inflammatory vs. Non-Inflammatory Disease → Morning Stiffness, Swelling, Redness in Inflammatory.
- Step 3: Pattern Recognition → Monoarthritis (1 Joint), Oligoarthritis (2-4 Joints), Polyarthritis (>5 Joints).
Mnemonic: "O.I.P. =
Origin, Inflammation, Pattern"
1. ORIGIN OF PAIN – ARTICULAR VS.
NON-ARTICULAR
Articular Pain
(Joint Origin)
- Deep, Diffuse Pain
- Pain in Both Active & Passive Movements
- Swelling, Joint Deformity Possible
- E.g., Rheumatoid Arthritis (RA), Osteoarthritis (OA)
Non-Articular Pain
(Soft Tissue Origin – Muscle, Tendon, Ligament, Bursa)
- Localized, Point Tenderness
- Pain More in Active Than Passive Movements
- E.g., Bursitis, Tendinitis, Fibromyalgia
Mnemonic: "A.N. =
Articular (Active + Passive), Non-Articular (Active Only)"
2. INFLAMMATORY VS.
NON-INFLAMMATORY DISEASE
Inflammatory (RA,
Lupus, Gout, Spondyloarthritis)
- Morning Stiffness >30 min (Gelling Phenomenon)
- Pain Improves with Activity
- Joint Swelling & Warmth
Non-Inflammatory
(Osteoarthritis, Fibromyalgia, Mechanical Issues)
- Morning Stiffness <30 min
- Pain Worsens with Activity, Improves with Rest
- No Significant Swelling or Warmth
Mnemonic: "I.N. =
Inflammatory (Improves with Movement), Non-Inflammatory (Needs Rest)"
3. PATTERN RECOGNITION IN
RHEUMATOLOGY
Monoarthritis (1
Joint) → Think Infection or Gout!
- Gout (Big Toe, Red, Hot, Painful)
- Septic Arthritis (Urgent! High Fever, Pus in Joint)
Oligoarthritis (2-4
Joints) → Think Reactive or Psoriatic Arthritis!
- Reactive Arthritis (After Infection, Asymmetrical)
- Psoriatic Arthritis (Skin Psoriasis, Nail Changes)
Polyarthritis
(>5 Joints) → Think RA or SLE!
- Rheumatoid Arthritis (Symmetrical, Small Joints, Chronic)
- Lupus (Fever, Rash, Butterfly Face Rash)
Mnemonic: "M.O.P. = Mono
(Gout, Infection), Oligo (Reactive, Psoriatic), Poly (RA, Lupus)"
KEY FEATURES OF COMMON RHEUMATIC
DISEASES
- Rheumatoid Arthritis (RA) → Symmetrical, Small Joints, Morning Stiffness >1 hour.
- Osteoarthritis (OA) → Asymmetrical, Large Joints, Worse with Activity, No Inflammation.
- Gout → Sudden Severe Pain, Big Toe, High Uric Acid, Needle-Shaped Crystals.
- Ankylosing Spondylitis (AS) → Young Male, Lower Back Pain, Morning Stiffness, Bamboo Spine on X-ray.
- Systemic Lupus Erythematosus (SLE) → Young Female, Polyarthritis, Rash, Photosensitivity.
Mnemonic: "R.O.G.A.S. =
RA, OA, Gout, Ankylosing Spondylitis, SLE"
DIAGNOSIS OF RHEUMATIC DISEASES
History & Physical Exam
(Most Important!)
Blood Tests
- CRP &
ESR (Inflammation Markers)
- Rheumatoid
Factor (RF) & Anti-CCP (RA Diagnosis)
- ANA
(Lupus, Connective Tissue Diseases)
- HLA-B27
(Ankylosing Spondylitis, Reactive Arthritis)
X-ray (Bone Changes, Joint Damage, Osteophytes in OA)
Synovial Fluid Analysis (WBC Count, Crystals in Gout/Pseudogout)
Mnemonic: "H.B.X.S. =
History, Blood, X-ray, Synovial Fluid"
TREATMENT OF RHEUMATIC DISEASES
1. GENERAL MANAGEMENT
- Rest During Acute Flare-Ups
- Regular Exercise to Prevent Stiffness
- Weight Loss to Reduce Joint Load
Mnemonic: "R.E.W. = Rest,
Exercise, Weight Loss"
2. MEDICAL MANAGEMENT
- NSAIDs (Ibuprofen, Diclofenac – For Pain & Inflammation)
- DMARDs (Methotrexate, Sulfasalazine – For RA, Psoriatic Arthritis)
- Biologics (TNF Inhibitors – Etanercept, Infliximab for Severe RA, AS)
- Steroids (Prednisolone – For Lupus, RA Flare-Ups)
Mnemonic: "N.D.B.S. =
NSAIDs, DMARDs, Biologics, Steroids"
3. SURGICAL MANAGEMENT (Severe
Joint Damage)
- Joint Replacement (For End-Stage OA, RA)
- Arthroscopy (For Joint Debridement)
Mnemonic: "J.A. = Joint
Replacement, Arthroscopy"
HOMOEOPATHIC MANAGEMENT OF
RHEUMATIC DISEASES
- For Joint Pain & Stiffness:
- Rhus Tox, Bryonia, Arnica, Calc Fluor.
- For Autoimmune Diseases (RA, SLE):
- Causticum, Kali Carb, Medorrhinum, Syphilinum.
- For Gout & Uric Acid Issues:
- Colchicum, Ledum Pal, Urtica Urens, Benzoic Acid.
Mnemonic: "R.B.A.C. =
Rhus Tox, Bryonia, Arnica, Calc Fluor for Joint Pain"
FINAL REVISION WITH MNEMONICS
- Definition = "R.H.E.U.M. = Rheumatic Health Examines Underlying Muscles & Joints"
- Approach = "O.I.P." (Origin, Inflammation, Pattern)
- Articular vs. Non-Articular = "A.N." (Articular = Both Active & Passive, Non-Articular = Active Only)
- Inflammatory vs. Non-Inflammatory = "I.N." (Inflammatory = Improves with Movement, Non-Inflammatory = Needs Rest)
- Pattern = "M.O.P." (Mono = Gout/Infection, Oligo = Reactive/Psoriatic, Poly = RA/Lupus)
- Common Diseases = "R.O.G.A.S." (RA, OA, Gout, Ankylosing Spondylitis, SLE)
- Diagnosis = "H.B.X.S." (History, Blood, X-ray, Synovial Fluid)
- Treatment = "N.D.B.S." (NSAIDs, DMARDs, Biologics, Steroids)
- Homeopathy = "R.B.A.C." (Rhus Tox, Bryonia, Arnica, Calc Fluor for Joint Pain)
