Rheumatology & Orthopedic Clinical Reference: Diagnostic Comparisons, Treatment Options and Key Clinical Features
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Rheumatology and Orthopedic Clinical Reference Tables
Inflammatory Arthritis: Diagnosis, Treatment and Differential Features
| RA RA factor: positive Joints: number of joints involved, swelling, ESR Health: bad at >3.7, moderate 2.4 to 1.6, good <1.6 (DAS28 style scoring) Stage (X-ray): I to IV HLA-DRB1: genetic marker | AS MRI: sacroiliac joint inflammation Blood: ESR and CRP Immune: HLA-B27 positive | Reactive arthritis (RTV): Autoimmune or post-bacterial trigger ESR: elevated Recent infection history HLA-B27: positive Synovial WBC: 5,000 to 50,000 | Septic arthritis: Arthrocentesis: synovial WBC above 50,000 Foul smell of joint fluid PMN: predominant neutrophils |
| 1. Methotrexate (bacteria, sulfasalazine interaction noted) 2. NSAIDs 3. Glucocorticoids (prednisone) 4. Biologics: infliximab | Sulfasalazine plus prednisone NSAIDs DMARDs Glucocorticoids | NSAID: indomethacin Antibiotic: doxycycline DMARDs Glucocorticoids injected into joint | Treatment: 2 weeks IV, then 2 weeks oral antibiotics Broad-spectrum coverage Gram-positive and Gram-negative (sulfonamide-based options) |
Crystal, Degenerative and Connective Tissue Disorders
| Gout Monosodium urate vs. polyarticular pattern | Osteoarthritis (DJD) X-ray: reduced joint space | SLE: FAR (family history, ANA, rash) Anti-dsDNA greater than ANA Anti-dsDNA Hemolytic anemia, thrombocytopenia and leukopenia | Scleroderma (systemic sclerosis): Calcinosis Raynaud phenomenon (white skin) Esophageal dysfunction Sclerodactyly Telangiectasia Diffuse form with multi-organ involvement |
| Acute: NSAID (diclofenac), colchicine, corticosteroids Chronic: allopurinol 100 mg, titrated to 200 to 300 mg Probenecid | NSAID: celecoxib (COX-2 selective) Glucocorticoids Hyaluronic acid injection into joint | Prednisone plus cyclophosphamide (renal involvement) Azithromycin (immune modulation) | Serology: anti-Scl-70, ANA positive ANA, RF, ENA panel Thick skin Symptomatic treatment: nifedipine ACE inhibitors |
Vasculitis: Granulomatosis with Polyangiitis and Giant Cell Arteritis
| Wegener (granulomatosis with polyangiitis, middle-sized vessels): Upper respiratory tract involvement 1. Blood: ESR, CRP 2. ANCA positive (non-specific) | Temporal (giant cell) arteritis: Blindness Scalp and skull pain Purpuric rash Asymmetric skin color |
| 1. Prednisone 2. Cyclophosphamide | Same regimen |
Axial Spine Disorders: Ankylosing Spondylitis vs. Mechanical Back Pain
| Ankylosing spondylitis (inflammatory) Male predominance Dull, chronic pain Clinical: sacroiliitis and spondylitis Pain improves with activity, morning stiffness over 30 minutes Radiographic: sacroiliitis, syndesmophytes, bamboo spine, squaring of vertebrae Responds to NSAIDs | Mechanical back pain Female predominance Sharp pain Clinical: disc herniation, radiculopathy Pain worsens with activity, morning stiffness under 30 minutes Radiographic: disc herniation, osteophytes in vertebral canal, spondylolisthesis (vertebral body displaced anteriorly) Limited response to NSAIDs |
Gout and Osteoarthritis: Treatment Comparison
| Gout Monosodium urate vs. polyarticular pattern | Osteoarthritis (DJD) X-ray: reduced joint space |
| Acute: NSAID (diclofenac), colchicine, corticosteroids Chronic: allopurinol 100 mg, titrated to 200 to 300 mg Probenecid | NSAID: celecoxib (COX-2 selective) Glucocorticoids Hyaluronic acid injection into joint |
SLE and Scleroderma: Treatment and Serology Summary
| SLE: FAR (family history, ANA, rash) Anti-dsDNA greater than ANA Anti-dsDNA Hemolytic anemia, thrombocytopenia and leukopenia | Scleroderma (systemic sclerosis): Calcinosis Raynaud phenomenon (white skin) Esophageal dysfunction Sclerodactyly Telangiectasia Diffuse form with multi-organ involvement |
| Prednisone plus cyclophosphamide (renal involvement) Azithromycin (immune modulation) | Serology: anti-Scl-70, ANA positive ANA, RF, ENA panel Thick skin Symptomatic treatment: nifedipine ACE inhibitors |
Humerus Diaphysis: Operative Management and Fracture Types
Humerus diaphysis operative management | Nail fixation: Segmental fracture Pathologic fracture |
| Open fracture Nerve and vessel damage Polytrauma Unstable fracture Intra-articular | Implant options: Flexible nail Interlocking nail Indications: polytrauma, infection, open fracture |
Multidisciplinary Rehabilitation Team
Occupational therapist
Orthotist
Physiotherapist
Prosthetist
Psychologist
Social worker
Speech therapist
Rehabilitation Program
Includes family involvement
School-Age Procedures (8 to 9 years)
Open hip reduction and capsule plasty
Iliac osteotomy / acetabular roof procedure
Derotational femoral osteotomy