Rheumatology

Ankylosing Spondylitis
Spondyloarthritis refers to a group of inflammatory diseases characterized by spinal & joint oligoarthritis, enthesitis, and sometimes mucocutaneous, ocular and/or cardiac manifestations.
Ankylosing spondylitis is a prototype of spondyloarthritis, particularly of the axial form.
Diagnosis of ankylosing spondylitis is definite if any of the radiological criterion (grade≥2 bilateral sacroiliitis or grade ≥3 unilateral sacroiliitis) is associated with at least one of the clinical criterion (low back pain & stiffness for >3 months that improves with exercise but not relieved by rest, limitation of motion of the lumbar spine in the sagittal and frontal planes, limitation of chest expansion relative to normal values correlated for age and gender.
Fibromyalgia

Fibromyalgia is a clinical syndrome wherein the patient experiences generalized pain and fatigue that cannot be explained by the presence of any other disorder.
It is often considered to be psychosomatic or psychogenic in nature.
It is found in approximately 2% of the population and the prevalence increases with age, most common in women 20-55 year of age

Gout
Gout is a condition that resulted from deposition of monosodium urate crystals in various tissues (eg joints, connective tissue, kidney).
The patient experiences acute and chronic arthritis, soft tissue inflammation, tophus formation, gouty nephropathy and nephrolithiasis.
Primary hyperuricemia is called when uric acid saturation arises without coexisting diseases or drugs that alter uric acid production and excretion.
While in secondary hyperuricemia there is an excessive uric acid production or diminished renal clearance that occurs as a result of a disease, drug, dietary product or toxin.
Infectious Arthritis
The classical presentation of infectious arthritis is acute onset of pain, warmth and swelling of a single joint.
The range of motion is usually decreased.
The knee is the most commonly affected but any joint may be involved.
Fever and chills may be present.
More than 1 joint may be involved in patients with pre-existing joint disease, other inflammatory conditions or severe sepsis, and in some patients infected with certain pathogens eg N gonorrheae, N meningitidis and Salmonella spp.
Infectious arthritis must always be a part of the differential diagnosis in a patient with an acute monoarthritis. 
Inflammatory Bowel Disease
Inflammatory bowel disease consists of ulcerative colitis and Crohn's disease.
Ulcerative colitis is a diffuse mucosal inflammation limited to the colon while Crohn's disease is a patchy, transmural inflammation that occurs in any part of the gastrointestinal tract.
The ileum and colon are the most frequently affected sites.
Juvenile Idiopathic Arthritis
Juvenile idiopathic arthritis was formerly known as juvenile rheumatoid arthritis or juvenile chronic arthritis.
It presents as chronic joint swelling, pain with functional limitation for at least 6 weeks of unknown cause that starts before 16 year of age.
It is the most common autoimmune-autoinflammatory disease in children.
Around half of the children with juvenile idiopathic arthritis may have active disease until adulthood.
Kawasaki Disease
Kawasaki disease is an acute, febrile illness that is self-limited. It is a systemic vasculitic syndrome that primarily involves the medium- and small-sized muscular arteries of the body.
It is also known as mucocutaneous lymph node syndrome.
It affects primarily children <5 years old with peak incidence in 1-2 year of age.
The cause remains unknown but current research supports an infectious origin.
Epidemiological findings suggest that genetic predisposition and environmental factors play a role in the pathogenesis of the disease.
Low Back Pain
It is pain, stiffness, or discomfort in the lower back area below the costal margin & above the gluteal creases.
Low back pain is also called spinal pain or lumbago.
Nonspecific low back pain is without identifiable specific causes that makes up 85-90% of all low back pain cases.  It also includes pain felt in the proximal lower extremities
Patients with low back pain maybe associated with mobility deficits caused by severe or progressive neurologic disorders or comorbidities.
Specific spinal pathology includes cauda equina syndrome, tumor, infection, ankylosing spondylitis, inflammatory disorders.
Low back pain associated w/ radiculopathy or spinal stenosis are dermatomal pain w/ or w/o neurologic deficits that most often caused by nerve root compression.

