Musculoskeletal Pathophysiology

Fall 2005

Illustration by William Henry Bunbury from Origin of the Gout, London,1815. (Image courtesy of nlm.nih.gov.)

Specialists in Rheumatology present a wealth of information in this medical field, from Rheumatoid Arthritis to Gout and Other Crystal Diseases.

This course teaches students about disorders that affect the musculoskeletal system. The students will become familiar with the immunology and pathophysiology of autoimmune diseases that may predominantly affect joints but also affect multiple organ systems of the body in some diseases.

• Gout and Other Crystal Diseases
• Gout and Other Crystal Diseases
• Systemic Lupus Erythematosus (SLE)
• Systemic Lupus Erythematosus (SLE)
• Systemic Lupus Erythematosus (SLE): Slide 15
• Gout and Other Crystal Diseases: Slide 1
• Gout and Other Crystal Diseases: Slide 1
  

  Syllabus

  Objectives Understand the goals and organization of the Musculoskeletal Pathophysiology Course Become familiar with the concept and categorization of the musculoskeletal or “rheumatic” diseases Learn the anatomy and physiology of the joint as well as its relationship to the periarticular structures including tendons, ligaments and bursas Understand the function and content of synovial fluid in normal and disease states Gain insight into utility of synovial fluid analysis in the diagnosis of joint pathology Learn the clincical presentation and pathophysiology of the acutely inflamed joint

  1. Introduction

  Welcome to the Musculoskeletal Pathophysiology course. This course introduces you to rheumatology, a subspecialty of internal medicine that is comprised of diseases that directly or indirectly affect the joints. A clinical elective available to students in the fourth year of medical school reinforces some of the principles presented during the second year course. We hope that some of you will be able to rotate with us during your fourth year.

  The conceptual nature of rheumatic diseases can be difficult to grasp. On the surface, some of the topics presented within the course may appear unrelated. For example, some students have wondered why vasculitis and scleroderma are presented within this course. Though scleroderma is a disease characterized by excess collagen deposition, patients may also experience joint pain and its pathophysiology is intimately correlated with poorly controlled cellular activity and autoimmunity, hence its categorization within the spectrum of rheumatic diseases. The same is true for the vasculitides that you will learn about in a lecture and small group laboratory. The pathogenesis of some of the rheumatic diseases involves immunologic mechanisms and these two entities fit well within this categorization. It would be useful for you to have your first year immunology syllabus handy to refer back to concepts you learned last year. The same is true for histology and anatomy.

  2. Content

  This course is comprised of nine lectures and two small group discussions on vasculitis and the differential diagnosis of arthritis. This syllabus contains materials prepared by the individual lecturers in the course and ideally should be read prior to the lectures. Additional materials may be distributed at the time of the lectures.

  3. Schedule

  Meeting	Time	Subject	Instructor
  		Introduction	Faculty
  1	1 hour	Introduction to Rheumatic Diseases and Joint Physiology	Kalish
  2	1 hour	Systemic Lupus Erythematosus	Kalish
  3	1 hour	Chronic Arthritis: Lyme Arthritis and Spondyloarthropathy	Kalish
  4	1 hour	Osteoarthritis	McAlindon
  5	1 hour	Nonarticular Rheumatism: Fibromyalgia and Soft Tissue Disorders	Faculty
  6	1 hour	Chronic Arthritis: Rheumatoid Arthritis	Massarotti
  7	1 hour	Scleroderma	Massarotti
  8	1 hour	Pediatric Rheumatology	Lopez
  9	1 hour	Crystal Arthritis	Roubenoff
  10	2 hours	Small group sessions: Vasculitis/Connective Tissue Disease	Faculty
  11	2 hours	Small group sessions: Differential Diagnosis Arthritis	Faculty
  12	1.5 hours	Musculoskeletal Pathophysiology Section Examination
  		Final Exam

  4. Readings

  4.1. Course Textbook

  The text for this course is: The Primer on the Rheumatic Diseases, Twelfth Edition. John H. Klippel, editor; Leslie J. Crofford, John H. Stone, Cornelia M. Weyand [associate editors]. Atlanta, Ga: Arthritis Foundation, c2001.

  The following chapters are optional but recommended reading for the course:

   

  • Chapter 8 (pp. 157-165): good introduction to clinical Rheumatology, pertinent to the first lecture
  • Chapter 8 (175-177, 178, 179, 181-2): Regional Pain Syndromes
  • Chapter 9 (pp. 209-232): Rheumatoid Arthritis
  • Chapter 11 (pp. 239-258): Seronegative Spondyloarthropathy
  • Chapter 12 (pp. 269-273): Lyme Disease
  • Chapter 17 (pp. 329-345): Systemic Lupus Erythematosus

  4.2. Small Group Reading

  The following chapter from The Primer on Rheumatic Diseases is required reading and is related to one of the small group sessions:

   

  • Chapter 21 (pp. 385-402): Vasculitis

  5. Examination

  The examination is based upon information presented in the lectures, syllabus, the required reading and the small group discussions.

  Calendar

  Session	Type	Title
  1	Lecture	Introduction to Rheumatic Diseases and Joint Physiology
  2	Lecture	Systemic Lupus Erythematosus
  3	Lecture	Chronic Arthritis: Lyme Arthritis and Spondyloarthropathy
  4	Lecture	Osteoarthritis
  5	Lecture	Nonarticular Rheumatism: Fibromyalgia and Soft Tissue Disorders
  6	Lecture	Chronic Arthritis: Rheumatoid Arthritis
  7	Lecture	Scleroderma
  8	Lecture	Pediatric Rheumatology
  9	Lecture	Crystal Arthritis
  10	Conference	Conference 1: Vascular/Connective Tissue
  11	Conference	Conference 2: Diagnosis of Arthritis
  12	Examination	Exam