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Rheumatology (Rheumatoid arthritis (Presentation (Morning stiffness, Pain…

- - - - Some patients are still seronegative
    - - Raised ESR
      - Raised plasma viscosity
      - Raised CRP
    - - Normal
      - Peri-articular osteopenia
      - Bone displacement
  - - - NSAIDs
      - Analgesia
      - Steroids
      - Physiotherapy
    - - Commence <3 months of diagnosis
      - Methotrexate
      - Sulphasalazine
      - Hydroxychloroquine
      - Leflunomide
    - - DAS-28 score >5.1
      - Anti-TNFs
- - - - Spinal/ SI sclerosis and fusion
      - Syndesmophytes
      - Bamboo spine
    - - Physiotherapy
      - Exercise
      - NSAIDs
      - Anti-TNFs
      - DMARDs do not work
  - - - Chlamydia
      - Gonorrhoea
    - - Salmonella
      - Campylobacter
    - - Urethritis
      - Uveitis
      - Conjunctivitis
  - - - With methotrexate
- - - - Fever
      - Fatigue
      - Weight loss
      - Arthralgia
      - Myalgia
      - Malar "butterfly" rash
      - Raynaud's phenomenon
      - Alopecia
      - Anything
    - - Thrombocytopenia
      - Leukopenia
      - Anaemia
      - ANCA
      - Anti-Ro
      - Anti-Sm
      - Anti-La
      - Urinalysis
      - Systemic imaging
    - - NSAIDs
      - Hydroxychloroquine
      - Steroids
      - Azathioprine in severe disease
  - - - Xerostomia
      - Keratoconjunctivitis sicca
      - Arthralgia
      - Fatigue
      - Vaginal dryness
      - Parotid swelling
    - - Positive Schirmer's test
      - Anti-Ro
      - Anti-La
    - - Symptomatic
      - Pilocarpine
      - Eye lubrication
      - Hydroxychloroquine
  - - - Sclerotic skin on face, hands, arms and neck
      - Telangectasia
      - Calcinosis
      - Sclerodactyly
      - Pulmonary fibrosis
      - Pulmonary hypertension
      - Hypertension
    - - Rapid development
      - Early organ involvement
      - Anti-SCL70
    - - Facial features predominate
      - Late organ development
      - Anti-centromere antibodies
    - - Calcium channel blockers
      - ACE inhibitors
      - PPIs
      - Cyclophosphamide
      - Monitoring of lung and renal function
  - - - Recurrent arterial and venous thrombosis
      - Foetal loss
      - Pulmonary embolism
      - Stroke
      - Migraine
      - Thrombocytopenia
    - - Anti-coagulation
- - - - Proximal myalgia
      - Affects shoulder/ hip girdle
      - Morning stiffness
  - - - Symmetrical, proximal muscle weakness
      - Dysphagia
    - - Raised inflammatory markers
      - Anti-Jo-1 antibodies
      - Muscle biopsy to show muscular dystrophy
    - - Prednisolone
      - Azathioprine
      - Methotrexate
  - - - Myalgia >3 months
      - Bilateral tenderness
      - Fatigue
      - Poor sleep
      - Cognitive dysfunction
      - Anxiety/ depression
    - - Analgesia
      - Exercise
      - Anti-depressants
- - - - Headache
      - Jaw claudication
      - Visual loss
      - Scalp tenderness
      - Fatigue
      - Palpable temporal artery
      - Swollen optic disc
      - Raised inflammatory markers
  - - - Granulomatosis with polyangiitis
        
        Wegener's granulomatosis
        
        Granulomatous deposits in vessels and respiratory tract
      - Microscopic polyangiitis
      - Renal-limited vasculitis
      - Churg-Strauss syndrome
        
        Eosinophilic
        
        Associated with asthma
      - Usually require treatment with IV corticosteroids
    - - Henoch-Schonlein purpura
        
        IgA mediated
        
        Affects children
        
        Rash over buttocks
        
        Self-limiting
    - - Fever
      - Weight loss
      - Raised, non-blanching purpuric rash
      - Arthralgia
      - Mononeuritis multiplex
      - Glomerulonephritis
      - Lung opacities
- - - - Renal underexcretion
      - Red meat
      - Alcohol
      - Fish
    - - Hot, swollen 1st MTP joint
      - Very painful
      - Tophi
    - - NSAIDs
      - Analgesia
      - Corticosteroids
      - Colchicine
      - Allopurinol