DR. CORA LIM-MEDICAL INSIDER
SERIOUS RHEUMATIC DISORDERS
Examples of Serious Rheumatic Diseases include the following: Infection, Malignancy and
Vasculitis
What are the warning signs of a Serious Rheumatic Disease: These are: Persistent, worsening pains, Pains unrelieved by regular intake of NSAIDs or other potent analgesics, “nerve pains”, “vascular pains”, “bone pains”
accompanying fever, weight loss, pallor etc., elderly
There are laboratory clues to a Serious Rheumatic Disorder and these are: anemia, thrombocytopenia, leucocytosis, leucopenia, elevated ESR (corrected for age & anemia), active urine sediment, abnormal radiographs e.g. pulmonary mass, lytic/blastic lesions on skeletal xrays, others: elevated alkaline phosphatase,
What are the Mimics of Rheumatic Diseases? These are: Cardiovascular disease e.g. myxomas, Vasculitis; Drug effects e.g. retinoids, ergot derivatives, Spondyloarthropathies, Raynaud’s phenomenon; Endocrine disorders e.g. thyroiditis, hypothyroidism, Vasculitis, Polymyositis, Carpal tunnel syndrome; Gastrointestinal disease e.g. celiac disease, Polyarthritis
There are some pitfalls in Rheumatic Disease Diagnosis and these are: Present polyarthritis may have started as intermittent monoarthritis of gout; Knee pain in a perfectly healthy looking knee may be coming from the hip; A rash is not a rash if you do not look for it; Gout may occur without hyperurcemia & vice versa, and ANA positivity does not always indicate SLE
In summary, we can say the following: Most rheumatic diseases are diagnosed by history & physical examination, occasionally with the use of basic laboratory tests; Analgesics & antiinflammatory drugs are a mainstay of therapy in most rheumatic diseases; Therapy is highly individualized even in patients with the same rheumatic disease; Recognition of a serious rheumatic disorder may be more important than making an actual diagnosis.