Clearing up some rheum-ors
Learning a few rheumatology pearls can help you find the right diagnosis and treatment for your patients.
Although rheumatologic conditions are rare, hospitalists will inevitably encounter them in their practices. Adding a few diagnostic and therapeutic rheumatology “pearls” to your toolkit will prepare you to meet these clinical challenges head-on.
Vivek K. Murthy, MD, MSc, is a rheumatologist and hospitalist at the University of California San Francisco. Before he was a rheumatologist, he was a full-time hospitalist at the Johns Hopkins University School of Medicine, and he continues to practice as a part-time hospitalist and clinician educator at the San Francisco Veterans Affairs Medical Center. These experiences have given him a sense of what hospitalists need to know about common rheumatologic disorders.
“I remember how mysterious and enigmatic the field of rheumatology felt to me before I became a rheumatologist,” he said. “Sometimes, I still feel that way.”
Dr. Murthy will address some of that mystery in Monday’s session, “No Rheum at the Inn? High Value Inpatient Rheumatology Pearls for Hospitalists.”
One of the nuanced parts of rheumatology is knowing the diagnostic approach to acute monoarticular arthritis in hospitalized adults when they develop warm and swollen joints with reduced range of motion.
“There’s urgency to diagnosis, from a symptomatic and quality of life perspective of course, but also from a safety perspective. If the patient has a septic joint, you need to know promptly since that’s an emergency,” Dr. Murthy said.
The prompt treatment of gout is another area of nuance. Although gout is usually treated with medications like ibuprofen, colchicine or steroids, Dr. Murthy said it can be difficult to know when to reach for each of these, in what order and what to do if contraindications exist to each of these agents.
Another condition hospitalists may encounter is giant cell arteritis, a form of vasculitis where the immune system inflames and compromises the large blood vessels in the body, reducing downstream tissue perfusion and producing debilitating symptoms. The most feared complication of giant cell arteritis is permanent vision loss, which can be prevented if hospitalists know when and how to act.
During this session, Dr. Murthy plans to cover when to consider the diagnosis of giant cell arteritis and how to go about securing the diagnosis in a timely manner. He said he hopes the session will answer some of the questions he had about rheumatology when he was a full-time hospitalist.
“You could say that this talk is a message from me to my prior self, casting light on some fundamental rheumatology concepts that I wish I’d internalized earlier,” he said.
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