Psoriatic Spondylitis: another label to confuse you?

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Xray of Sacroiliac Joints - Grade 3 sacroiliitis

By Dr Irwin Lim, Rheumatologist

Here’s a nice example of sacroiliitis on an Xray of my patient’s pelvis. Grade 3 on both sides with erosions and irregular joint lines. Pretty classic.

Sacroiliitis = Inflammation of the Sacroiliac joints. It can only be inferred on X-rays late in the disease after the inflammation has led to irreversible damage.

This finding leads to the diagnosis of Ankylosing Spondylitis

Yes but the more accurate label (probably) in this particular patient is Psoriatic Arthritis.

It’s a gentleman who’s suffered for years with some skin manifestations of psoriasis as well as some nail abnormalities (read about these nail changes). Treatment had consisted of topical steroids.

The aches in his hands and feet, the heel pain, & the tender chest wall were largely ignored. He never really mentioned it to his dermatologist (until now).

And he doesn’t even have significant back pain currently.

But he did 20 years ago as a young 20 year-old. It was always considered due to a sporting incident and he’s needed to live with a “weak” back being careful not to trigger an episode.

I just wanted to highlight these overlapping diseases. Psoriasis & Ankylosing Spondylitis. They are grouped together as spondyloarthritis and it can be confusing.

Rheumatologists may use different ways to classify the array of symptoms & signs our patients present with. The terms used may actually differ from doctor to doctor, from specialist to generalist, from country to country. In some places like Australia, it matters to the rheumatologist as it affects subsidised access to different medications.

But, I’m not so sure it matters to the sufferer. Sure, some name for the disease is important. Labels, while potential confusing, have a place.

But ultimately, the problem’s the pain and stiffness and reduced quality of life. Most would just want it sorted out.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
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Musculoskeletal Disease: Australia’s Burden

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By Dr Irwin Lim, Rheumatologist

Please check out the Arthritis Victoria website.

They’ve highlighted a recent report called “A Problem Worth Solving” which details the extent of musculoskeletal disease in Australia.

The figures are scary. I’ve highlighted some of their excellent infographic:

APWS-Infographic1

APWS-Infographic2

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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Your Y chromosome means your gouty arthritis might frustrate us

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Swollen footBy Dr Irwin Lim, Rheumatologist

Another swollen foot. Another swollen big toe.

Another male.

A typical story. The doctors reading this have already diagnosed gout.

Usually an easy diagnosis especially when there is a typical clinical context as in this case, where a series of work functions with much more alcohol likely played a part.

Unlike many of the other diseases we see in rheumatology, gout is generally easy to diagnose (to be certain, a sample of joint fluid should be obtained & analysed) and easy to treat.

(read Gout: the most curable joint disease is the worst treated)

The frustrating thing about treating gout are the patients.

Males.

Generally compliant while they are in pain, much less so over time.

Less inclined to take effective medication long term & less inclined to make lifestyle change. They often stop showing up for appointments. They often just decide to stop taking their Allopurinol.

While I might be fairly accused of gross generalisation, this is often a topic of conversation among rheumatologists. This really common, often debilitating inflammatory arthritis should really be so much simpler to sort out.

Any males out there with gout willing to challenge this?

p.s I don’t think many of you will be taking the time to read this

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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A Milestone for our Rheumatology Blog

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6000By Dr Irwin Lim, Rheumatologist

Overnight, the number of unique monthly visitors to this blog reached 6000.

I know that’s not much compared to the many 1000s of popular blogs but it has exceeded  my expectations when I started this in December 2010.

Thank you for reading. It’s nice to know that people are interested in this stuff, and that it does help raise awareness of rheumatology & arthritis.

Please keep reading and please let your interested friends and family know about us.

Instead of giving you a list of the more popular posts, I thought I’d provide you hyperlinks to 5 posts which are more personal:

I’m also hoping more of you take the plunge and actually comment. Very often, your thoughts & experiences are more interesting & instructional than the actual post.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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Heroes for Oxfam: They did it!

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Finish lineBy Dr Irwin Lim, Rheumatologist

They made it! All 4 got through in a great time. 19 hours & 16 minutes! Started at 7am & finished at 2.18am.

A wonderful effort for them personally, and as a group.

Team HEROES: Rachael Butterworth, Hans Lee, Errol Lim & Sarah Comensoli

Dinner at the 70km mark

Dinner at the 70km mark

The runners were heroic. The support crew rock solid. Thanks to Amanda Fincham, Vanessa Ogata, Belinda Prince, Joanne Lee, Chloe McLeod, Jean Redmond & Jan. Thanks to all BJC Health staff who worked with the runners preparing them for the event.

Errol's foot after 70km

Errol’s foot after 70km

 

Well done!

And there’s still time to donate – here’s the link.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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