Internal Medicine: Clinical Immunology - Rheumatology

Data

Official data in SubjectManager for the following academic year: 2026-2027

Topic

Getting acquainted with the basic knowledge of rheumatology and clinical immunology. Practicing the examination of a patient with musculoskeletal complaints, learning the diagnosis and treatment of common rheumatological diseases. Getting acquainted with some of the clinical immunological disorders.

Lectures

• 1.

  Introduction. General characteristics of systemic autoimmune diseases. Raynaud's phenomenon. MCTD and overlap syndromes.

  - Kumánovics Gábor
• 2.

  Differential diagnosis of arthritis. Clinical characteristics of rheumatoid arthritis.

  - Sarlósné Varjú Cecília
• 3.

  Treatment of rheumatoid arthritis

  - Sarlósné Varjú Cecília
• 4.

  SLE. Sjögren's syndrome. Antiphospholipid syndrome.

  - Czirják László István
• 5.

  Scleroderma. Myositis.

  - Czirják László István
• 6.

  Systemic vasculitis. Immune deficiency states. Autoinflammatory syndromes.

  - Nagy Gabriella (Reumatológia)
• 7.

  Spondyloarthritis. Juvenile idiopathic arthritis.

  - Horváth Gábor (Reumatológia)
• 8.

  Crystal arthropathies. Musculoskeletal abnormalities associated with internal medicine diseases. Sarcoidosis

  - Undiné Tamaskó Mónika
• 9.

  Osteoporosis, osteonecrosis.

  - Sarlósné Varjú Cecília
• 10.

  Degenerative musculoskeletal diseases of peripheral joints: Diagnosis of osteoarthrosis of the hand. Knee arthrosis. Hip arthrosis. Shoulder pain. Ankle and foot pain.

  - Szendelbacherné T. Kovács Katalin
• 11.

  Degenerative disorders of the spine. Discopathy. Spondylosis. Spondylarthrosis.

  - Szendelbacherné T. Kovács Katalin
• 12.

  Generalized and localized pain syndromes. Soft tissue rheumatism. Tunnel syndromes.

  - Gulyás Katinka
• 13.

  Treatment of musculoskeletal pain. Musculoskeletal rehabilitation. Physiotherapy.

  - Tuba Éva
• 14.

  Diagnostic opportunities, therapeutic procedures and follow up strategies in rheumatology.

  - Sarlósné Varjú Cecília

Practices

• 1.

  Overview of the examination of a musculoskeletal patient, typical musculoskeletal abnormalities, GALS examination. General characteristics of systemic autoimmune diseases. Differentiation of inflammatory and non-inflammatory pain.

• 2.

  Overview of the examination of a musculoskeletal patient, typical musculoskeletal abnormalities, GALS examination. General characteristics of systemic autoimmune diseases. Differentiation of inflammatory and non-inflammatory pain.

• 3.

  Overview of the examinations of a musculoskeletal patient. Demonstration of characteristic differences in arthritis and arthrosis. Separation of early and late disease stages. Causes of elbow, ankle and foot pain.

• 4.

  Overview of the examinations of a musculoskeletal patient. Demonstration of characteristic differences in arthritis and arthrosis. Separation of early and late disease stages. Causes of elbow, ankle and foot pain.

• 5.

  Causes and characteristics of polyarthritis. Rheumatological imaging procedures: X-ray, CT, MRI imaging - basic concepts on inflammation/degenerative diseases (e.g. spondylosis vs spondylitis). Joint ultrasound examination. Joint puncture.

• 6.

  Causes and characteristics of polyarthritis. Rheumatological imaging procedures: X-ray, CT, MRI imaging - basic concepts on inflammation/degenerative diseases (e.g. spondylosis vs spondylitis). Joint ultrasound examination. Joint puncture.

• 7.

  Capillaroscopy. Differential diagnosis of Raynaud's syndrome. Characteristic skin and mucous membrane symptoms in rheumatology. Differential diagnosis of cervical spine and shoulder pain and proximal limb weakness.

• 8.

  Capillaroscopy. Differential diagnosis of Raynaud's syndrome. Characteristic skin and mucous membrane symptoms in rheumatology. Differential diagnosis of cervical spine and shoulder pain and proximal limb weakness.

• 9.

  Inflammatory rheumatology patient examination (SPA, gout). Differential diagnosis of back and lumbar spine pain.

• 10.

  Inflammatory rheumatology patient examination (SPA, gout). Differential diagnosis of back and lumbar spine pain.

