Universitat Internacional de Catalunya

Rheumatology and Systemic Diseases

Rheumatology and Systemic Diseases
3
12105
5
First semester
OB
Main language of instruction: Catalan

Teaching staff


Dr. ROZADILLA SACANELL, Antoni - arozadilla@uic.es

Dr. A Rozadilla 

arozadilla@uic.es

Introduction

The intention of the rheumatology and systemic diseases course is for students to acquire knowledge and skills in the diagnosis and therapeutic management of rheumatic diseases (joint and bone metabolism) and autoimmune disorders with joint and systemic involvement, along with the criteria for care at different levels of healthcare.

Pre-course requirements

Students must have passed the module: Structure and Function of the Locomotor System. Sufficient knowledge of English to read and understand clinical and scientific texts in this language is also essential.

Objectives

The student must acquire the ability to make a diagnosis and define the therapeutic approach for major rheumatic disorders.

More specifically, the objectives of the course are as follows:

  • Know the definition, classification and epidemiology of the main rheumatic diseases in our population.
  • Know the aetiology of rheumatic diseases, autoimmune disorders and bone metabolism and their Physiopathological mechanisms.
  • Learn to recognise systemic manifestations of autoimmune and rheumatic diseases.
  • Know the methods used in the diagnosis of rheumatic and systemic diseases.
  • Learn how to use diagnostic tools (laboratory, imaging and pathological tools) and know how to interpret their results.
  • Learn about the action mechanisms and conditions of use of the most common drugs in the field of rheumatology.
  • Know the indications for joint injection techniques in common periarticular processes.
  • Know the functional impact scales for the assessment of disability and quality of life in the various rheumatic and systemic diseases.
 

Competences/Learning outcomes of the degree programme

  • 01 - Recognise the essential elements of the medical profession, including ethical principles, legal responsibilities and patient-centered professional skills.
  • 02 - Understand the importance of central principles, in particular of professional confidentiality for the benefit of patients, society and the profession.
  • 03 - Know how to apply the principle of social justice to professional practice and understand the ethical implications of health in a changing global context.
  • 04 - Develop professional practice with respect for patient autonomy, beliefs and culture.
  • 05 - Recognize own limitations and the need to maintain and upgrade professional skills, with particular emphasis on autonomous learning of new knowledge and skills and motivation for quality.
  • 06 - Develop professional practice with other health professionals, acquiring teamwork skills.
  • 07 - Understand and recognise normal structure and function of the human body at the molecular, cellular, tissue, and organ and systemetic levels, at different stages of life and in both sexes.
  • 09 - Understand and recognize the effects, mechanisms and manifestations of disease on the structure and function of the human body.
  • 10 - To understand and recognise the agents and risk factors which determine health status, and learn how they determine the symptoms and natural development of acute or chronic diseases in individuals and populations.
  • 11 - Understand and recognize the effects of growth, development and aging on the individual and their social environment.
  • 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
  • 13 - Obtain and develop a clinical history that contains all relevant information.
  • 14 - Perform a physical examination and a mental assessment.
  • 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
  • 16 - Recognize and deal with situations that put life in immediate danger and those that require immediate attention.
  • 17 - Establish the diagnosis, prognosis and treatment, applying principles based on the best information possible and safe clinical practice..
  • 18 - To indicate the most appropriate (pharmacological, surgical, psychological, social or other) treatments that are pertinent to the most prevalent procedures, in terms of rehabilitation and also terminally ill patients, including an evaluation of their effectiveness.
  • 19 - Propose preventive measures appropriate to each clinical situation.
  • 20 - Acquire adequate clinical experience in hospitals, health centers and other health institutions under supervision, as well as basic knowledge of clinical management and patient-centered proper use of tests, drugs and other health system resources.
  • 21 - Listen carefully, obtain and synthesize relevant information about the problems affecting the patient and understand the contents of this information.
  • 22 - To write and maintain medical records and other medical documents which can be understood by third parties and are adapted to the protocols and information that is required.
  • 23 - Communicate effectively and clearly, both orally and in writing with patients, family members, media and other professionals.
  • 24 - Establish good interpersonal communication skills that enables efficient and empathetic communication with patients, relatives, media and other professionals.
  • 25 - Recognize the determinants of public health; genetic and sex-dependent lifestyle, demographic, environmental, social, economic, psychological and cultural determinants.
  • 28 - Obtaining and using epidemiological data and assess trends and risks in health related decision-making.
  • 29 - Understand national and international health organisations, and the environments and conditions of the different health care systems.
  • 30 - To acquire basic knowledge of the National Healthcare System and general healthcare legislation.
  • 31 - Understand, critically evaluate and know how to use sources of clinical and biomedical information to obtain, organize, interpret and communicate scientific and health care information.
  • 32 - Know how to use information and communication technology in clinical, therapeutic, preventive health care and research.
  • 33 - Maintain and use records with patient data for later analysis, preserving the confidentiality of the data.
  • 34 - Ability for critical thinking, creativity and constructive skeptisim with a focus on research within professional practice.
  • 35 - Understand the importance and limitations of scientific thinking in the study, prevention and treatment of disease.
  • 36 - Be able to formulate hypotheses, collect and critically evaluate information for problem solving using the scientific method.
  • 37 - Acquire basic training for research.

