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Study sets matching "rheum"

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Study sets matching "rheum"

49 terms
Rheum1
Joint structure, cartilage fact
Types of joints
Synovial fluid
Arthrocentesis risk
Cartilage is avascular ... Synovial membrane lacks tight junctio…
Diarthrodial: capsule + synovial lining + movement (ie, hip j…
ultrafiltrate of extra-articular fluids, made by chondrocytes…
- infection... - bleeding... - damage... - skin to joint fistula... - pain
Joint structure, cartilage fact
Cartilage is avascular ... Synovial membrane lacks tight junctio…
Types of joints
Diarthrodial: capsule + synovial lining + movement (ie, hip j…
161 terms
Rheum 2
22 yr old student w/ diarrheal illness…
Antecedent infection (GI-postedemic, o…
Oligoarthritis, dactylitis, enthesitis…
what has a classic triad of uveitis, u…
Reactive Arthritis
Reactive Arthritis
Reactive Arthritis
Reactive Arthritis
22 yr old student w/ diarrheal illness…
Reactive Arthritis
Antecedent infection (GI-postedemic, o…
Reactive Arthritis
101 terms
*Ortho/Rheum
Collagen disorder... Scoliosis, joint lax…
Osteopenia, blue sclera, recurrent fra…
12-30yo... Facial weakness, hand grip, hy…
5-15yo... Milder progressive weakness, go…
Ehlers-Danlos Syndrome
OI (Osteogenesis imperfecta)... AD - Connective tissue disorder…
Myotonic Muscular Dystrophe... AD trinucleotide CTG expansion D…
Becker Muscular Dystrophe... XR deletion dystrophin gene Xp21
Collagen disorder... Scoliosis, joint lax…
Ehlers-Danlos Syndrome
Osteopenia, blue sclera, recurrent fra…
OI (Osteogenesis imperfecta)... AD - Connective tissue disorder…
9 terms
Intro to Rheum
what are the common demographics for t…
what are the steps of physical exam?
Clinical features helpful in evaluatin…
anatomic structure of a joint
-young men... -young women... -middle aged men (postmenopausal wome…
-active and passive ROM... -assess tenderness, swelling, warmth,…
1-age, sex, ethnicity, fam hx... 2-pattern of joint involvement…
what are the common demographics for t…
-young men... -young women... -middle aged men (postmenopausal wome…
what are the steps of physical exam?
-active and passive ROM... -assess tenderness, swelling, warmth,…
167 terms
Rheum Review
CRP is useful to monitor what two cond…
CRP is elevated in SLE w/ what other m…
C3 and C4 is used to monitor what cond…
What conditions are assoc w/ HYPOcompl…
RA and Giant Cell
Serositis and Synovitis
SLE
SLE, Vasculitis, Polyarteritis nodosa
CRP is useful to monitor what two cond…
RA and Giant Cell
CRP is elevated in SLE w/ what other m…
Serositis and Synovitis
13 terms
rheum Definitions
MCTD
UCTD
raynaud's phenomenon
scleroderma
presence of anti-U1 ribonucleoprotein antigens (anti-ENA)... It…
RA patients with symptoms that can't be diagnosed, up to 25%…
fingers go from a white - blue - red... Peripheral digital ischa…
disease that is either diffuse or limited... Diffuse = disease i…
MCTD
presence of anti-U1 ribonucleoprotein antigens (anti-ENA)... It…
UCTD
RA patients with symptoms that can't be diagnosed, up to 25%…
123 terms
Rheum review
SLE etiology
Hallmark of SLE
SLE triad
SLE skin
women, AA... genetic predisposition + hormonal/environmental tri…
ANA
Joint pain... fever ... malar rash
butterfly rash... photosensitive rash
SLE etiology
women, AA... genetic predisposition + hormonal/environmental tri…
Hallmark of SLE
ANA
114 terms
Rheum Quiz 2
who is likely to get lupus?
what is SLE?
describe the pathophys of SLE: hormona…
describe the pathophys of SLE: immune…
F > M... (except when drug induced --> then it's F = M)... Poorer…
a chronic inflammatory dz of unknown cause that can affect vi…
Estrogen Effect = huge effect on development of lupus... -why…
Phagocytosis of immune complexes, apoptotic cells are defecti…
who is likely to get lupus?