Multiple Sclerosis
Multiple sclerosis is an acquired chronic immune-mediated inflammatory disease of the brain and the spinal cord characterized by presence of multiple discrete areas of myelin loss within the CNS and subsequent axonal degeneration.
Affects more women than man; however, men are more likely to have a malignant clinical course.
A multiple sclerosis attack is usually characterized by any neurological disturbance with minimum 24 hours duration, in the absence of fever or infection.
Osteoarthritis

Osteoarthritis is a chronic progressive disease where there is degeneration & loss of articular cartilage that occurs together with new bone formation at the joint surfaces and margins, that causes pain and deformity.

The patient experiences pain, stiffness, decreased movement, inflammation and crepitus.

The pain is usually aggravated by pain and relieved by rest.

Osteoporosis
Osteoporosis is the progressive, systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration of bone tissue leading to bone fragility and increased susceptibility to fractures.
The more risk factors (eg history, of fracture, advanced age, comorbidities, impaired vision) that are present, the greater the risk of fracture.
Paget's Bone Disease
Paget's bone disease, also known as osteitis deformans, is characterized by a significant increase in bone resorption and turnover in localized parts of the skeleton causing enlargement and thickening of the bone that is disordered and architecturally unstable.
The prevalence increases with age, with men and women affected equally.
Genetic factors and/or viral infection may play a role in the etiology.
May affect one bone (monostotic) or several bones (polyostotic).
By decreasing frequency, involved bones may include pelvic bone and sacrum, spine, skull and femur, tibia, humeri and clavicles.
Psoriatic Arthritis
Psoriatic arthritis is a chronic inflammatory arthropathy associated with cutaneous psoriasis.
It is a progressive disease with asymmetric joint distribution pattern and rheumatoid factor is negative.
It can develop at any time including childhood but most often occurs between 30-50 years old.
Symptoms may range from mild to very severe.
Rheumatic Fever - Acute
Acute rheumatic fever is an autoimmune response to a previous group A beta-hemolytic streptococcal (GAS) infection causing acute generalized anti-inflammatory response primarily affecting the heart.
It often presents in patients 5-14 years of age and uncommon before 3 years and after 21 years of age.
Patients presenting with acute rheumatic fever are severely unwell, in extreme pain and requires hospitalization.
Rheumatoid Arthritis

Rheumatoid arthritis is a systemic autoimmune rheumatic disorder of unknown etiology.
It is the most common form of inflammatory arthritis.
Patient usually complains of joint pain and/or swelling with morning stiffness that lasts for more than an hour.

Goals of treatment are clinical & radiological remission of disease and to reduce functional limitations & permanent joint damage.

Scleroderma
Scleroderma is a connective tissue disorder characterized by skin thickening and fibrosis. It is rare, autoimmune and chronic.
It has an idiopathic cause and not contagious.
Early microvascular damage, mononuclear cell infiltrates and slowly developing fibrosis are the important features of the tissue lesions.
The leading causes of death are pulmonary fibrosis and pulmonary arterial hypertension.
Systemic Lupus Erythematosus
Systemic lupus erythematosus is a chronic, multisystem, inflammatory, autoimmune disorder characterized by formation of autoantibodies directed against self-antigens and immune-complex formation.
It can be suspected when ≥2 organ systems are involved.
It is predominantly diagnosed in females of childbearing age, rarely diagnosed before 8 years old.
Clinical presentation varies in different patients and the disease activity varies over time in a single patient. Majority of patients have arthralgia of the hand.
Tendinopathy

Tendinopathy is a clinical syndrome characterized by tendon thickening and localized tendon pain, swelling or impaired performance.
It usually is a temporary condition if treated early but may also be recurrent or chronic.
Principles of therapy include: ddentification & elimination of the cause of tendinopathy, behavior modification to minimize or eliminate sources of continuing irritation, specialist referral for appropriate follow up care and to reduce pain & to return function