A 'Rheumatoid' ward round

I am hanging around in UM these days until next Friday (Argh, jz reminded that i hvnt bought my Transnational ticket back!), and i only need to go Dermatology clinic on Tues and Fri morning to hunt for patients with psoriasis, this is part of my elective project to collect data from them in the form of interview with questionnaire.

Rheumatology (风湿病学) = mainly deal with clinical problems involving joints, soft tissues and allied conditions of connective tissues. The term rheumatology originates from the Greek word rheuma, meaning "that which flows as a river or stream" and the suffix -ology, meaning "the study of." abstracted from Wikipedia (many students find it very powerful!)

Actually i'm under Dr Amir, the only one UM rheumatologist available now :p ... Why am i wondering around in dermatology clinic?

Hmm...Dermato & Rheumato, what association? Thats my elective topic:

Teng teng teng teng..... (u hv to sing in that manner)

"Incidence of Psoriatic Arthritis among Patients with Psoriasis in Dermatology Clinic"

Yesterday was totally free, so I decided to follow Dr Amir in his round in the morning. Although there is a special ward/cubicle for rheumato patients in Ward 8TD, but many other patients are all over the hospital eg. geriatric, paediatric etc.. now i know why Dr is so fit, coz we keep climbing stairs and walk around like visiting UMMC :)

First case was a middle age man presented with prox muscle weakness and dysphagia. Dr showed us a few signs which are Gottron's papules (pic on the left), Mechanic's hands... sweat! luckily i got bring oxford handbook and flip through.. it is Dermatomyositis! First time saw it, I could bet it is not easily diagnosed coz the signs were not obvious, with only a few manifestation..

Second case was a young lady with SLE (Systemic Lupus Erythematosus) with atypical presentation, no butterfly rash, photosensitivity but the ANA & anti-dsDNA were positive. She got APLS (antiphospolipid syndrome) too.

There were 2 more SLE cases, one with jaundice and another one presented with a rare association, Dr said it is urticarial vasculitis. Urticaria-like lesions were seen on almost every parts of body (pic on right is an example of urticaria). There was also a chinese guy with pleural effusion and pericardial effusion. Water inside the heart is an emergency! But why there is water there? they are still working on it... Bilateral gouty arthritis on both legs was the next patient problem. He responded well to colchicine, and will be discharged once he could walk well. But his presentation was quite atypical too, coz usually it only involves one side.

Looks like many things are not that straight forward, sometimes totally memorize and rely on textbook is not the best approach, it is the experience that we need to collect along the way.