SIU School of Medicine

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Department of Internal Medicine

Rheumatology Rotation

1) Name of Division/Rotation:Rheumatology

2) Division Faculty:

Sriya Ranatunga, MD
Anne Miller, MD

3) Contact Information:

Ms. Chris Melito
Secretary, Rheumatology

Those starting on Monday should come to the internal medicine clinic by 8:30.
Those starting on Tuesday should come to the internal medicine clinic after grand rounds.

The rheumatology nurse is Sue Redding, R.N. 545-0637

4) Length of Rotation: 2 weeks.

5) General Objectives:

Learning history and physical exam skills to evaluate patients with musculoskeletal problems.

Learn clinical presentations and management of the more common rheumatic disorders, such as:

  • Rheumatoid Arthritis
  • Osteoarthritis
  • Systemic Lupus Erythematosis
  • Bursitis and Tendonitis
  • Fibromylagia
  • Crystaline Disorders
  • Seronegative Spondyloarthropathies

Become acquainted with aspiration and injection techniques.

Learn basic science principals for rheumatology

  • Purine metabolism (gout)
  • HLA and other genetic factors and disease (ankylosing spondylitis, rheumatoid arthritis, others)
  • Histology, physiology, and pathology of joints (rheumatoid arthritis, others)
  • Autoantibodies and B cells (SLE, rheumatoid arthritis, others)
  • T cells (rheumatoid arthritis, SLE, others)
  • Cytokines (rheumatoid arthritis, SLE, others)
  • Cartilage physiology and pathology (OA and others)
  • Immune complexes (vasculitis, viral arthritis, SLE, others)
  • Inflammation (crystalline disorders, rheumatoid arthritis, others)
  • Pharmacology (all)
  • Anatomy (localized joint and soft tissue problems, others

6) Key Learning Resources:

The major resource in rheumatology is the Primer on the Rheumatic Diseases. I have attached a list of the most pertinent chapters that are required reading. There is ample time to accomplish this meager goal. Please make this a priority during your rotation.

Chapter 7 Evaluation of the Patient
Chapter 8 Musculoskeletal Signs and Symptoms
Chapter 9 Rheumatoid Arthritis
Chapter 10 Psoriatic Arthritis
Chapter 11 Seronegative Spondyloarthropathies
Chapter 13 Osteoarthritis
Chapter 14 Arhtritis Associated with Calcium-Containing Crystals
Chapter 15 Gout
Chapter 17 Systemic Lupus Erythematosis
Chapter 24 Antiphospholipid Syndrome
Chapter 45 NSAIDS
Chapter 46 Corticosteroids
Chapter 47 Disease-Modifying Antirheumatic Drugs
Chapter 48 Biologic Agents
Chapter 21 Vasculitides
Chapter 12 Infectious Arthritis
Chapter 19 Inflammatory and Metabolic Diseases of Muscle
Chapter 20 Sjogren's Syndrome
Chapter 18 Systemic Sclerosis and Related Syndromes

Other sources are available in my office; please let me know if you borrow any of them:

  • We are putting together a file of key articles on a variety of rheumatology topics that are recommended by the ACR for rheumatology fellows. You are welcome to copy what you like but be sure to return the originals.
  • Primary rheumatology texts. Klippel's Rheumatology does a particularly good job with figures and photographs; Koopman's Arthritis and Allied Conditions is a good overall text. Each will supply more information than the Primer on a given topic.
  • Moskowitz's Clinical Rheumatology. A good source to explore differential diagnosis. Chapters are grouped according to clinical presentation rather than disease (acute monoarticular arthritis, arthritis and skin rash, etc.).
  • ACR Rheumatology Core Curriculum Slide Series. 26 cases with questions and answers keyed to slides. Sides are arranged in order on three carousels with a question and answer book. Lots of physical exam findings. Donated by the SIU Alumni Association.
  • Schumacher's Case Studies in Rheumatology. Short cases are presented with a clue followed by questions, answers, pearls, and pitfalls. A fun way to learn some rheumatology.
  • Brower's Arthritis in Black and White. Best introductory text on X-rays in rheumatology. Short.
  • MKSAP reviews and questions and answers.
  • West's Rheumatology Secrets. Uneven but with a question and answer format.
  • Rheumatic Disease Clinics of North America. Generally good but uneven reviews.
  • Dieppe's Atlas of Clinical Rheumatology and Hunder's Atlas of Rheumatology for clinical exam findings.
  • Sheon's Soft Tissue Rheumatic Pain for wide variety of nonsystemic, local musculoskeletal problems.

Immunology:

  • Janeway's Immunobiology and Roitt's Immunology. Best introductory texts into immunology with a heavy emphasis on diagrams.
  • Stites' Medical Immunology. Background information shorter than Janeway and Roitt but not as well explained. Useful, short synopses of immunological problems in a variety of diseases.
  • Paul's Fundamental Immunology. Short of the primary source material, this is the best immunology text, but it is not for the faint-hearted.

7) Expectations of Students:

  • Students will perform history and physical exams on rheumatology patients, primarily in the outpatient setting. They will dictate new patient summaries and write notes for follow-up patients.
  • Students may also perform history and physical exams on inpatients. They may also follow inpatients and are responsible for collecting data, performing follow-up histories and physicals, presenting at rounds, and writing notes.
  • Students may participate in aspirations and injections of joints and tendons.
  • Students may be asked to prepare short case presentations and literature reviews.
  • Students are expected to read the sections of The Primer as outlined and to read about the patients they evaluate.
  • You are not responsible for call on the weekends during this rotation.

8) Clinical Activity, Division

  • Attend required conferences (Friday morning from 11:00-12:00, Medical Grand Rounds on Tuesday morning, and noontime conferences on Monday, Wednesday, and Thursday from 12:00-1:00 p.m.).
  • Clinics (Monday at 8:30, Tuesday at 9:00, Thursday at 8:30). May vary depending on clinical load.
  • Daily teaching sessions (Monday, Tuesday, and Thursday at 2:00; Wednesday at 8:30, and Friday at 9:00). May vary

9) Assessment Methods:

  • Observation/verification of history and physican exams
  • Assessment of students' clinical impression and plans for the patients they evaluate
  • Clarity of oral presenations and written notes
  • During learning sessions, students will have the opportunity to demonstrate their knowledge of the topic assigned
  • We may have sets of multiple choice and other written questions
  • Students will present a critical analysis of one or more research papers to the faculty
  • We will meet at the end of the rotation for feedback.

10) Assessment of the Rotation:

  • At the end of the rotation, we will have a meeting at which time I will ask for feedback and recommendations for improvement

11) Web Sites

www.arthritisrheum.org American College of Rheumatology

www.arthritis.org Arthritis Foundation

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