Internal Medicine: Clinical Immunology - Rheumatology

Data

Official data in SubjectManager for the following academic year: 2024-2025

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.

  Rheumatology imaging procedures - in the MediSkills Laboratory: X-ray, CT, MR imaging. Joint ultrasound examination. Articular puncture.

• 6.

  Rheumatology imaging procedures - in the MediSkills Laboratory: X-ray, CT, MR imaging. Joint ultrasound examination. Articular 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. Practical Exam.

• 14.

  Rehabilitation. Types of physiotherapy. Medical gymnastics. Supply of assistive devices. Practical Exam.

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

1,A short, written test at least 5 of the 7 practice sessions, max. 5-minute long from a randomly selected from a preestablished test bank, on extremely important knowledge that has already been covered (in lecture and/or practice). Five successfully completed test will exempt you from the written part of the exam. Successful completion is if at least 75% of the answers are correct. The results of the tests are registered centrally by the secretary in an Excel spreadsheet.

2, On week 13-14. a practical exam is possible for those who successfully pass the written tests, which exempts them from the practical part of the exam. The practice exam cannot be performed by the original practice leader, only by another specialist of our team.

3. All students are obliged to contribute to night duty for 2 hours during the semester during the on-call period (5:00 p.m. to 6:30 p.m.), based on a prior agreement with their group leader. If necessary, another group leaders can be involved.

Mid-term exams

1,A short, written test at least 5 of the 7 practice sessions, max. 5-minute long from a randomly selected from a preestablished test bank, on extremely important knowledge that has already been covered (in lecture and/or practice). Five successfully completed test will exempt you from the written part of the exam. Successful completion is if at least 75% of the answers are correct. The results of the tests are registered centrally by the secretary in an Excel spreadsheet.

2, On week 13-14. a practical exam is possible for those who successfully pass the written tests, which exempts them from the practical part of the exam. The practice exam cannot be performed by the original practice leader, only by another specialist of our team.

Making up for missed classes

You have to complete 6 practices during the semester.
During the practice of another group.

Exam topics/questions

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

The exam starts with a 30-minute, 30-point test (24 simple-choice questions for 1-1 points + 2 open question for 3 point each), which draws the most important minimum questions. In case of at least 23 points out of 30, the exam can be continued with the oral practical exam part. This test can be replaced by short tests written during the semester, if someone can show at least 5 success-fully completed tests. Every student receives at least one minimum question during the oral exam directly from the examiner, which question must be asked from a topic independent of the selected items.

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 educa-tion 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 practical exam can be replaced by a practical exam between the 13th and 14th weeks of the semester for those who have successfully written at least 5 tests during the semester.

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. In addition, everyone receives a minimum question, which must be asked from a topic independent of the selected items.

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.

2. When do we think of the existence of a systemic autoimmune disease? What are the most common symptoms?

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

4. Differential diagnosis of arthritis: characterization of mono-oligo- and polyarthritis.

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

6, Late stage of rheumatoid arthritis. Extraarticular symptoms.

7, Diseases of the scleroderma family. Clinical characteristics of systemic sclerosis. Major sub-groups. Risk assessment

8. Pulmonary, cardiovascular and gastrointestinal involvement of systemic sclerosis.

9. Clinical characteristics of systemic lupus erythematosus. Classification criteria.

10. Lupus nephritis. Central nervous system involvement in lupus. Principles of management.

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

12. Main clinical characteristics and diagnosis of Sjögren's syndrome. Extraglandular symptoms.

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

14. Classification of systemic vasculitis. Primary and secondary vasculitis. General characteris-tics.

15. Large vessel vasculitis. Polymyalgia rheumatica and giant cell arteritis (arteritis temporalis).

16. Classification and charachteristics of ANCA-associated vasculitis. Classification criteria.

17. Vasculitis of medium vessels. Other vasculitis: Henoch-Schönlein, Behcet. Cryoglobulinemic vasculitis. Urticaria vasculitis. Goodpasture syndrome.

18. Primary immunodeficiencies in adulthood - CVID. Secondary immunodeficiencies.

19. Autoinflammatory syndromes. Macrophage activation syndrome.

20. Sarcoidosis.

21. Juvenile idiopathic arthritis.

B, Classic rheumatological symptoms

1. General characteristics of spondyloarthritis. Peripheral anf axial joint involvement. Enthesitis. Extra-articular involvement.

2. Ankylosing spondylitis. Inflammatory back pain. Axial and peripheral joint involvement in spondylarthropathies. Symptoms and diagnosis of ankylosing spondylitis.

3, Psoriatic arthritis. Spondylarthropathies associated with inflammatory bowel disease. Reactive arthritis.

4. Crystal arthropathies. Diagnosis of gout. CPPD and hydroxyapatite arthropathy

5, Characteristics of infectious arthritis: pyogen bacterial arthritis. TB. Lyme. Viral arthritis.

6. Musculoskeletal consequences of internal medicine diseases. Musculoskeletal consequences of diabetes. Musculoskeletal symptoms of thyroid diseases. Acromegaly.

7. Risk factors of osteoporosis, its prevention, clinical characteristics and diagnosis. Primary oste-oporosis. Secondary osteoporosis.

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

9. Diagnosis of osteoarthrosis of the hand. Clinical characteristics of knee arthrosis. Clinical char-acteristics of hip arthrosis.

10. Degenerative channges of the spine. Discopathy. Spondylosis. Spondylarthrosis.

11, Differential diagnosis of shoulder, elbow, ankle, and foot pain.

12. Grouping of osteonecrosis. Most common reasons.

13. Diseases of the soft tissues.

14. Tunnel syndromes.

C, Diagnostic and therapeutic modalities.

1 Basic screening methods in the diagnosis of systemic autoimmune diseases: routine laboratory results, testing of autoantibodies. Capillary microscopy

2. Imaging in rheumatoid arthritis and spondyloarthritis

3. Imaging in degenerative disorders.

4. DEXA, FRAX index.

5. GALS

6. NSAID administration, contraindications and side effects

7. The most common side effects of glucocorticoid therapy and their prevention

8. DMARD treatment and its groups. CsDMARD dosage, side effects, control: methotrexate, leflunomide, sulfasalazine, chloroquine/hydroxychloroquine.

9. Biological DMARDs and tsDMARDs, heir contraindications and side effects.

10. Treatment of scleroderma

11. SLE remission induction and remission maintenance treatment.

12. Treatment of antiphospholipid syndrome

13. Treatment of Sjögren's syndrome

14. Treatment of myositis

15. Treatment of vasculitis

16. Treatment of primary and secondary immunodeficiencies

17. Treatment of spondyloarthritis.

18. Treatment of crystal arthropathies.

19. Treatment of osteoporosis.

20. Treatment of musculoskeletal pain. Musculoskeletal rehabilitation.

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
• Szendelbacherné T. Kovács Katalin
• Tuba Éva
• Undiné Tamaskó Mónika
• Vélin Valentina