Rheumatology for Primary Care Providers. A Clinical Casebook

Preface
Contents
Contributors
1: An Approach to a Patient with Joint Pain
	Introduction
		Epidemiology
		The Assessment of a Patient with Joint Pain
	General History
	Rheumatological Emergencies
	Patterns of Rheumatological Conditions
	Referred Visceral Pain
	Spinal Disease
	Periarticular Pain
	Inflammatory Arthritis
	Osteoarthritis
	Muscle Syndromes
	Connective Tissue Disease (CTD)
	Pain Syndromes
	Joint Examination
		General Examination
		Musculoskeletal Examination
		Individual Joint Examination
	Summary
	References
2: Osteoarthritis
	Introduction
	Pathophysiology
	Risk Factors
	Clinical Presentation
		Knees
		Hips
		Hands
	Diagnostic Testing
	Management
		Nonpharmacologic Therapy
			Exercise and Weight Loss
			Knee Braces
		Pharmacologic Therapies
		Complimentary Therapies
		Future Direction
	Summary
	References
3: Rheumatoid Arthritis
	Pathophysiology
	Clinical Presentation and Diagnosis
	Approach to Patients with Suspected RA
	Assessment of Clinical Disease Activity
	Therapy
	Nonpharmacological Interventions
	Comorbidities, Vaccination, and Pregnancy
	Summary
	References
4: SLE for Primary Care Providers
	Introduction
	Pathogenesis
	Classification
	Clinical Evaluation
	General
	CNS
	Cardiovascular
	Gastrointestinal
	Hematologic
	Musculoskeletal
	Pulmonary
	Renal
	Skin
	Laboratory Evaluation
	Clinical Management
	Summary and Suggestions
	References
5: Fibromyalgia for the Primary Care Physician
	Patient Case
	Overview
		What Is Fibromyalgia?
		Epidemiology
		Misconceptions Associated with FM
		What Causes Fibromyalgia?
		Pathophysiology
		Why Is Fibromyalgia Challenging to Diagnose and Treat … and Does It Have to Be This Way?
	Approach to Diagnosis and Management
		Diagnosis of Fibromyalgia
		Criteria
		Overall Management of Fibromyalgia
		Pharmacotherapy
		Nonpharmacologic Options
		Support Systems
		Tracking Symptoms and Progress
		Patient-Centered Medical Homes (PCMHs)
	Conclusion
	Patient and Provider Resources
		Tools for Fibromyalgia Tracking
		Organizations and Support Groups
		Books
		Smartphone Apps
	References
6: Metabolic Bone Disease and Osteoporosis
	Osteoporosis
		Assessment for Fracture Risk and Osteoporosis
		The Limitation of DXA and Newer Techniques
		Treatment of Osteoporosis
		Combination and Sequential Treatments
	Secondary Osteoporosis
	Summary
	References
7: Crystal-Induced Arthritis
	Gout
		Presentation and Progression
			Cause
			Presentation
			Pitfalls and Pearls of Acute Monoarticular and Polyarticular Gout
		Natural History of Gout
			Acute Gout
			Chronic Tophaceous Gout
			Transplant-Associated Gout
		Treatment of Acute Gout
			NSAIDs, Colchicine, and Glucocorticoids
			Biologic Therapy
		Treatment of the Hyperuricemic State
			Allopurinol
			Febuxostat (Uloric)
			Uricosuric Drugs
			Uricases (Rasburicase, Pegloticase)
			Pitfalls and Pearls of Urate-Lowering Therapy (ULT)
		Comorbidities, Contraindications, and Therapeutic Choice
			Chronic Kidney Disease
			Hypertension
			Diabetes Mellitus and Hyperlipidemia
			Cardiovascular Disease
			Hepatic Impairment and Gastrointestinal Bleeding
			Drug Interactions
			When to Refer to the Rheumatologist
				Pitfalls and Pearls of Comorbidities
	Calcium Pyrophosphate Deposition Disease (CPPD)
		Presentation and Progression
			Cause
			Presentation
				Osteoarthritis and CPPD Disease
				Precipitators of Acute Pseudogout in the Elderly
			Diagnosis
		Natural History
		Treatment
			Agents That May Prevent Crystal Formation and Deposition in CPPD
				Magnesium
				Dietary Calcium
				Probenecid
				Phosphocitrate
				Hyaluronan
				Radiosynovectomy
			When to Refer
				Pearls and Pitfalls of CPPD
	Basic Calcium Phosphate (BCP) Crystal Deposition Disease
		Presentation and Progression
			Cause
			Presentation
			Diagnosis
			Expected Outcome
			Treatment
			Expected Response
			When to Refer
			Pearls and Pitfalls of BCP
		Summary
	References
8: Overuse Injuries
	Overuse Injuries
		Tendinopathy
			Epidemiology
			Pathophysiology
			Presentation/Symptoms
			Symptom Classification
			Physical Exam
			Diagnosis
			Treatment
		Stress Fractures
			Epidemiology
			Pathophysiology
			Presentation/Symptoms
			Physical Exam
			Diagnosis
			Treatment
		Periostitis and Periosteal-Muscle Junction
			Epidemiology
			Pathophysiology
			Presentation/Symptoms
			Physical Exam
			Example Images
			Diagnosis
			Treatment
		Peripheral Nerve Entrapment
			Epidemiology
			Pathophysiology
			Presentation/Symptoms
			Physical Exam
			Diagnosis
			Treatment
		Bursitis/Bursopathies
			Epidemiology
			Pathophysiology
