José António Pereira da Silva

Inflammatory Low Back Pain

In patients with lumbar pain, we must investigate the rhythm of the pain and other associated aspects that may be alarm signals of a specific or even sinister underlying pathology (Chapter 11).

Chronic, Asymmetrical Oligo- Or Polyarthritis

When enquiry and clinical examination establish that the patient has chronic (lasting for more than 6 weeks) asymmetric oligo- or polyarthritis. You identify a pattern that makes for the first step of diagnosis.

Systemic Syndromes Connective Tissue Diseases Vasculitis Raynaud’s Phenomenon

Under the heading of connective tissue diseases (CTDs), we include a very broad spectrum of conditions that are all systemic and are all of immunological and inflammatory origin (although of unknown etiology). Their systemic nature (several organs and tissues are affected) derives from the ubiquitous distribution of connective tissue and vessels, which are the site of the pathological changes found.

Acute Oligo- or Polyarthritis Febrile Arthritis Arthritis with Mucocutaneous Manifestations

This syndrome involves the rapid onset (days or weeks) of oligo- or polyarticular synovitis. It is often, but not invariably, associated with concomitant cutaneous and/or mucosal manifestations, with or without fever. In many cases, symptoms appear two to three weeks after an infection of variable severity. Young people predominate.

Chronic, Additive, Symmetrical, Peripheral Polyarthritis

This concept requires the presence of articular inflammation (arthritis1) affecting five or more joints (polyarthritis) that is persistent (>6 weeks), additive (rather than migratory or recurrent), and approximately symmetrical (the same joints or articular areas affected on each side of the body), with preferential involvement of the wrists, hands, ankle joints and feet.

Drugs Commonly Used in Rheumatic Diseases

This chapter describes some of the classes of drugs often used to treat rheumatic diseases, and addresses the basic rules for selecting, dosing and monitoring them. Other drugs with more specific indications, like immunosuppressants, osteoporosis treatment and gout medications have been dealt with in the appropriate chapters.

Arthritis of the Shoulder and Pelvic Girdles Polymyalgia Rheumatica

The symptoms and signs of polymyalgia rheumatica (PMR) are fairly well defined. The patient, usually an elderly one, presents with subacute onset of pain and accentuated stiffness affecting the shoulder and hip limb girdles. The stiffness is the predominant aspect and may be very marked. The pain may radiate to the proximal part of the limbs or into the neck (Figure 17.9.). The patient may find mobility very limited, especially in the morning, and may need help to get up or even just turn over in bed.

Regional Syndromes The Knee

The knee is the largest and one of the most complex joints in the human body. With a large synovium and subject to extreme mechanical demands, it is highly prone to both mechanical and inflammatory lesions.Diseases of the knees, such as osteoarthritis, and lesions of the meniscus and ligaments, are some of the most common causes of disability.

Osteoporotic Syndrome Osteoporosis

Since he was a young man, Carlos Silvestre aged 56 had suffered from severe bronchial asthma, which had progressed to respiratory insufficiency. The severity of his condition had led to the chronic use of inhaled and oral corticosteroids. His physical activity was extremely limited and he rarely left home. We were called to see him after an emergency admission with violent chest pain and flail chest caused by multiple rib fractures that had occurred, according to the patient, during a recent coughing attack. Marked dorsal kyphosis reflected the presence of multiple vertebral fractures (confirmed by x-ray.), facilitated by the high pillows that he used.

The Importance of Rheumatic Diseases

Rheumatology is the branch of medicine that deals with the treatment (preventive, active and rehabilitative) of patients suffering from joint and musculoskeletal diseases, including diffuse diseases of the connective tissue, but excluding trauma.