リウマチ科英語

"rheumatoid arthritis"

A chronic autoimmune disease causing symmetric inflammatory polyarthritis, joint destruction, and systemic manifestations driven by synovial inflammation

"The patient presented with a two-year history of rheumatoid arthritis, with bilateral wrist and MCP joint swelling that was worse in the mornings."

"synovitis"

Inflammation of the synovial membrane lining a joint, resulting in warmth, swelling, tenderness, and effusion

"Ultrasound confirmed active synovitis in six metacarpophalangeal joints, consistent with poorly controlled rheumatoid arthritis."

"pannus formation"

An abnormal layer of fibrovascular tissue that develops in the inflamed synovium and invades articular cartilage and bone, causing irreversible joint destruction

"MRI of the wrist demonstrated pannus formation eroding the distal radius, indicating the need to escalate therapy."

"morning stiffness"

Prolonged joint stiffness lasting more than one hour after waking, a hallmark feature of inflammatory arthritis that distinguishes it from mechanical joint disease

"The patient reported morning stiffness lasting approximately two hours, which the rheumatologist used as a marker of disease activity."

"disease activity score"

A composite numerical index — such as DAS28 — that quantifies the severity of rheumatoid arthritis using swollen joint count, tender joint count, ESR or CRP, and patient global assessment

"A disease activity score of 5.6 at the follow-up visit indicated high disease activity and prompted a switch in biologic therapy."

"erosive disease"

A form of arthritis characterised by radiographic bone erosions at joint margins, reflecting irreversible structural damage caused by chronic synovial inflammation

"Plain radiographs of the hands showed erosive disease at the second and third PIP joints, confirming long-standing inadequately treated rheumatoid arthritis."

"psoriatic arthritis"

A chronic inflammatory arthritis occurring in patients with psoriasis, presenting with asymmetric joint involvement, enthesitis, dactylitis, and nail changes

"The dermatologist referred the patient with psoriatic arthritis after noticing swollen sausage-shaped fingers and onycholysis on examination."

"reactive arthritis"

An aseptic inflammatory arthritis triggered by an infection at a distant site, most commonly genitourinary or gastrointestinal, causing joint pain weeks after the triggering infection

"Reactive arthritis developed three weeks after a confirmed Chlamydia trachomatis infection, affecting the right knee, left ankle, and causing conjunctivitis."

"systemic lupus erythematosus"

A multisystem autoimmune disease characterised by autoantibody production, immune complex deposition, and inflammation affecting the skin, kidneys, joints, and other organs

"The nephrologist confirmed lupus nephritis in the patient with systemic lupus erythematosus after a kidney biopsy showed class III proliferative disease."

"antinuclear antibody"

An autoantibody directed against components of the cell nucleus, used as a screening test for systemic autoimmune diseases such as lupus and systemic sclerosis

"A positive antinuclear antibody at a titre of 1:640 with a homogeneous pattern prompted further testing for anti-dsDNA antibodies."

"Sjögren's syndrome"

A chronic autoimmune disease predominantly affecting exocrine glands, causing sicca symptoms — dry eyes and dry mouth — and potentially systemic complications

"The ophthalmologist's Schirmer test and salivary gland biopsy confirmed primary Sjögren's syndrome in the patient with severe keratoconjunctivitis sicca."

"systemic sclerosis"

A connective tissue disease characterised by immune activation, vasculopathy, and progressive fibrosis of the skin and internal organs including the lungs and gastrointestinal tract

"High-resolution CT of the chest revealed interstitial lung disease in a patient with diffuse cutaneous systemic sclerosis and anti-topoisomerase antibodies."

"Raynaud's phenomenon"

Episodic vasospasm of small digital arteries triggered by cold or emotional stress, causing sequential colour changes — white, blue, and red — in the fingers and toes

"Raynaud's phenomenon was the presenting complaint, with nailfold capillaroscopy revealing dilated loops consistent with an underlying connective tissue disease."

"myositis"

Inflammatory muscle disease, encompassing polymyositis and dermatomyositis, causing proximal muscle weakness, elevated muscle enzymes, and characteristic skin rashes

"The myositis specialist initiated high-dose corticosteroids after confirming dermatomyositis with a heliotrope rash, Gottron's papules, and elevated CK at 4,500 U/L."

"antiphospholipid syndrome"

An acquired thrombophilia caused by antiphospholipid antibodies that promotes arterial and venous thrombosis and recurrent pregnancy morbidity

"Antiphospholipid syndrome was diagnosed after the patient's third unexplained miscarriage revealed persistently positive lupus anticoagulant and anti-cardiolipin antibodies."

"overlap syndrome"

A clinical entity in which a patient simultaneously meets diagnostic criteria for two or more distinct connective tissue diseases

"The rheumatologist described the case as an overlap syndrome, with features of both systemic sclerosis and polymyositis confirmed by myositis-specific antibody testing."