Learning outcomes of the subject

At the end of the course, the student should be able to:

  • Draw up a complete medical history of major rheumatic processes including a description of the main local (e.g. pain, functional impairment) and systemic symptoms
  • Conduct a systematic exploration of the locomotor system
  • Develop a diagnosis other than a rheumatic syndrome (monoarthritis, oligoarthritis, polyarthritis, mechanical and back pain, non traumatical vertebral fracture,...)
  • Read the result of synovial fluid analysis
  • Read a radiological study of joint and bone structures methodically and know the utility and indication of other diagnostic techniques.
  • Know the main preventive strategies and therapeutic options for rheumatic diseases 

Syllabus

Lecturers:

  1. Rheumatic disorders: classification. Rheumatoid arthritis I
  2. Rheumatoid artrhtiris II. Juvenile idiopathic arthritis.
  3. Spondyloarthropathy. Introduction. Ankylosing spondylitis.
  4. Other spondyloarthropathies: psoriatic arthritis, AS associated with inflammatory bowel disease, Reiter's syndrome).
  5. Introduction to autoimmune diseases. Etiopathogenesis, clinical treatment and diagnosis.
  6. Systemic lupus erythematosus. Anti-phospholipidic syndrome. 
  7. Sjögren's syndrome. Systemic inflammatory myopathies.
  8. Systemic sclerosis. Other connective tissue diseases. 
  9. Vasculitis. Introduction. Pathogenesis and classification of vasculitis.
  10. Small and medium vessel vasculitis.
  11. Large vessel vasculitis. Horton's vasculitis and polymyalgia rheumatica. 
  12. Autoinflammatory syndromes. Familial Mediterranean fever. Amyloidosis.
  13. Infectious arthritis 
  14. Osteoarthritis. Non-inflammatory spine diseases.
  15. Soft tissue rheumatisms. Fibromialgia and chronic fatigue syndrome. 
  16. Crystal induced arthropathies.
  17. Post-menopausal osteoporosis.
  18. Secondary and male osteoporosis.
  19. Other bone metabolism diseases: Paget’s disease and osteomalacia
  20. Diagnostic imaging in rheumatic diseases.

Case methods

  1. Suspecting of Connective tissues disease. Arthritis ANA +
  2. Oligo-polyarticular onset arthritis
  3. Suspecting spondyloarthropathy
  4. Arthritis in patients with systemic disease
  5. Acute monoarthritis 
  6. Non-traumatic vertebral fracture

Laboratory skills

  1. Semiology of the musculoskeletal diseases
  2.   Joint injection techniques

Autonomous learning content

1. Adult-onset Still's disease 

2. Palindromic rheumatism:

3. RS3PE syndrome:

4. SAPHO syndrome:

5. Rrheumatic paraneoplasic syndromes:

6. Thromboangiitis obliterans:

7. Pseudovasculitis:

8. Neuropathic arthropathy:

9.Hypertrophic osteoarthropathy (HOA):

10. Rheumatic fever:

11. Soft tissue infections. Osteomyelitis:

12. Transient regional osteoporosis. Complex regional pain syndrome:

13. Difusse idiopathic skeletal hyperostosis (DISH)

14. Arthropathies by deposit (hemochromatosis and Wilson's disease):

15. Hereditary connective tissue diseases (osteogenesis imperfecta and joint hypermobility syndromes):

16. Multicentric reticulohistiocytosis:

Teaching and learning activities

In person



Lectures: In a classroom, the teacher will transmit knowledge to the entire group of students on the course.

