Interrelation between rheumatic and dermatological diseases

Interrelation between rheumatic and dermatological diseases: from laboratory to clinical practice in a Brazilian reality

 

GENERAL DESCRIPTION

Rheumatology and Dermatology have a wide spectrum of clinical diseases that are commonly seen in primary care. Early recognition and adequate evaluation are key factors for prognosis and adequate referral. They are a crescent specialty worldwide, although it is usually an elective rotation in many medical programs.

    The Department of Medicine of our Institution offers the opportunity to international medical students to share a unique approach of systemic and skin diseases, facilitating education across disciplines. In addition, the Department aims to share their experience in diagnosing and treating common diseases in the southeastern region of the country.

This course will focus on clinical principles of Rheumatology and Dermatology, tropical diseases and autoimmune/inflammatory diseases,  intermingled with histopathology, immunology, and basic science concepts.

 

COURSE OBJECTIVES

  1. Discuss an interrelation between rheumatologic and dermatologic diseases from a clinical and immunological perspective.

  2. Discuss dermatological and rheumatologic manifestations of tropical and emerging diseases such as leprosy, tuberculosis, leishmaniosis, dengue fever, Zika and Chikunguya.

  3. To recognize the principal differential diagnoses and comorbidities (infectious / neoplastic).

  4. Basic concepts of treatments.

 

TEACHING METHODS

1. Lectures with active interactive methodology.

2. Visit to the university hospital.

3. Discussion of didactic clinical cases at Dermatology and Rheumatology outpatient clinic.

The course dinamics include one hour of practical experience, with patients at the outpatient clinic at the University Hospital or cases in power-point  presentation. After that, there will be a discussion with the experts about clinical cases or lectures about the subject.

 

Assessment:

1. Presence and punctuality

2. Interaction with the faculty and other students.

 

Duration: 1 week.

Pre requisites:

Pre-clinical knowledge (at least 50% of the medical course at the foreign institution) and fluent English.

Course material:

1. Papers and power point presentation elaborated by the faculty.

FACULTY Course organization and responsibility:

Simone Appenzeller

Renata Ferreira Magalhães

Additional Faculty: Professors and Teaching Assistants from the Division of Dermatology and Rheumatology, School of Medical Sciences, University of Campinas (Unicamp).

WHO SHOULD ATTEND?

∙ Medical students with pre-clinical knowledge (at least 50% of the medical course at the foreign institution)

∙ 8 to 10 students.    

 

ONE-WEEK-SCHEDULE

 

 

Monday July 1st

Tuesday July 2 nd

Wednesday July 3 rd

Thursday July 4 th

Friday July 5 th

8:30-9:30

Welcome and visit to Clinics Hospital of University of Campinas (Unicamp)

Pediatric Rheumatology

SLE and cutaneous LE

Systemic scerosis+

Other  forms of scleroderma

Emerging Disease

9:30-1145

Psoriasis and Psoriatic arthritis

PHYSIOPATHOLOGY OF COLLAGEN DISEASE

Discussion

Discussion

Discussion

12pm-14pm

Lunch

Lunch

Lunch

Lunch

Lunch

14pm-15pm

PEMPHIGUS FOLIACEOUS AND OTHER AUTOIMMUNE BLISTER DISEASE

Spondyloarthritis

+ Hanseniase

TROPICAL DERMATOLOGY+

Cutaneous neoplasm

Rheumatoid arthritis+

Allergy

Laboratory in Dermatology and Rheumatic diseases

15pm-17pm

Discussion

Discussion

Discussion

Discussion

Derma-Rheumatology Quiz

       

Happy Hour

 

 

Detailed course Program

 

WELLCOME AND VISIT TO THE  UNICAMP CLINICS HOSPITAL

 

PART I – PSORIASIS AND PSORIATIC ARTHRITIS (Profa. Dra. Renata Magalhães and Dr. Michel Yasbeck)

During the practical course today, you must see:

  • Clinical presentation of psoriasis

  • Differential diagnosis

  • Investigate psoriatic arthritis, and differential diagnosis of joint pain

  • Semiological techniques, skin biopsy

  • Joint ultrasound and radiologic images in psoriatic arthritis

  • Treatment discussion

  • Phototherapy.

 

PART II – PEMPHIGUS FOLIACEOUS AND OTHER AUTOIMMUNE BLISTER DISEASE (Profa. Dra. Renata Magalhães, Dra. Juliana Massuda, Profa. Dra. Simone Appenzeller, Prof. Dr. Paulo Velho)

At this afternoon, you will examine patients with pemphigus foliaceus, also called fogo selvagem, an autoimmune blistering disease, common in South America. Please pay attention in:

  • Clinical presentation of blistering disease, elementary lesions, epidemiologic profile of the patients

  • Differential diagnosis

  • Semiological techniques, Nikolsky sign

  • How to make diagnosis, histopathology and immunofluorescence findings

  • Discussion about treatment

  • Behçet disease and Sjogren syndrome, clinical presentation and differential diagnosis of oral ulcers

Many infectious diseases are seen in tropical areas. Sexually transmitted diseases are also a big problem in Brazil and their incidences are increasing all over the world. Now, you can discuss cases of:

  • Emerging diseases on tropical areas.

