Knowledge guides

LG14: Foundations of adult rheumatology

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced will identify important specialty-specific issues and the impact of these on diagnosis, management and outcomes.

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  • Anatomy structure and function relevant to musculoskeletal disease
  • Basic knowledge of non-musculoskeletal conditions involved in rheumatic disease differential diagnosis, or those which have implications on rheumatic condition management, such as:
    • cardiovascular and kidney disease
    • diabetes mellitus
    • hypercoagulable states
    • hypertension
    • infections
    • interstitial lung diseases
    • malignancies, including:
      • haematological
      • solid mass
    • muscle dystrophies and metabolic myopathy
  • Epidemiological principles, such as:
    • cultural, economic, individual, and societal impact of rheumatic disease
    • incidence, outcomes, and prevalence of rheumatic disease in different patient groups and populations
    • limitations of investigations, and their appropriate use and interpretation
  • Immunology, including an understanding of the cells and pathways involved in the innate and adaptive immune systems
  • Non-pharmacological and non-surgical interventions
  • Pharmacological principles, such as the appropriate selection of medications and other therapeutic options
  • Physiology relevant to musculoskeletal conditions
Clinical assessment tools
  • Measures of cumulative damage, disease activity, functional status, and quality of life appropriate to the patient’s condition
Investigations and procedures
  • Aspiration:
    • bursae
    • joints
  • Diagnostic imaging techniques
  • Injections – intra-articular
  • Synovial fluid analysis
Investigations – optional
  • Biopsy and histopathology:
    • kidney
    • metabolic bone
    • muscle
    • peripheral nerve
    • skin
  • Neuroelectrophysiological tests, such as:
    • electromyography
    • nerve conduction studies
  • Polarised light microscopy for crystal arthritis
  • Considerations for the transition from paediatric to adult care
  • Disability determination, such as:
    • career advice and planning
    • carer allowance and payments
    • difference between impairment and disability
    • disability pension, social security disability, and workers compensation
    • educational supports
    • medical and function evaluation and measurement
  • Impact of determinants of health on overall rheumatology patient management, such as:
    • access to care, such as geography
    • cultural, language, religious, and socioeconomic diversity
    • emotional and psychological burden of chronic disease
    • spiritual aspects of disease
  • Pharmaceutical Benefits Scheme (PBS) / Pharmac prescribing requirements for biologic disease-modifying antirheumatic drugs (DMARD)
  • Psychosocial aspects of disability and pain
  • Transitional care of adolescents, and transfer to adult services