Rheumatology
Inflammatory arthritis, connective tissue disease and vasculitis.
- Rheumatoid Arthritis The symmetrical small-joint pattern that spares the DIPs, reading rheumatoid factor against anti-CCP, and the treat-to-target strategy that starts with methotrexate.
- Osteoarthritis Separating it from inflammatory arthritis on stiffness and pattern, the LOSS radiographic features, and why exercise and weight loss come before analgesia and long before replacement.
- Crystal Arthropathy Gout and pseudogout side by side: needle-shaped versus rhomboid crystals under polarised light, why a normal urate excludes nothing, and never starting allopurinol during an attack.
- Seronegative Spondyloarthropathies Recognising inflammatory back pain, why MRI of the sacroiliac joints beats plain films, the extra-articular A list, and the reactive and enteropathic relatives.
- Psoriatic Arthritis The five patterns, the DIP involvement, dactylitis and nail changes that mark it out, the pencil-in-cup deformity, and why methotrexate treats skin and joints together.
- Systemic Lupus Erythematosus Reading ANA against anti-dsDNA and falling complement, why lupus nephritis decides long-term outcome, and the CRP that stays normal in a flare but rises in infection.
- Scleroderma and Mixed Connective Tissue Disease Limited versus diffuse disease, recognising scleroderma renal crisis and the steroid dose that triggers it, and the overlap syndrome that sits alongside them.
- Sjogren Syndrome Investigating sicca symptoms with Schirmer's test, anti-Ro and anti-La and labial gland biopsy, the extraglandular disease, and the lifetime lymphoma risk.
- Polymyositis and Dermatomyositis Symmetrical proximal weakness with a markedly raised CK, the heliotrope rash and Gottron's papules, the malignancy that must be looked for, and antisynthetase syndrome.
- Giant Cell Arteritis Headache, scalp tenderness and jaw claudication in an older patient: why steroids are started on suspicion alone, and the visual loss that makes it a same-day emergency.
- Polymyalgia Rheumatica Girdle pain with prolonged morning stiffness, the normal CK that rules out myositis, the dramatic steroid response, and screening for the giant cell arteritis that accompanies it.
- Vasculitis Classifying by vessel size, matching c-ANCA and p-ANCA to their diseases, and recognising the pulmonary-renal syndrome that needs induction immunosuppression the same day.
- Raynaud Phenomenon The white-blue-red sequence, using age, symmetry and nailfold capillaroscopy to separate primary disease from secondary, and treating from nifedipine up to prostacyclin.
- Fibromyalgia Central sensitisation rather than inflammation: diagnosing it clinically without a battery of tests, the exercise and psychological support that work, and the drugs NICE says not to use.
- Osteoporosis and Fragility Fractures Assessing risk with FRAX, reading a DEXA T-score, screening for secondary causes, and the bisphosphonate first line - plus the rebound that follows stopping denosumab.
- Juvenile Idiopathic Arthritis The subtypes and what distinguishes each, the silent uveitis that needs slit-lamp screening whatever the symptoms, and excluding leukaemia before steroids are ever started.
- Disease-Modifying Antirheumatic Drugs The conventional, biologic and targeted synthetic classes, what to monitor on each, the screening that precedes any biologic, and which are safe to continue in pregnancy.