• 11.

  Rheumatology patient examination (osteoporosis, osteoarthrosis). Differential diagnosis of neck and shoulder pain.

• 12.

  Rheumatology patient examination (osteoporosis, osteoarthrosis). Differential diagnosis of neck and shoulder pain.

• 13.

  Rehabilitation. Types of physiotherapy. Medical gymnastics. Supply of assistive devices. Practic-ing physical examination

• 14.

  Rehabilitation. Types of physiotherapy. Medical gymnastics. Supply of assistive devices. Practic-ing physical examination

Seminars

Reading material

Obligatory literature

Presentations and material from the practices

Literature developed by the Department

Presentations: on POTEPEDIA

Notes

Recommended literature

Lynn S. Bickley: Bates´ Guide to Physical Examination and History Taking. (The actual version.)

Harrison´s Principles of Internal Medicine Companion Handbook. Short pocket book. (The actual version.)

Philip Seo (with Alan J. Hakim, Gavin P. R. Cluine, Inam Haq): Oxford American Handbook of Rheumatology, Oxford University Press. (The actual version.)

Conditions for acceptance of the semester

It is recommended for interested students - not obligatory - to spend 2 hours during the semester during the on-call period (17.00-18.30) to participate in the patient care process, based on a prior agreement with their instructor. If necessary, other instructors may also be involved. With this on-call appearance, an internship can be replaced.

Mid-term exams

1. During the 12th weeks of the academic year, we will hold a test exam at the grade level, where we will offer exam exemption to colleagues who achieve a good (4 or 5) level.
2. 2. During weeks 13-14th of the academic year, we will hold a practical exam at the bedside. Students who successfully complete this exam will be exempt from this part of the exam period and will only have to take the theoretical exam (provided they did not accept the grade offered during the written test exam in week 12).

Making up for missed classes

You have to complete 6 practices during the semester.
During the practice of another group, or optional on-call activities also provide an opportunity for this.

Exam topics/questions

Final exam:
It consists of two parts: an oral practical bedside exam, and then an oral item-based exam. Any part of the exam has a failing effect in itself.

The practical exam consists of taking an anamnesis, assessing physical examination (internal medicine, rheumatology), and discussing additional differential diagnostic and therapeutic options related to the patient and his/her illness. As the students do not receive detailed neurology education until this semester, we expect only the most basic aspects (LIV-LV-SI root involvement symptoms in case of disc herniation, differentiation of central/peripheral symptoms, polyneuropathy).

The oral exam consists of 3 theoretical parts/item answers: A, systemic autoimmune diseases, B, classic rheumatological disorders, C, diagnostic and therapeutic modalities. It is not possible to be exempted from the oral exam during the semester.

A, Systemic autoimmune diseases and their borders

1. The pathomechanism of autoimmune diseases, phases that can be separated during their devel-opment. Undifferentiated collagenosis. MCTD and overlap syndromes.
a, knowledge of the factors necessary for its development and its temporal progression

b, basic clinical and laboratory signs of UCTD, its clinical significance, its relationship to the development of autoimmune diseases

c, the essence of overlap phenomena

d, why MCTD is a separate entity among overlap syndromes

2. When do we think of the existence of a systemic autoimmune disease? What are the most common symptoms?
a) What are the most characteristic clinical features and laboratory abnormalities?

b) How can it be distinguished from more common diseases such as infections, tumors, and metabolic disorders?

3. Raynaud's syndrome: Differential diagnosis of primary and secondary Raynaud's syndrome. Basic tests in Raynaud's syndrome.
a, definitions

b, types of underlying conditions, list them

c, importance of timing in relation to the primary/secondary classification

d, tests that must be performed when making a diagnosis

4. Differential diagnosis of arthritis: characterization of mono-oligo- and polyarthritis.
a, the significance of skin symptoms in monoarthritis

b, monoarthritis and joint puncture

c, list of conditions associated with spondyloarthritis

d, list of disease groups causing polyarthritis

5. Clinical features of the early stage of rheumatoid arthritis, classification criteria, laboratory and radiological characteristics.
a, definition of early arthritis

b, clinical significance of early diagnosis in terms of treatment

c, knowledge of classification criteria

6, Late stage of rheumatoid arthritis. Extraarticular symptoms.
a, Clinical differences compared to early stages

b, Changes in treatment compared to early stages

7, Clinical characteristics of systemic sclerosis. Major sub-groups. Risk assessment
a, significance of Raynaud's syndrome

