Key facts and checkpoints Selected Differential Diagnosis of Chronic Fatigue . Red flags that raise suspicion of serious underlying disease Red flags Examples of potential serious underlying disease Recent onset of fatigue in a previously well older patient MalignancyAnaemiaCardiac arrhythmiaRenal failureDiabetes mellitus Unintentional weight loss MalignancyHIV infectionDiabetes mellitusHyperthyroidism Abnormal bleeding…

Epidemiology Differential Diagnosis Pathophysiology Causes: Symptoms (Asymptomatic in 70% of cases) Signs Labs Radiology: XRay Monitoring Associated conditions Management Non-Pharm management

Giant Cell Arteritis  Introduction Also called temporal arteritis or cranial arteritis Clinical syndromes: polymyalgia rheumatica and temporal arteritis 20% association between temporal arteritis and PR Symptoms: ACR diagnostic criteria for GCA Age >50 years New onset of localised headache Temporal artery tenderness or decreased temporal artery pulse ESR ≥50 mm/hr…

Further follow up

Disorder characterised by inflammation in several organ systems and the production of auto-antibodies that participate in immunologically-mediated tissue injury.  Epidemiology: Proposed aetiology Triggers: Presentations SLE can present is various ways depending on the system(s) that it affects. Common clinical manifestations include: Diagnostic criteria (4 of the 11 must present serially…

Epidemiology Diagnostic criteria (4 or more of): Clinical Manifestations Stage Manifestations Signs Radiographic changes 1 Usually none – – 2 Malaise, mild joint stiffness & swelling Swelling of small joints of hands or wrists or pain in hands, wrists, knees & feet – 3 Joint pain and swellingMorning stiffness, malaise…

Epidemiology Symptoms Associated Conditions: Symptoms Diagnosis: Fibromyalgia is a diagnosis of exclusion American College of Rheumatology 1990 Critera 2010 Criteria Recognizing the limitations of the 1990 criteria, the ACR revised the diagnostic criteria in 2010 to include a more comprehensive assessment of fibromyalgia symptoms. The new criteria focus on both…

    History Physical exam Labs Radiology RA Symmetric Polyarthritis (small joint involvement) Morning stiffness Effusive joints Tendosynovitis Nodules Bone-on-bone crepitus ↑ ESR (50-60%) RF (80%) ↓Hb, ↑ platelets, ↓ wbc Demineralisation Joint space narrowing Erosions of subchondral bone Absence of bone repair SLE Multisystem disease – rash, photosensitivity, Raynaud’s,…

Introduction Clinical Features Investigation Management Pharmacological Management Non-pharmacological management involves a comprehensive approach focusing on physical activities, patient education, psychological support, and lifestyle adjustments, all aimed at improving the overall quality of life for patient. Prognosis

Introduction Clinical Diagnosis

Introduction Presentation Symptoms can be divided into exocrine and extra-exocrine disease. EXOCRINE = Lacrimal and salivary glands are commonly affected. Eyes Oral Other Exocrine EXTRA-EXOCRINE = SS can affect the patient systemically. Common extra-exocrine involvement are: History and Physical Tests for SS DDx Treatment Symptoms vary widely in intensity. For…

Epidemiology: Hyperuricemia: Due to dietary excess, overproduction of urate (<10% of cases) or relative under-secretion of urate (>90% of cases) Risk factors of hyperuricemia and gout   Modifiable risk factors                                   Nonmodifiable risk factors      …

Causes Aetiology: Predisposing factors Differentials Clinical Diagnosis:

Epidemiology Pathogenesis Classification: Assessment Clinical Features Symptoms Signs Joint pain with motion, relieved with restShort duration of stiffness after immobility(less than 30 mins morning stiffness)Joint instability/bucklingLoss of functionJoint locking due to “joint mouse” (loose piece of bone in joint) Joint line tenderness, stress painBony enlargements at affected jointsMalalignment/deformity (angulation)Limited ROMPeriarticular…

a term for arthritis following an infection (e.g. rheumatic fever, Reiter’s syndrome) Epidemiology: Aetiology: Clinical features Diagnosis: Treatment: Prognosis Complications

Clinical features Investigations Treatment Approaches Disease Monitoring: Non-Pharmacological Treatment prognosis  Features associated with a relatively good prognosis are: Features associated with a poor prognosis include: Dactylitis – differentials

Clinical features Interpretation:  Normal is > 5 cm increase in length. Less than 5 cm represents hypomobility Investigations Imaging Laboratory tests Diagnosis Treatment:

  Classification Characteristic features Seropositive rheumatic diseases 1. Connective tissue diseases Rheumatoid arthritis (RA) Systemic lupus erythematosus (SLE) Antiphospholipid antibody syndrome (APS) Scleroderma/progressive systemic sclerosis (PSS) Polymyositis/dematomyositis (PMY/DMY) Mixed connective tissue disease Sjogren’s syndrome Skin: Nodules, ulceration, rash, mucosal ulcers Raynaud’s phenomenon Sicca syndrome Neurological involvement Renal involvement Vascular involvement…

Background Definitions of vitamin D status  Severe deficiency  <12.5 nmol/L  Moderate deficiency  12.5–29 nmol/L Mild deficiency  30–49 nmol/L  Sufficient  ≥50 nmol/L Elevated  ≥250 nmol/L Toxicity is defined as serum 25-OH-D >250 nmol/L with hypercalcaemia and suppression of parathyroid hormone (PTH) Assessment Management Flowchart – Investigation and treatment of low vitamin…

Deficiency and Recommended Levels: Who should be tested for vitamin D deficiency? Australian Therapeutic Guidelines on disorders of bone and calcium homeostasis only recommend vitamin D testing for people at heightened risk of vitamin D deficiency. A 2014 Department of Health MBS review reported that the number of MBS claims for…