Episode 334: Rafael Medina Subspecialty Series – Polyarticular Joint Pain
May 8, 2024
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Rheumatologist Rafael Medina discusses polyarticular joint pain with Dr. Lianne Gensler, exploring inflammatory vs. non-inflammatory causes, morning stiffness, spondyloarthritis differentiation, radiographic vs. non-radiographic axial spondyloarthritis, and management of neurological complications in arthritis treatment.
Thorough history and physical exams are crucial for accurate diagnosis of rheumatic diseases.
Interpreting imaging results like bone marrow edema can aid in diagnosing spondyloarthritis.
Timely identification of inflammatory joint symptoms is essential for personalized arthritis management.
Deep dives
Clinicians Discuss Rheumatology Case Presentation
The focus of this podcast episode was a rheumatology case presentation featuring Dr. Leanne Gensler and Dr. Appledeen Osborne from UCSF. They discussed a 40-year-old man with polyarticular joint pain, highlighting the importance of history and physical exams in narrowing down differential diagnoses.
Insights into Spondyloarthritis Diagnosis
The podcast provided insights into Spondyloarthritis diagnosis, emphasizing the significance of axial and peripheral joint inflammation, along with inflammatory markers. The discussion delved into interpreting imaging results, such as bone marrow edema and fatty metaplasia around the sacroiliac joints, helping to clarify the diagnosis.
Treatment Progression for the Patient
The patient's treatment journey involved initial NSAID therapy, followed by sulfasalazine due to lack of symptom control, and later transitioning to a TNF inhibitor. However, issues arose with the TNF inhibitor, leading to neurologic symptoms, necessitating a switch to an IL-17A inhibitor. The case highlighted the complexities of managing inflammatory arthritis and adjusting treatment based on individual responses.
Key Teaching Points for Medical Decision-Making
The podcast concluded with three key teaching points emphasized by Dr. Leanne Gensler. These included the importance of thorough history and physical exams for accurate diagnosis, the role of imaging, especially MRI for early axial involvement, and the significance of timely identification of inflammatory joint symptoms to prevent delayed diagnosis and offer appropriate management strategies.
Summary Wrap-Up and Appreciation
The episode wrapped up with expressions of gratitude from the hosts towards the clinicians for their valuable insights and teaching. The importance of continued learning, case discussions, and the impact of sharing clinical experiences in podcast format were underscored. The audience was encouraged to engage further with the clinical problem solvers through newsletters and virtual morning reports for ongoing educational opportunities.
The goal of this series is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case Discussant: Dr. Lianne Gensler is a rheumatologist and serves as director of the UCSF Ankylosing Spondylitis Clinic, which is dedicated to care for this inflammatory disease. Gensler’s primary research interest is the disease progression of axial spondyloarthritis (a category that includes ankylosing spondylitis).
Case Presenter: Dr. Appledene Osbourne is a current rheumatology fellow at UCSF.
