Rheumatology

Rheumatology

The majority of athletes presenting to a sports medicine clinic have a musculoskeletal condition. While this is typically related to trauma, a reasonable percentage of these patients have pain that is related to either an inflammatory condition or another medical problem. It is not uncommon for patients to relate their pain to an injury.

It is outside the scope of this module to review individual rheumatological conditions. It is important however to be able to distinguish between pain which is related to mechanical factors and pain which is caused by an inflammatory condition.

This module will also discuss some of the issues related to osteoarthritis.

Please read this important instructions carefully !!!
This course is designed to be flexible and used in a number of different ways. You can choose to read a single page, complete a module or complete all 42 modules (and receive the FIFA diploma).

In order to get the best out of each module please remember the following things:

If you have any problems or questions relating to the course please click on the “need support” button located to the left of the screen.

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Learning outcomes

By the end of this topic you should:

  • be able to distinguish between mechanical and inflammatory joint pain by taking an appropriate history, conducting a clinical examination and by ordering appropriate investigations;
  • have an approach to the treatment of patients with inflammatory joint pain;
  • be able to identify a patient presenting with septic arthritis and be able to initiate an emergency response;
  • understand the relationship between significant trauma and osteoarthritis;
  • be able to prescribe physical activity for those with osteoarthritis – including after a joint replacement.

Tasks

  • Read the relevant section in the FIFA Medical Manual and other required reading.
  • Review the suggested reading.
  • View, or listen to, any relevant multimedia content.
  • Complete the course quiz.

Suggested Reading

Brukner & Khan’s

Clinical Sports Medicine – 4th Edition

Chapter 55 (pages 1093-1101)

References

  1. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO,3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, et al. 2010 rheumatoid arthritis classification criteria: An American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum 2010 Sep;62(9):2569-81.
  2. Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA 2007 Apr 4;297(13):1478-88.
  3. Li S, Cassidy C, Chang C, Gharib S, Torres J. Diagnostic utility of laboratory tests in septic arthritis. Emergency Medicine Journal 2007 – 2007 Feb;24(2):75-7.
  4. Waits JB. Rational use of laboratory testing in the initial evaluation of soft tissue and joint complaints. Prim Care 2010 Dec;37(4):673,89, v.
  5. Costenbader KH, Chibnik LB, Schur PH. Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: Clinical significance. Clin Exp Rheumatol 2007 Sep-Oct;25(5):746-9.
  6. Suresh E. Diagnosis of early rheumatoid arthritis: What the non-specialist needs to know. J R Soc Med 2004 Sep;97(9):421-4.
  7. Waits JB. Rational use of laboratory testing in the initial evaluation of soft tissue and joint complaints. Prim Care 2010 Dec;37(4):673,89, v.
  8. Hannan M, T FD, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. Journal of Rheumatology 2000 – 2000 Jun;27(6):1513-7.
  9. Bond D. Ankylosing spondylitis: Diagnosis and management. Nurs Stand 2013 Dec 18;28(16-18):52,9; quiz 60.
  10. Sari I, Ozturk MA, Akkoc N. Treatment of ankylosing spondylitis. Turk J Med Sci 2015;45(2):416-30.
  11. Dagfinrud H, Kvien TK, Hagen KB. The cochrane review of physiotherapy interventions for ankylosing spondylitis. J Rheumatol 2005 Oct;32(10):1899-906.
  12. Luukkainen R, Nissila M, Asikainen E, Sanila M, Lehtinen K, Alanaatu A, Kautiainen H. Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy. Clin Exp Rheumatol 1999 Jan-Feb;17(1):88-90.
  13. Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis. Phys Ther 2005 Sep;85(9):907-71.
  14. Christensen R, Astrup A, Bliddal H. Weight loss: The treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage 2005 Jan;13(1):20-7.
  15. Fogleman C D. Analgesics for osteoarthritis. American Family Physician 2013 – 2013 Mar 1;87(5):354-7.
  16. Clegg DO, Reda DJ, Harris CL, Klein MA, O’Dell JR, Hooper MM, Bradley JD, Bingham CO, Weisman MH, Jackson CG, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006 02/23; 2015/09;354(8):795-808.
  17. Malvankar S, FAU KW, Mahapatra AF, Dowd GS. How effective are lateral wedge orthotics in treating medial compartment osteoarthritis of the knee? A systematic review of the recent literature. The Open Orthopaedics Journal JID – 101480491 PMC – PMC3522189 OID – NLM: PMC3522189 OTO – NOTNLM 1219.
  18. FAU RD, FAU RM. Unloader braces for medial compartment knee osteoarthritis: Implications on mediating progression. Sports Health.
  19. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: A prospective, double-blind, randomized trial. Am J Sports Med 2013 Feb;41(2):356-64.
  20. Mounsey A, Ewigman B. Arthroscopic surgery for knee osteoarthritis? just say no. J Fam Pract 2009 Mar;58(3):143-5.
  21. Hunter DJ, Eckstein F. Exercise and osteoarthritis. J Anat 2009 Feb;214(2):197-207.
  22. Richmond SA, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA. Are joint injury, sport activity, physical activity, obesity, or occupational activities predictors for osteoarthritis? A systematic review. J Orthop Sports Phys Ther 2013 Aug;43(8):515-B19.
  23. Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: Osteoarthritis. Am J Sports Med 2007 Oct;35(10):1756-69.
  24. Simon D, Mascarenhas R, Saltzman BM, Rollins M, Bach BR, MacDonald P. The relationship between anterior cruciate ligament injury and osteoarthritis of the knee. Adv Orthop 2015;2015:10.1155/2015/928301.
  25. Schmalzried TP, Shepherd EF, Dorey FJ, Jackson WO, dela Rosa M, Fa’vae F, McKellop HA, McClung CD, Martell J, Moreland JR, et al. The John Charnley award. Wear is a function of use, not time. Clin Orthop Relat Res 2000 Dec;(381)(381):36-46.
  26. Healy WL, Iorio R, Lemos MJ. Athletic activity after joint replacement. Am J Sports Med 2001 May-Jun;29(3):377-88.
  27. Huch K, Müller KAC, Stürmer T, Brenner H, Puhl W, Günther K. Sports activities 5 years after total knee or hip arthroplasty: The Ulm osteoarthritis study. Br J Sports Med 2006 Feb;40(2):113.