"ankylosing spondylitis"

A chronic inflammatory disease primarily affecting the axial skeleton — spine and sacroiliac joints — causing pain, stiffness, and eventual bony fusion

"The young man was diagnosed with ankylosing spondylitis after MRI sacroiliitis and a positive HLA-B27 test explained his three years of inflammatory back pain."

"sacroiliitis"

Inflammation of the sacroiliac joints, causing deep buttock pain that is often the earliest manifestation of axial spondyloarthritis

"MRI demonstrated bilateral grade 3 sacroiliitis with bone marrow oedema, establishing the diagnosis of axial spondyloarthritis in this 24-year-old patient."

"enthesitis"

Inflammation at the site where a tendon, ligament, or joint capsule inserts into bone, a hallmark feature of spondyloarthropathies

"Ultrasound-guided assessment confirmed enthesitis at the Achilles tendon insertion and the plantar fascia, consistent with a spondyloarthropathy."

"dactylitis"

Diffuse inflammatory swelling of an entire digit — finger or toe — giving a sausage-like appearance, characteristic of psoriatic and reactive arthritis

"The rheumatologist documented three episodes of dactylitis affecting the second toe bilaterally, which strongly supported the diagnosis of psoriatic arthritis."

"bamboo spine"

A radiographic appearance seen in advanced ankylosing spondylitis in which spinal ossification of the annulus fibrosus creates a continuous column of bone

"A plain lumbar spine X-ray revealed classic bamboo spine with flowing syndesmophytes from L1 to L5, indicating long-standing poorly treated ankylosing spondylitis."

"inflammatory back pain"

Chronic back pain with features suggesting an inflammatory cause: onset before age 40, insidious onset, improvement with exercise, no relief with rest, and nocturnal waking

"The five criteria for inflammatory back pain were met, prompting an urgent MRI and HLA-B27 testing to rule out axial spondyloarthritis."

"non-radiographic axial spondyloarthritis"

A form of axial spondyloarthritis with inflammatory changes visible only on MRI, without the structural damage detectable on conventional radiographs

"The patient received a diagnosis of non-radiographic axial spondyloarthritis after MRI sacroiliitis was found on a normal pelvic radiograph."

"HLA-B27"

A human leukocyte antigen gene variant strongly associated with axial spondyloarthropathies, present in approximately 90% of patients with ankylosing spondylitis

"The HLA-B27 test returned positive, increasing the pre-test probability of axial spondyloarthritis in the context of the patient's inflammatory back pain."

"gout"

A painful crystal-induced arthritis caused by deposition of monosodium urate crystals in joints and periarticular tissues due to chronic hyperuricaemia

"The patient presented to the emergency department with acute gout affecting the first metatarsophalangeal joint, with serum uric acid at 540 micromol/L."

"hyperuricaemia"

Elevated serum uric acid above the threshold of urate solubility (approximately 360 micromol/L), the necessary biochemical precursor to gout

"Dietary counselling and allopurinol were prescribed to treat the patient's hyperuricaemia and reduce the frequency of acute gout flares."

"tophus"

A deposit of monosodium urate crystals surrounded by granulomatous inflammation that forms a palpable nodule in chronic tophaceous gout

"A large tophus on the right elbow had ulcerated, and the chalky white crystalline material was submitted for microscopy to confirm urate crystal deposition."

"podagra"

Acute gout of the first metatarsophalangeal joint — the big toe — which is the most common site of initial gout presentation

"Classic podagra presented overnight with the patient unable to bear weight on the left foot due to extreme tenderness of the first MTP joint."

"urate-lowering therapy"

Long-term pharmacological treatment — typically xanthine oxidase inhibitors such as allopurinol or febuxostat — aimed at reducing serum uric acid below 360 micromol/L to dissolve urate crystals

"Urate-lowering therapy was initiated six weeks after the acute attack resolved, with the dose titrated monthly until the target uric acid was achieved."

"pseudogout"

Acute crystal arthritis caused by calcium pyrophosphate dihydrate crystals, often affecting the knee, presenting similarly to gout but with positively birefringent crystals on polarised microscopy

"Joint aspiration of the swollen knee revealed weakly positively birefringent crystals, confirming pseudogout rather than septic arthritis or urate gout."

"chondrocalcinosis"

Calcification of articular cartilage visible on plain radiographs, typically caused by calcium pyrophosphate crystal deposition, particularly in the knee menisci and wrist triangular fibrocartilage

"Bilateral chondrocalcinosis of the knee menisci on plain radiographs supported the diagnosis of calcium pyrophosphate crystal arthropathy in this elderly patient."

"intercritical gout"

The asymptomatic period between acute gout attacks during which urate crystals remain in joints and urate-lowering therapy should ideally be commenced and maintained

"The rheumatologist explained that intercritical gout was not a pain-free state but a period of ongoing crystal deposition requiring continuous urate-lowering therapy."

"disease-modifying antirheumatic drug"

A medication that not only relieves symptoms but also retards or prevents joint damage and disease progression, as opposed to purely symptomatic treatments

"Methotrexate was chosen as the first-line disease-modifying antirheumatic drug given its long track record, low cost, and efficacy in early rheumatoid arthritis."

