CCS Rheumatology

Gout Septic Arthritis RA

Physical exam Complete Complete Complete
Location Ward Ward Office
Initial orders CBC, CMP, PT, PTT, CRP, ESR CBC, CMP, PT, PTT, CRP, ESR CBC, CMP, PT, PTT, CRP, ESR
Bld C/S, UA, S. uric acid, Bld C/S, UA, S. uric acid, Bld C/S, UA, S. uric acid,
RF RF RF, Anti CCP, ANA
Arthrocentesis (cell count, Arthrocentesis (cell count, Arthrocentesis (cell count,
crystals, graim stain, culture) crystals, graim stain, culture) crystals, graim stain, culture)
XR joint XR joint XR joint

Initial treatment: NSAID, oral IV access, IV Morphine NSAID, oral

Advance Clock Waiting results Waiting results Waiting Results

Specific treatment NSAID Ceftriaxone & vancomycin MTX
If CI: cholicicine Consult orthopaedics If not tolerated Leflunomide
If CI: steroid If poor response PPD, Anti TNF
If pregnancy Sulfasalazine and
hydroxychloroquine

Counselling: Avoid Alcohol, low protein Immobilize joint Reassure patient

diet, Aspirin, Diuretics Medication compliance, SE
Advance Clock Patient update Patient update Patient update
Physical exam Physical exam Physical exam
End orders Allopurinol in several weeks Aspirate joint daily Consult rheumatology
S. uric Acid CBC, LFT, ESR, XR joint

Osteoarthritis Osteoporosis
Physical exam Complete Complete
Location Office Office
Initial orders CBC, CMP, CRP, ESR CBC, CMP, CRP, ESR
S. phosphorus, S. Calcium, S. phosphorus, S. Calcium,
TSH, SPEP, RF, ANA TSH, SPEP, RF
XR joint XR joint , DEXA scan

Initial treatment: IV access, IV Morphine if severe pain

NSAID, oral NSAID, oral
Brace Brace

Advance Clock Waiting results Waiting results

Specific treatment: if failed NSAID Vit D, Calcium, Bisphosphonate
Hyaluronic acid injection
Intraarticular triamcinolone

Counselling: Weight loss, Exercise High Ca diet, Exercise

Advance Clock Patient update Patient update
End orders Physical therapy Physical therapy
Consult Orthopaedics if TTT failed
 PAN SLE
Physical exam Complete Complete
Location Office Office/ Ward
Initial orders CBC, CMP, PT, PTT, CRP, ESR CBC, CMP, PT, PTT, CRP, ESR
ANA, CPK, RF, ANA, Anti DS, Anti SM,
Viral hepatitis, UA Anti-cardiolipin, S. Complement, UA
Renal angiography CXR

Initial treatment: Prednisone, oral Prednisone, oral

Advance Clock Waiting Results Waiting Results

Specific treatment: Cyclophosphamide Hydroxychloriquine

Counselling: Avoid sharing needle Avoid sun, sunscreen cream

Medication compliance, SE Medication compliance, SE
Advance Clock Patient update Patient update
Physical exam Physical exam
LFT, CBC, ESR Complement, Anti DS
HAV vaccination if B +ve Fundus exam yearly

End orders Consult rheumatology Consult rheumatology

SLE complications: Ward

Pleural effusion: decubitus CXR, thoracentesis, pleural fluid (cell count, gram stain, culture, PH
protein, Glucose, LDH, Acid fast), S. Protein, S. LDH
High creatinine: renal biopsy, Cyclophosphamide

Giant cell arteritis Polymyalgia Rheumatica

Physical exam Complete Complete
Location Office/ Ward Office
Initial orders CBC, CMP, CRP, ESR CBC, CMP, CRP, ESR
UA, UC, Bld C/S ANA, RF, CK, TSH
CXR, Head CT CXR

Advance Clock Waiting ESR Waiting ESR

Specific treatment: Prednisone Prednisone
Vit D, Calcium, Bisphosphonate Vit D, Calcium, Bisphosphonate
Pantoprazole Pantoprazole
Aspirin
Temporal artery biopsy

Counselling: Medication compliance, SE Medication compliance, SE

Advance Clock Patient update Patient update

Physical exam Physical exam
CBC, CRP, ESR, DEXA CBC, CRP, ESR, DEXA

End orders Consult rheumatology Consult rheumatology

 Ankylosing spondylitis Sjögren Syndrome
Physical exam Complete Complete
Location Office Office
Initial orders CBC, CMP, CRP, ESR CBC, CMP, CRP, ESR
ANA, RF, Anti-CCP, HLA B27 ANA, RF, Anti- LA, Anti- RO
Spine, SIJ XR Schirmer test

Initial treatment: NSAID, oral Artificial tears , Pilocarpine,

Cevimeline, Fluoride oral treatments

Advance Clock Waiting results Waiting results

Specific treatment: Anti- TNF Cyclosporine eyedrops
Lip biopsy

Counselling: Medication compliance, SE, Exercise Avoid cola, coffee, and tea.
Risk of Lymphoma

Advance Clock Patient update Patient update

Physical exam Physical exam

End orders Consult rheumatology Consult rheumatology

Consult ophthalmology Dental consultation
Physical therapy

Scleroderma Polymyositis/ Dermatomyositis

Physical exam Complete Complete
Location Office Office
Initial orders CBC, CMP, CRP, ESR CBC, CMP, CRP, ESR
ANA, CK, Aldolase, TSH, UA ANA, CK, Aldolase, LDH, TSH, UA
Anti-topoisomerase I (Scl-70) Anti Jo-1
Anti-centromere
CXR

Initial treatment: Captopril, Nifedipine, sildenafil, PPI Prednisone

Advance Clock Waiting results Waiting results

Specific treatment: MTX MTX
EMG, Muscle biopsy

Counselling: Medication compliance, SE Medication compliance, SE

Advance Clock Patient update Patient update

Physical exam Physical exam
End orders Consult rheumatology Physical therapy
Screening for lung involvement: Screen for malignancy:
PFT, CT chest, lung biopsy CXR, US pelvis, colonoscopy,
Mamography
PSA (Male), CA-125 (Female)