Case Method: Students, divided into two groups, are asked about situations of great importance and so that they conduct a thoughtful analysis of the cases provided. Students seek information about the case in order to respond to questions, and can explore other clinical aspects of the specific case. In the classroom, students present the information obtained and discuss the case actively with the teacher and the rest of the group.

Problem-Based Learning: A group training activity in which, unlike in the case method, the student is responsible for finding a solution to the problem. In this sense, active participation by the student and, particularly, greater integration of the knowledge learned, are required. The teacher plays the role of facilitator of the learning process. It does not include a conclusion or summary of the problem in question.

Laboratory Skills: Students, in small groups, can develop technical skills on the basis of patient simulators, with mannequins and robots.Attendance is mandatory. Injection techniques LH will require a previous task that will be explained  the day of the  laboratory. Students will act as teachers for the rest of the group through oral presentation and support during the workshop.

E-learning: Individual work on content that has been prepared on the intranet.

Evaluation systems and criteria

In person



The final evaluation of the student will be the result of the evaluation of the different methodologies used. The weigth percentage of each of them is detailed below:

Theoretical evaluation represents 85% of the grade. It consists of a written test type test with 85 multiple choice questions (4 possible answers). 1/3 of the question value will be deducted for each incorrect answer. A score equal to or greater than 5 will be required to pass the test (essential condition). The subject matter assessed in the multiple-choice exam includes the content of lectures, case methods, problem-based learning sessions, intranet teaching material, and recommended core bibliography as self-contained learning content. The maximum time to take the exam will be 2 hours. Once the exam is finished, the student will remain seated until the teacher can verify that the exam has been closed correctly.

 Practical evaluation represents 10% of the final grade. The quality, exposure (structure, content, originality and feedback) and the correct resolution of the clinical cases raised during the development of the skill laboratories (LH) will be evaluated. The works or, failing that, the clinical cases, are totally PERSONAL and NON-TRANSFERABLE. Plagiarized works will get a score of zero.

 Participation and involvement represents 5% of the final grade. This score will be added to the previous ones valuing the activities proposed throughout the course, especially the clinical cases of individual work that will be posted on the intranet or during the development of the master classes.

 Final Note of the Course 20232-24 : Rheumatology and Systemic Diseases

a)First call:

Theoretical evaluation (85%): The student must obtain in the final exam a grade equal to or greater than five. This condition is strictly necessary, since it will be considered that the minimum theoretical knowledge to be able to give the approved subject is represented in the cut of 5/10 in this exam.

Practical evaluation and participation (15%). The score obtained will be added to that of the theoretical exam and will be maintained for a hypothetical second call

It is recalled that attendance at LH and practical methodology is mandatory.*

b) Second call:

The final score will be the result of a theoretical exam type test. The exam will consist of a written test type test with 40 multiple choice questions (4 possible answers). 1/3 of the question value will be deducted for each incorrect answer. A score equal to or greater than 5 will be required to pass the test (essential condition). It is considered that the minimum theoretical knowledge to pass the subject is represented in the 5/10 cut of the exam. The subject matter assessed in the multiple-choice exam includes lecture content, case methods, problem-based learning sessions, intranet teaching material and recommended core bibliography as well as autonomous learning content. The maximum time to take the exam will be 1 hour. Once the exam is finished, the student will remain seated until the teacher can verify that the exam has been closed correctly.

 

Final Note:

The notable will correspond to a final score equal to or greater than 7 and the excellent, equal to or greater than 9. Honors will be given to students who have obtained the best grades with an average grade equal to or greater than 9. The total number of Matricules d ́Honor will depend in addition to the score, the number of students enrolled in the course. This qualification can only be obtained in the first call.

 

Bibliography and resources

Bibliography:

