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4.3 Polyarthritis - Coggle Diagram

- - - - synovitis,
        joint restricition
        swollen
        earliest = symmetrical hand & feet
  - - - corneal melt
      - scleroperforans
    - - systemic disease
        incr CVS risk
        incr infection risk
  - - - DMARDs (mainly =) methotrexate
        1st line
        
        SE: bowel issues bc changes
        GI epithelial lining turnover time
        
        quicker start: better response
        
        pts doing worse:
        older, male, smokers,
        late presenting (already have bone damage)
      - NSAIDs
      - immune tx
        
        anti-TNF agents
        
        e.g. infliximab
      - IA/IM corticosteroids
  - - - rheumatoid factor
        anti-CCP Ab
        ESR
        CRP
    - - x-rays
        isotope bone scan
        
        shows areas of high blood flow
        
        shows bone marrow & areas of inflamm - early RA
        ultrasound
        MRI
        
        quickest, immediate, see inside joints
        
        can use Doppler to see blood flow
      - ultrasound/MRI confirms x-ray dx
        or bloods
- - - - psoriatic, reactive, enteropathic, ankylosing spondylitis
    - - rubella, hep B & C, EBV
    - - sepsis, lyme disease, post streptococcus
    - - sarcoidosis, SLE, gout, neoplasia
  - - - sepsis, immunosuppressed
        lyme disease
        rheumatic fever - post streptococcla know Jones criteria
    - - gout
        sarcoidosis
- - - - antiviral therapy
    - - anti-infective tx necessarry