b, most common organ manifestations

c, differences between subgroups

d, possibilities for establishing a prognosis

8. Pulmonary, cardiovascular and gastrointestinal involvement of systemic sclerosis.
a, ILD frequency and its progression
b, systolic and diastolic dysfunction, arrhythmias

c, types of pulmonary hypertension

d, reflux, dysmotility

e, malabsorption

9. Clinical characteristics of systemic lupus erythematosus. Classification criteria.
a, Most characteristic clinical signs

b, Common routine laboratory abnormalities

c, Immunological abnormalities

10. Lupus nephritis. Central nervous system involvement in lupus. Principles of management.
a, possible types of nephritis

b, the importance of kidney biopsy

c, classification of nervous system disorders: primary - secondary, CNS-PNS, focal - generalized

d, the importance of patient education: prevention (photosensitivity, planned pregnancy, etc.)

11. Primary, secondary antiphospholipid syndrome. Classification criteria. Minor clinical symp-toms.
a, typical clinical symptoms

b, typical laboratory abnormalities

c, difference between syndrome and antibody positivity and its significance

12. Main clinical characteristics and diagnosis of Sjögren's disease. Extraglandular symptoms.
a, typical clinical and laboratory symptoms

b, secondary Sjögren's disease

c, important extraglandular symptoms and their significance in terms of treatment

13. Idiopathic inflammatory myopathies. Division of myositis. Extramuscular symptoms. Risk assessment
a, Classification of myositis.

b, Extramuscular symptoms.

c, Prognosis assessment.

14. Systemic vasculitis.
a, Classification: primary and secondary vasculitis.
b general characteristics.

15. Large vessel vasculitis.
a, Giant cell arteritis (temporal arteritis).

b, Takayasu arteritis

c, Polymyalgia rheumatica and its relationship to vasculitis

16. Classification and charachteristics of ANCA-associated vasculitis.
a, Classification criteria. The importance of the clinic and the laboratory.
b, GPA

c, MPA

d, EGPA

17. Vasculitis of medium vessels. Other vasculitis
a, Henoch-Schönlein
b, Behcet.
c, Cryoglobulinemic vasculitis.
d, Urticaria vasculitis.
e, Goodpasture syndrome.

18. Immunodeficiencies in adulthood
a, primary immunodeficiences - CVID.
b, Secondary immunodeficiencies.

19. Autoinflammatory syndromes. Macrophage activation syndrome.
a, the structure of the immune system and its relationship to IMID conditions

b, underlying diseases leading to autoinflammation

20. Juvenile idiopathic arthritis.
a, definition

b, classification, subgroups

c, cooperation between related professions

d, transition to adult care

B, Classic rheumatological symptoms

1. Spondyloarthritis.
a, general characteristics, common and distinct features of the associated clinical pictures

b, peripheral or axial joint involvement. Enthesitis.

c, extra-articular involvement.

2. Ankylosing spondylitis.
a, Inflammatory back pain.
b, Basic radiology terminology

3, Other spondyloarthritides.
a, Psoriatic arthritis.
b, Spondylarthropathies associated with inflammatory bowel disease.
c, Reactive arthritis.

4. Crystal arthropathies.
a, Definition of gout

b, Spontaneous course and stages of gout

c, Diagnosis of gout
d, CPPD and hydroxyapatite arthropathy

5, Characteristics of infectious arthritis.
a, purulent bacterial arthritis.

b, tuberculosis. Lyme disease.

c, gonococcus

d, viral arthritis.

6. Musculoskeletal consequences of internal medicine diseases.
a, Musculoskeletal consequences of diabetes.
b, Musculoskeletal symptoms of thyroid diseases.

7. Osteoporosis
a, Risk factors of osteoporosis,
b, its prevention,
c, clinical characteristics and diagnosis.
d, Primary osteoporosis.
e, Secondary osteoporosis.

8. Generalized and localized pain syndromes.
a, Diagnosis of fibromyalgia.
b, Sudeck syndrome.

9. 9. Peripheral degenerative joint diseases

a, Main locations: hands, lower limbs

b, Characteristics of pain

c, Degenerative changes in the hand – diagnosis of osteoarthritis.

d, Characteristics of knee arthrosis.

e, Characteristics of hip arthrosis.