  • HARRISON PRINCIPIOS DE MEDICINA INTERNA. 20a edición. Mcgraw Hill, 2019. ISBN: 9781456264864
  • FARRERAS-ROZMAN. MEDICINA INTERNA. Rozman Borstnar & Cardellach 19ª edición. Elsevier, 2020.
  • KELLEY Y FIRESTEIN, TRATADO DE REUMATOLOGÍA. 10ª edició. Elsevier, 2018. ISBN: 9788491133070
  • TRATADO DE ENFERMEDADES REUMÁTICAS DE LA SER 1ª edició. Editorial Mèdica Panamericana. 2018 ISBN 9788491102816
  • SEMIOLOGIA DE LAS ENFERMEDADES REUMÁTICAS Editorial Médica Panamericana 2006 ISBN 9788479039073
  • MANUAL DE ENFERMEDADES ÓSEAS 2ª edició. Editorial Mèdica Panamericana 2010 ISBN 9788498352306
  • TRATADO SER DE DIAGNÓSTICO Y TRATAMIENTO DE ENFERMEDADES AUTOINMUNES SISTÉMICAS 1ª edició. Editorial Mèdica Panamericana 2018 ISBN 9788491102847
  • TRATADO DE ENFERMEDADES REUMÁTICAS 2ª edición. Editorial Panamericana 2022.
  • TRATADO DE INFILTRACIONES EN REUMATOLOGÍA. Dr. Delfi Rotes Sala. Temis Medical SL 2007 ISBN978-84-935611-5-4

The recommended bibliographic citations for autonomous learning are: 

Ruscitti P, Giacomelli R. Pathogenesis of adult onset still’s disease: current understanding and new insights. Expert Rev Clin Immunol 2018;14:965-976

Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still’s disease. J Autoimmun 2018 ;93:24-36

Mankia K, Emery P. Palindromic rheumatism as part of the rheumatoid arthritis continuum. Nat Rev Rheumatol. 2019; 15 :687-695

Karmacharya P, Donato AA, Aryal MR, Ghimire S, Pathak R, Shah K, et al. RS3PE revisited: a systematic review and meta-analysis of 331 cases. Clin Exp Rheumatol 2016; 34:404-15

Firinu D, Garcia-Larsen V, Manconi PE, Del Giacco SR. SAPHO Syndrome: Current Developments and Approaches to Clinical Treatment. Curr Rheumatol Rep 2016;18:35

Manger B, Schett G. Paraneoplastic syndromes in rheumatology. Nat Rev Rheumatol 2014;10:662-70

Fazeli B, Dadgar Moghadam M, Niroumand S. How to Treat a Patient with Thromboangiitis Obliterans: A Systematic Review. Ann Vasc Surg 2018;49:219-228

Rivera-Chavarría IJ, Brenes-Gutiérrez JD. Thromboangiitis obliterans (Buerger’s disease). Ann Med Surg (Lond) 2016;7:79-82

Subesinghe S, van Leuven S, Yalakki L, Sangle S, D’Cruz D. Cocaine and ANCA associated vasculitis-like syndromes - A case series. Autoimmun Rev 2018; 17:73-77

Schmidt BM, Holmes CM. Updates on Diabetic Foot and Charcot Osteopathic Arthropathy. Curr Diab Rep 2018;18:74

Callemeyn J, Van Haecke P, Peetermans WE, Blockmans D. Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical signi­ cance. Acta Clin Belg 2016;71:123-30

Khanna K, Liu DR. Acute Rheumatic Fever: An Evidence-Based Approach To Diagnosis And Initial Management. Pediatr Emerg Med Pract 2016;13:1-23

Bonne SL, Kadri SS. Evaluation and Management of Necrotizing Soft Tissue Infections. Infect Dis Clin North Am 2017; 31:497-511

DePaola K, Fernicola J, Collins C. Pediatric Musculoskeletal Infections. Pediatr Clin North Am 2020;67:59-69

Shim H, Rose J, Halle S, Shekane P. Complex regional pain syndrome: a narrative review for the practising clinician. Br J Anaesth 2019;123:e424-e433

Mader R, Verlaan JJ, Eshed I, Bruges-Armas J, Puttini PS, Atzeni F ET AL. Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open 2017; 3: e000472

Fernandes B, Dias E, Mascarenhas-Saraiva M, Bernardes M, Costa L, Cardoso H et al.  Rheumatologic manifestations of hepatic diseases. Ann Gastroenterol 2019;32:352-360

Tauer JT, Robinson ME, Rauch F. Osteogenesis Imperfecta: New Perspectives From Clinical and Translational Research. JBMR Plus 2019; 3: e10174.

Tinkle BT, Levy HP. Symptomatic Joint Hypermobility: The Hypermobile Type of Ehlers-Danlos Syndrome and the Hypermobility Spectrum Disorders. Med Clin North Am 2019;103:1021-1033

Toz B, Büyükbabani N, Inanç M. Multicentric reticulohistiocytosis: Rheumatology perspective. Best Pract Res Clin Rheumatol 2016; 30:250-260

 

Web pages recommended:

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