The Clinical Problem Solvers Episode 405- Rafael Medina Subspecialty Episode- Joint pain, rash and dry mouth
Jul 2, 2025
Dr. Eli Miloslavsky, a rheumatologist and medical educator at Massachusetts General Hospital, joins Ana Valle, a rheumatology fellow focusing on health equity. They delve into a complex case of a patient with joint pain and skin rash, emphasizing the importance of clinical reasoning. The conversation highlights the significance of workforce diversity in improving care for underrepresented communities and explains diagnostic strategies for autoimmune conditions. Their insights into patient relationships and ongoing learning in rheumatology make for an engaging discussion.
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Approach Joint Pain Categorization
- When assessing joint pain, categorize it into inflammatory, mechanical, or pain-related causes like fibromyalgia.
- Focus on history features like location, duration, tempo, and morning stiffness to identify inflammatory arthritis.
Use Three Buckets for Rheumatic Diagnosis
- Use three disease buckets when symptoms involve joints and sicca: inflammatory arthritis, connective tissue diseases, and vasculitis.
- Let symptom combinations guide targeted lab work and differential diagnosis strategies.
Raynaud's Age Clue to Disease Type
- Raynaud's in older adults is usually secondary to systemic disease, unlike primary Raynaud's in young women.
- Raynaud's and sicca symptoms strongly point to connective tissue diseases like Sjogren's or scleroderma rather than inflammatory arthritis.