Monitoring of patients with rheumatic diseases at the outpatient stage (36 hours)

Relevance of the educational program:
Immuno-inflammatory rheumatic diseases (IVRS) are characterized by the development of variable multi-organ symptoms, a chronic course, alternating remissions and exacerbations, and frequent severe damage to internal organs. The lack of timely diagnosis and adequate treatment methods for IVR, including at early stages, leads to disability, shortening the duration and reducing the quality of life of patients. The great medical and socio-economic significance of rheumatic diseases is determined by the high prevalence of IVRS (up to 2-5% of the adult population for some inflammatory diseases of the joints and spine). In some rheumatic diseases, the time interval from the appearance of the first symptoms to the verification of a reliable diagnosis can reach several years. Atypical variants of the debut are possible, and therefore patients seek primary care from doctors of therapeutic specialties who do not have sufficient skills in curating such patients. There are errors in the interpretation of laboratory and instrumental methods of examination. As the duration of the disease increases, the number of comorbid conditions associated with both complications of the disease itself and the treatment carried out increases.
Thus, increasing the knowledge of doctors about the features of rheumatic diseases, modern methods of diagnosis, treatment and monitoring of patients is an urgent need, and explains the need for continuous education of doctors of therapeutic specialties in rheumatology.

As a result of mastering the Program, the student must:

- acquire or improve the following necessary knowledge: 

• Etiology, pathogenesis, clinical picture, differential diagnosis, features of the course, complications and outcomes of rheumatic diseases.
• Features of physical examination of patients with rheumatic diseases.
• Modern diagnostic and classification criteria for rheumatic diseases;
• Diagnosis based on the current International Statistical Classification of Diseases and health-related problems (ICD).
• A list of laboratory and instrumental research methods for assessing the patient's condition, the main medical indications for conducting research and interpreting the results.
• Variants of the debut and clinical symptomatology of the early stages of rheumatic diseases.
• Differential diagnosis of rheumatic diseases at an early stage.
• Criteria for assessing the activity of rheumatic diseases.
• Referral of the patient to an instrumental examination in the presence of medical indications in accordance with the current procedures for the provision of medical care, clinical recommendations (treatment protocols) on the provision of medical care, taking into account the standards of medical care.
• Referral of the patient for consultation with medical specialists in the presence of medical indications in accordance with the current procedures for the provision of medical care, clinical recommendations (treatment protocols) on the provision of medical care, taking into account the standards of medical care.
• Referral of a patient for specialized medical care in an inpatient setting or in a day hospital setting, if there are medical indications, in accordance with the current procedures for providing medical care, clinical recommendations (treatment protocols) on the provision of medical care, taking into account the standards of medical care.
• Prevention of irreversible organ damage, development of comorbid pathology.

- acquire or improve the following necessary skills and practical skills:

• Get the necessary information about the disease from the patient or others.
• Collect complaints, anamnesis of the patient's life and illness, and analyze the information received.
• Perform a complete physical examination of the patient (examination, palpation, percussion, auscultation) and interpret its results.
• Identify common and specific signs of rheumatic diseases.
• Formulation of a preliminary diagnosis and preparation of a plan for laboratory and instrumental examinations of the patient.
• Referral of the patient for laboratory examination in the presence of medical indications in accordance with the current procedures for the provision of medical care, clinical recommendations (treatment protocols) on the provision of medical care, taking into account the standards of medical care.
• Justify the need and scope of laboratory examination of the patient.
• Justify the need and scope of instrumental examination of the patient.
• Analyze the results of the patient's examination, if necessary, justify and plan the scope of additional studies.
• Perform early diagnosis of rheumatic diseases.
• Determine the order of the scope, content and sequence of diagnostic measures.
• Interpret the data obtained during the patient's consultations with specialist doctors.
• Early detection of comorbid conditions (atherosclerosis, cancer, etc.) in patients with rheumatic diseases.

Internship base: department of Rheumatology of the State Medical Institution of the Moscow State Medical Center named after A. S. Loginov DZM.
Internship Supervisor: Lukina Galina Viktorovna, MD, Professor.