			Presentation/Symptoms
			Physical Exam
			Diagnosis
			Treatment
	References
9: Systemic and Localized Inflammatory Diseases of Older Adults
	Inflammatory Arthritis
		Epidemiology, History, and Diagnosis
		Differential Diagnosis
		Treatment
	Polymyalgia Rheumatica and Giant Cell Arteritis
		Polymyalgia Rheumatica
		Giant Cell Arteritis
	Drug-Induced Lupus
	Localized Musculoskeletal Disorders
		Bursitis
		Spontaneous Osteonecrosis of the Knee (SONK)
		Diffuse Idiopathic Skeletal Hyperostosis (DISH)
	Discussion
	References
10: Interpretation of Rheumatological Tests
	Case Scenario
	Testing for Connective Tissue Diseases
	Systemic Lupus Erythematosus
	Antinuclear Antibodies
	Anti-Double-Stranded DNA Antibodies
	Anti-Smith Antibodies
	Drug-Induced Lupus
	Sjögren Syndrome
	Mixed Connective Tissue Disease
	Systemic Sclerosis (Scleroderma)
	Dermatomyositis and Polymyositis
	Rheumatoid Arthritis
		Rheumatoid Factor
		Anticyclic Citrullinated Peptide Antibodies
	Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis
		ANCA
	Other Tests
		Erythrocyte Sedimentation Rate
		C-Reactive Protein
	Human Leukocyte B27 Antigen
		Final Comment
	References
11: Infectious Arthritis
	Septic Arthritis
	Disseminated Gonococcal Infection
	Acute Rheumatic Fever
	Lyme Arthritis
	Chikungunya Virus Infection
	Parvovirus Infection
	Osteoarticular Tuberculosis
	References
12: Autoinflammatory Disease
	Introduction
	General Pathophysiology
	Diagnostic Clues for AIDs
	Familial Mediterranean Fever [18–20]
	Cryopyrin-Associated Periodic Syndrome [21–24]
	TNF Receptor-Associated Periodic Syndrome [16, 25, 26]
	Hyper-IgD Syndrome/Mevalonate Kinase Deficiency [27–29]
	NOD2-Associated Diseases
	Blau Syndrome
	Yao Syndrome [37–40]
	References
13: Scleroderma
	Patient Case
	Introduction
	Epidemiology
	Mechanisms/Pathophysiology
		Inflammation and Autoimmunity
		Vasculopathy
		Fibrosis
	Diagnosis and Screening
		Identifying Specific Clinical Features of Scleroderma
			Skin Sclerosis
			Raynaud’s Phenomenon
			Abnormal Nailfold Capillaries
			Fingertip Lesions: Cutaneous Ulcers
			Telangiectasia
			Pulmonary Hypertension
			Interstitial Lung Disease
			Scleroderma-Related Autoantibodies
		Identifying Other Important Signs and Symptoms of Scleroderma (Not Included in the 2013 ACR/EULAR Classification Criteria)
			Gastrointestinal Dysmotility and Vasculopathy
			Cardiac Involvement
			Scleroderma Renal Crisis
			Skin Calcinosis
			An Algorithmic Approach to the Diagnosis of Scleroderma
	Staging and Management
		Skin Sclerosis
		Raynaud’s Phenomenon
		Pulmonary Hypertension
		Interstitial Lung Disease
		Gastrointestinal Dysmotility
		Scleroderma Renal Crisis
		Quality of Life in Scleroderma
		Risk of Malignancy and Associated Autoimmune Conditions
	Referral Guidelines and Outlook
	Conclusion/Case Summary
	References
14: Vasculitis
	Introduction
	Large-Vessel Vasculitis
		Giant Cell Arteritis
			Epidemiology
			Clinical Features and Findings
			Diagnosis
			Treatment
		Takayasu’s Arteritis
			Epidemiology
			Clinical Features and Findings
			Diagnosis
			Treatment
	Medium-Vessel Vasculitis
		Polyarteritis Nodosa
			Epidemiology
			Clinical Features and Findings
			Diagnosis
			Treatment
	Small-Vessel Vasculitis
		ANCA-Associated Vasculitis
			Granulomatosis with Polyangiitis
				Epidemiology
				Clinical Features and Findings
				Diagnosis
				Treatment
			Microscopic Polyangiitis
				Epidemiology
				Clinical Features and Findings
				Diagnosis
				Treatment
			Eosinophilic Granulomatosis with Polyangiitis
				Epidemiology
				Clinical Features and Findings
				Diagnosis
				Treatment
		Cryoglobulinemic Vasculitis
			Epidemiology
			Clinical Features and Findings
			Diagnosis
			Treatment
		Behcet’s Syndrome
			Epidemiology
			Clinical Features and Findings
			Diagnosis
			Treatment
		Paraneoplastic Vasculitis
	Relevant Comorbidities
	References
15: Ankylosing Spondylitis
	Epidemiology
	Etiology and Pathogenesis
		Genetic Factors
		Intestinal Dysbiosis
	Clinical Features
		Musculoskeletal Manifestations
		Extra-Articular Manifestations
		Complications
	Diagnosis
		History
		Physical Exam
			Spinal Mobility
		Laboratory Tests
		Imaging
	Treatment
		Initial Therapy
			Nonpharmacologic Interventions
			Pharmacologic Therapy
		NSAID Nonresponders
			When to Consider Tapering Biologic Therapy
			When to Consider Switching a Biologic Agent
		Resistant to Standard Therapies
		Management of Extra-Articular Manifestations
		Surgery
		Considerations in Preoperative Clearance of AS Patients
	Risk of COVID-19 in AS Patients
	Prognosis
		Prognostic Indicators
	Conclusions
	References
Index