  • Sexually transmitted diseases.

 

PART III – PHYSIOPATHOLOGY OF COLLAGEN DISEASE

(Profa. Dra. Simone Appenzeller, Dra Estephania Pignaton and Dr. Allison Pugliesi)

Review physiopathology of autoimmune collagen diseases, especially systemic lupus erythematosus and Sjogren syndrome. Discuss main clinical presentations, main differential diagnosis, reaction to drugs.

  • Visit to the Infusion Center of Biologics

  • Clinical examination for the diagnostic of spondilytis

  • Systemic lupus erythematosus.

 

PART IV – HANSENIASE (Profa. Dra. Andrea Eloy)

Please, pay attention in:

  • Elementary lesions that you can see in hanseniase and the signs of reactions

  • Characteristics of joint pain in an infectious disease

  • Epidemiologic profile of the patients

  • Discussion about the treatment of the disease and its reactions

  • Public politicy to control the disease.

SPONDILOARTHRITIS (Dr. Alisson Pugliesi)

  • Clinical presentation

  • Differential diagnosis

  • Semiologic techniques

  • Joint ultrasound and radiologic images

  • Treatment discussion.

 

PART V – COLLAGEN DISEASES - CUTANEOUS LUPUS ERYTHEMATOSUS (Profa. Dra. Simone Appenzeller and Profa. Dra. Andreia Eloy)

During this morning, we hope you can see patients with systemic lupus erytematosus, and check the diagnostic criteria, and know the cutaneous lesions that are typical of lupus. The objectives of the day are:

  • Attention to the elemental lesions that are characteristic of cutaneous and systemic lupus

  • Discuss about differential diagnosis

  • Laboratory tests findings

  • Treatment.

 

PART VI – TROPICAL DERMATOLOGY (Prof. Dr. Hamilton Stolf)

  • Osteoarticular manifestations of tuberculosis

  • Tropical dermatology, including paracoccidioidomicosis and other diseases.

  • Practice with clinical cases of common dermatosis such acne.

 

PART VII – SYSTEMIC SCLEROSIS (Dra. Ana Paula Toledo) AND CUTANEOUS SCLERODERMA (Profa. Dra. Andrea Eloy)

  • Clinical presentation

  • Differential diagnosis

  • Semiologic techniques

  • Joint ultrasound and radiologic images

  • Treatment discussion.

 

CUTANEOUS NEOPLASMS (Profa. Dra. Renata Magalhães)

Brazil is a very sunny country and we have great incidences of basal cell and spinocell carcinoma. Part of population is of European descent and have worked under the sun for a long period of their lives, in construction and farming. Basal cell carcinoma is the most common cancer in Brazil and all the population, but has low mortality index. It’s almost a public health issue in Brazil. Now you can see:

  • Patient’s profile with epithelial skin tumors is Brazil

  • The risk factors for this cancer

  • Clinical presentation of the basal cell carcinoma and spinocell carcinoma

  • Clinical presentation of pre-neoplastic lesions, such as actinic keratosis

  • Discuss about the surgical treatments modalities

  • Discuss photoprotection and other preventive measures.

 

PART VIII – CLINICAL CASES OF RHEUMATOID ARTHRITIS AND CUTANEOUS ALLERGY – A PRACTICE VIEW

ATOPIC DERMATITIS (Profa. Dra. Andrea Eloy and Dra. Marina Maciel)

Atopic dermatitis is the best example of the allergic manifestation, affect children and adults, is common in all populations. It’s very important to the generalist physician to know about this condition.

The objectives of this afternoon are:

  • See the elemental lesions that are characteristcs of eczema

  • Think about differential diagnosis

  • How to indicate lab tests

  • Discuss about treatment option

  • Focus in prevention risk factors: skin cares and environmental care measures.

RHEUMATOID ARTHRITIS (Prof Dr Manoel Bertolo)

  • Clinical presentation

  • Differential diagnosis

  • Semiologic techniques

  • Joint ultrasound and radiologic images

  • Treatment discussion

 

PART IX – EMERGING DISEASES

 

LYME DISEASE (Profa. Dra. Simone Appenzeller)

  • Clinical presentation

  • Differential diagnosis

  • Semiologic techniques

  • Treatment discussion.

ARBOVIROSIS (Dra. Mariana Beleli)

  • Clinical presentation

  • Differential diagnosis

  • Semiologic techniques

  • Joint ultrasound and radiologic images

  • Treatment discussion.

 

LABORATORY IN TROPICAL DISEASES

You can see the laboratorial findings of the cases presents during this week, including skin biopsies and culture of skin fragment).

 

DERMA-RHEUMA QUIZ

Test yourself: did you enjoy the Winter School?

 

REMARKS AND CLOSING SESSION