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Great. Hi guys. Um, let me know if you can hear me. Um, I'm Hinie, I'm a third, your medic and I'm your crash course lead today. We're just gonna be doing our M SK crash course, which will be around, you know, two hours and 15 minutes. Hopefully, if we're, you know, going if we're on time, um I just wanna say a couple of things before we start. First of all, everything's gonna be recorded. You're gonna have access to the slides after as well. If you've got any questions at all, just drop a message in the chat box. And um, I'll also send out all of our emails. So my emails and the lecturers, emails if you have any questions after. Um, so for today, we're gonna have three different lecturers. We're gonna have a lecture from around 6 to 630 then from there probably onwards to about uh 630 to 8 and then at sorry, 630 to 7 and then at seven, I'll just ask if we sort of need a break and then if you guys want to, then we'll take a break and move on to our last set of lectures. Um, please interact as much as possible because, you know, it's your one opportunity to sort of get one on one feedback from the lecture as well and it really helps them um with their presentations and yeah, that's pretty much all I want to say. Um Yeah, so on if you can get started, start sharing your slides. Hello? Can you hear me? Yeah, I can hear you. Ok. Yes. Um I'm actually gonna try and get all your slides together. Um So that you can sort of access it during the presentation. I'll drop a message when it's available. Ok. Can you see my slides? Yes. Can you change your slides? Uh Yeah. Yeah. Yeah, great. Yeah. So hi, everyone. My name is Anna Bo and I'm gonna do the rheumatology section of M SK and my email is there as well. So what we're gonna cover today is just some basics at first and then um acute mono arthritis, rheumatoid versus osteo and then seronegative arthritis and then some practice questions at the end. So, um the way my slides work is that all the content you need for the exam will be on the slides. But anything which is extra is boxed in red and anything which is cool, like kind of revision tips will be boxed in green. Unfortunately, I'm not gonna annotate the slides today. Cos I'm on campus and the internet doesn't let me like screen share stuff like annotations, but this topic. I don't think we need too many annotations in general. So basically, rheumatology is the study of joints. So in M SK it's gonna be where two bones meet. And um, arthritis is basically if there's any disease of this joint. So there are two main types. Um, one is kind of degenerative, um, osteoarthritis. We, we will have a lecturer, lecturer cover that. So I'm not gonna focus too much on that. It's gonna be mainly about the inflammatory joint diseases. So first, I'm just going to do some basics on kind of clinical like how to diagnose this kind of stuff. Because I think the rheumatology lecture is, it was one of my favorite lectures in first year and second year. And um it kind of focuses more on like diagnostics, which is what a lot of people enjoy about medic medicine. So um you might get presented a case and um you, you got to ask a few questions about what potential like diagnosis could this be? Um And um it will be a lot more symptom based rather than some of the more phys physiology um physiology in the other lectures. So the signs of inflammation which I think you've covered in pom is basically redness, pain, heat, swelling and loss of function. So this is quite a good um diagram here of some swollen um interphalangeal joints. There are also some cardinal signs of infection and inflammation which cannot be seen where you can measure them such as CRP, which is c reactive protein and white cell count. So both of these will be raised if there is something going on, which is inflammatory and white cell count typically is raised in infection, um fever as well, you will get a raised fever and in infection and there are also infection associated symptoms in their history. So for example, if someone said they've been abroad or if someone says they've had like diarrhea or food poisoning, you can pretty much say that, ok, there is probably some sort of infection going on. And um like I said before, it's a very kind of clinical topic. And in the exam, the question that you'll get from rheumatology will definitely be kind of like case study slash investigation star. So a step by step guide on how to approach this will be first classify the arthritis, they'll give you like a paragraph. You want to try and figure out what the arthritis just from the paragraph. Um And then step two is look at the history for any like signs of w what it could be. Um Step three, these are all kind of questions they might potentially ask. You need to know how to investigate different types of arthri um different types of arthritis and how to diagnose them and their treatments as well. So we'll cover all of this in the lecture today. Um The first thing is how do you actually classify the arthritis. So there are a lot of things you need to look at. If you can see signs of inflammation, then, you know, it's an inflammatory type of arthritis. If there's no signs of inflammation, then you can pretty much usually already go down the, the sort of route where you're saying this might be osteoarthritis. And then the second thing is looking at speed. Some things are very kind of acute as you will see and some things are more chronic over time. So, autoimmune conditions are tend to be quite chronic and osteoarthritis tends to be quite chronic. Um and then pattern of joint involvement. So how many joints are affected? Which joints are affected and the symmetry of the joints affected? And the fourth thing is systemic features. So for each type of type of arthritis, I will tell you the answers to all these questions as we go through them. So these are the different types you have infection based. So the main one here is septic. They also have mentioned tuberculosis, but it will not come up in the exam because there's no um content on it. There's two types of crystal arthritis. So gout and pseudogout and then there's immune mediated. So that is autoimmune. Um sero positive is rheumatoid arthritis and there are four types of sero negative arthritis um which will cover and then lupus as doctor says, it's not lupus. Um And in your phase one, a they don't teach you about lupus. So, please don't learn anything about it because it will not come up in the exam. So, let's start off with septic. So, septic arthritis is typically asymmetrical and it's one singular joint. So that's what monoarthritis means. It's one joint and, um, it's typically quite a large joint as well. You won't, you won't typically see septic arthritis on like one of your fingers or something. It's more likely to be the knee or the elbow or something like that. Um, these are, um, the two bugs which it's most commonly associated with um, staphylococcus aureus and strep, um, gonococcus as well is associated with um, um septic arthritis. So that's um Nisar uh gonorrhea, that um, those like, that's the main bacteria which is um associated with this. However, with gonococcus, it can technically be polyarthritis. It's very, very, um, mean for them in the exams if they give you polyp arthritis, but just know that it's possible. Um, but if you do see something which is asymmetrical and one joint just think can be septic. And um, the reason this happens is bacterial infection of the joint, which typically occurs due to bacteria in your bloodstream. So this is when your joint itself is actually being attacked by bacteria and that is a medical emergency because it can completely um destroy your joint. And you can, um, like, for example, if it affects your knee, you will basically lose all function in the knee if you leave it untreated and here are three risk factors which can increase the chance of someone getting septic arthritis. So, if you're immunosuppressed, it's a lot easier to, um, it's a lot easier to get bacteremia when you're immunosuppressed. So that's why, um, if there's preexisting joint damage, your joint is quite prone to being attacked and if you do, um, drugs intravenously, um, you're more likely to also get bacteremia due to that. So, the next thing is gout, um, these three that we're gonna call so septic gout and pseudo gout, they're all quite similar presenting. So it's asymmetrical monoarthritis for all three of them, which is why it's quite difficult clinically to kind of investigate what's going on without doing some tests. But.