10. Degenerative channges of the spine.
a, Discopathy.
b, Spondylosis.
c, Spondylarthrosis.

11. Diseases of the soft tissues.
a, bursitis – relevance in the context of degenerative and inflammatory conditions

b, tendinopathies, tendinitis, fasciitis

c, myofascial pain

12. Tunnel syndromes.
a, general description

b, CTS

C, Diagnostic and therapeutic modalities.

1 Basic screening methods in the diagnosis of systemic autoimmune diseases:
a, routine laboratory results, routine laboratory results -, blood count, inflammatory parameters, laboratory tests characteristic of organ abnormalities, urine analysis
b, testing of autoantibodies.
c, Capillary microscopy

2. Imaging in rheumatoid arthritis and spondyloarthritis
a, Activity and assessment of damage

b, Prognosis estimation

c, X-ray abnormalities in RA

d, Potential of ultrasound in RA

e, X-ray abnormalities in spondyloarthritis

f, Ultrasound examination of soft tissues in spondyloarthritis

3. Imaging in degenerative disorders.
a, X-ray

b, Ultrasound

c, MRI

4. Imaging tests for osteoporosis

a, DEXA scan

b, T-score

c, Z-score

d, FRAX index and its components, significance

5. GALS

6. NSAID administration
a, contraindications
b, side effects

7. Glucocorticoid therapy
a, methods of use, dosage

b, most common side effects and their prevention

8. DMARD treatment
a, definition
b, its groups.
c, CsDMARD dosage, side effects, control: methotrexate, leflunomide, sulfasalazine, chloroquine/hydroxychloroquine.

9. Biological DMARDs and tsDMARDs
a, indications,
b, their contraindications
c, pharmacodynamic groups, their drugs
d, side effects.

10. Treatment of scleroderma
a, non-pharmacological treatment

b, treatment options by organ

11. Treatment of SLE
a, non-pharmacological treatment
b, remission induction
c, remission maintenance treatment.

12. Treatment of antiphospholipid syndrome
a, coumarin derivatives vs NOAC

b, pregnancy considerations

13. Treatment of Sjögren's syndrome
a, treatment of glandular abnormalities

b, extraglandular manifestations and their treatment

14. Treatment of myositis
a, the importance of non-pharmacological therapy

b, steroid vs. DMARD treatment

c, treatment of extramuscular symptoms

15. Treatment of vasculitis
a, Treatment of large vessel vasculitis

b, Small vessel vasculitis and its treatment

16. Treatment of spondyloarthritis.
a, differences between axial and peripheral manifestations in terms of treatment

b, targeted therapeutic options

17. Treatment of crystal arthropathies.
a, non-pharmacological treatments

b, therapy in acute attack

c, pillars of attack prevention

18. Treatment of osteoporosis.
a, Ca and vitamin D3 supplementation, contraindications, assessment of short- and long-term effects

b, drugs based on inhibiting bone resorption processes

c, possibilities for stimulating bone formation processes

19. 19. Treatment of musculoskeletal pain.

a, Treatment of early and reversible abnormalities

b, Physiotherapy options

c, WHO steps

d, Musculoskeletal rehabilitation options.

Examiners

• Bakai Rita
• Birkás Gyöngyvér
• Czirják László István
• Deme Marcell István
• Filipánits Kristóf József
• Gulyás Katinka
• Horváth Gábor (Reumatológia)
• Jász Dávid Kurszán
• Kéringer Patrik
• Kremzner Noémi Rita
• Kumánovics Gábor
• Kurucz Grácia Katalin
• Minier Tünde
• Nagy Gabriella (Reumatológia)
• Péter Ágnes Eszter
• Sarlósné Varjú Cecília
• Szendelbacherné T. Kovács Katalin
• Tuba Éva
• Undiné Tamaskó Mónika
• Vélin Valentina

Instructor / tutor of practices and seminars

• Bakai Rita
• Birkás Gyöngyvér
• Czirják László István
• Deme Marcell István
• Filipánits Kristóf József
• Gulyás Katinka
• Horváth Gábor (Reumatológia)
• Jász Dávid Kurszán
• Kéringer Patrik
• Komjáti Dalma
• Kremzner Noémi Rita
• Kumánovics Gábor
• Kurucz Grácia Katalin
• KURZUSHOZ RENDELT OKTATÓ
• Minier Tünde
• Nagy Gabriella (Reumatológia)
• Palancsa Máté
• Péter Ágnes Eszter
• Sarlósné Varjú Cecília
• Szabó Attila
• Szendelbacherné T. Kovács Katalin
• Tuba Éva
• Undiné Tamaskó Mónika
• Vélin Valentina