"TNF inhibitor"

A biologic drug that blocks tumour necrosis factor alpha, a key pro-inflammatory cytokine, reducing joint inflammation and structural damage in rheumatoid arthritis and spondyloarthropathies

"After failing two conventional DMARDs, the patient was started on a TNF inhibitor, with clinical response assessed at 12 weeks using the DAS28 score."

"methotrexate"

An anchor DMARD used as first-line therapy for rheumatoid arthritis that works by inhibiting dihydrofolate reductase, reducing folate-dependent lymphocyte proliferation and cytokine production

"The rheumatologist prescribed weekly methotrexate alongside daily folic acid supplementation to reduce the risk of mucositis and haematological side effects."

"JAK inhibitor"

A targeted synthetic DMARD that blocks Janus kinase enzymes inside immune cells, disrupting cytokine signalling pathways and reducing inflammation in rheumatoid arthritis and other inflammatory conditions

"A JAK inhibitor was prescribed after the patient developed tuberculosis on a TNF inhibitor, which precluded the use of further biologic therapies."

"treat-to-target"

A treatment strategy in which therapy is adjusted at regular intervals until a defined goal — such as remission or low disease activity — is achieved and then maintained

"Following a treat-to-target protocol, the rheumatologist escalated therapy every three months until the patient achieved and sustained DAS28 remission."

"biosimilar"

A biological medicine that is highly similar in quality, safety, and efficacy to an already-approved reference biologic, typically available at lower cost after the originator's patent expires

"The hospital formulary committee approved switching stable rheumatoid arthritis patients from the originator to a biosimilar version of adalimumab."

"secondary non-response"

The loss of initial therapeutic benefit from a biologic or targeted synthetic DMARD over time, often due to the development of anti-drug antibodies

"Secondary non-response to the first TNF inhibitor prompted measurement of drug levels and anti-drug antibodies before deciding on the next treatment strategy."

"tocilizumab"

A biologic drug that blocks the interleukin-6 receptor, used for rheumatoid arthritis and giant cell arteritis, reducing systemic inflammation and suppressing acute-phase reactants

"Tocilizumab was selected for the patient with refractory rheumatoid arthritis partly because it normalises CRP and ESR, complicating the use of these markers for monitoring disease activity."

"giant cell arteritis"

A granulomatous vasculitis of large and medium vessels predominantly affecting the temporal artery in older adults, presenting with headache, jaw claudication, and risk of irreversible visual loss

"The emergency team initiated high-dose corticosteroids for suspected giant cell arteritis before the temporal artery biopsy result was available to prevent blindness."

"ANCA-associated vasculitis"

A group of small-vessel vasculitides — including granulomatosis with polyangiitis and microscopic polyangiitis — characterised by positive ANCA serology and necrotising inflammation of small vessels

"The diagnosis of ANCA-associated vasculitis was confirmed by a positive PR3-ANCA and renal biopsy showing pauci-immune crescentic glomerulonephritis."

"polymyalgia rheumatica"

An inflammatory condition in adults over 50 causing bilateral shoulder and hip girdle pain and stiffness with markedly elevated inflammatory markers, closely associated with giant cell arteritis

"Polymyalgia rheumatica resolved dramatically within 48 hours of starting 15 mg prednisolone daily, confirming the diagnosis and prompting a gradual taper over 18 months."

"osteoporosis"

A skeletal disorder defined by reduced bone mineral density and degraded bone microarchitecture that increases fracture risk, commonly assessed by DEXA scan

"DEXA scanning revealed a T-score of −2.8 at the lumbar spine, confirming osteoporosis and prompting initiation of bisphosphonate therapy."

"glucocorticoid-induced osteoporosis"

Bone loss resulting from long-term corticosteroid therapy, driven by reduced osteoblast activity and increased osteoclast-mediated bone resorption

"Guidelines recommend calcium, vitamin D, and bisphosphonate therapy to prevent glucocorticoid-induced osteoporosis in patients receiving more than 7.5 mg prednisolone daily for over three months."

"fragility fracture"

A fracture resulting from a low-energy force equivalent to falling from standing height or less, indicating underlying bone fragility consistent with osteoporosis

"A fragility fracture of the vertebral body was identified incidentally on a chest CT, prompting referral for a fracture liaison service assessment and DEXA scan."

"Takayasu arteritis"

A granulomatous large-vessel vasculitis primarily affecting the aorta and its major branches in young women, causing vascular stenosis, aneurysm, and limb claudication

"CT angiography confirmed Takayasu arteritis with narrowing of the left subclavian artery, explaining the blood pressure discrepancy between the two arms."

"DEXA scan"

Dual-energy X-ray absorptiometry — the gold-standard imaging technique for measuring bone mineral density at the lumbar spine and hip, used to diagnose and monitor osteoporosis

"A DEXA scan was arranged at baseline before commencing long-term corticosteroid therapy to document bone mineral density and guide fracture prevention treatment."