F > M... (except when drug induced --> then it's F = M)... Poorer…
what is SLE?
a chronic inflammatory dz of unknown cause that can affect vi…
68 terms
Rheum Basics
SLE IX?
SLE disease monitoring?
RX Acute severe SLE?... *AIHA, nephritis…
RX cutaneous SLE?
95% ANA+ve... dsDNA is very specific (sensitivity 60%)... 30% ENA+v…
Anti-dsDNA titres... Complement: C3, C4... Inc ESR
High-dose prednisolone + IV cyclophosphamide
topical steroids and prevent ̄c sun cream
SLE IX?
95% ANA+ve... dsDNA is very specific (sensitivity 60%)... 30% ENA+v…
SLE disease monitoring?
Anti-dsDNA titres... Complement: C3, C4... Inc ESR
77 terms
Rheum Terms
rice bodies
Bouchard node
Herbeden node
PIP and MCPJ
RA
PIP
DIP
RA
rice bodies
RA
Bouchard node
PIP
19 terms
Rheum Derm 7 Dermatology
Layers of the skin: outermost to inner…
Where are the blood vessel of your ski…
tight junction: proteins
Intermediate junction: proteins
Stratum:... Corneum... Lucidum... Granulosum... Spinosum... Basale
Dermis
claudin... occludin
actin... E cadherin
Layers of the skin: outermost to inner…
Stratum:... Corneum... Lucidum... Granulosum... Spinosum... Basale
Where are the blood vessel of your ski…
Dermis
13 terms
rheum Investigations
MCTD
UCTD
Raynaud's phenomenon
sclereoderma
anti-ENA (U1 RNP)... FBC - leukopenia, thrombocytopenia and anae…
same as RA
ANA - positive - can be positive in the normal population... FBC…
Centromere ANA pattern... FBC - anaemia from GIT blood loss... Urea…
MCTD
anti-ENA (U1 RNP)... FBC - leukopenia, thrombocytopenia and anae…
UCTD
same as RA
13 terms
rheum Management
mixed connective tissue disease
undifferentiated connective tissue dis…
Raynaud's phenomenon
Scleroderma
lifestyle - maintain healthy body weight, decrease salt (decr…
symptoms - anti-inflammatory... Monitor for joint deterioration…
Keep peripherals warm... Calcium channel blockers... Amlodipine... Fel…
Lifestyle changes to reduce risk of heart, lung and kidney se…
mixed connective tissue disease
lifestyle - maintain healthy body weight, decrease salt (decr…
undifferentiated connective tissue dis…
symptoms - anti-inflammatory... Monitor for joint deterioration…
440 terms
Rheum -All
Who is at risk for RA?
Onset age of RA
Characteristics of RA
Joints subject to RA
Women (2-3x)
30-50... Juvenille possible (5-15yo)
Morning stiffness greater than 30min... Tissue swelling
Peripheral diarthrodial joints... -symmetric & BL... -PIP, MCP, wri…
Who is at risk for RA?
Women (2-3x)
Onset age of RA
30-50... Juvenille possible (5-15yo)
35 terms
MKSAP Rheum
Joint-space narrowing, subchondral scl…
periarticular osteopenia and marginal…
flowing osteophytes involving the ante…
Sicca treatment
OA
RA
Diffuse idiopathic skeletal hyperostosis (DISH)
Cyclosporine eye drops
Joint-space narrowing, subchondral scl…
OA
periarticular osteopenia and marginal…
RA
181 terms
Rheum Quickstudy
symmetrical morning stiffness lasting…
HLA-DR1 + 4
Bouchard nodes + MCPJ of hands are pai…
Rubbery nodules on elbows and knees
RA
RA
RA
RA {rheumatoid nodules}
symmetrical morning stiffness lasting…
RA
HLA-DR1 + 4
RA
29 terms
Rheum - Sponlyloarthropathies
AS mostly effects (Sex, age)
Suspect AS
AS features
AS systemic Sx
Men age 20-40
<40 yo with NOC back pain, FH
> 3 mo stiffness, ↓ lumbar motion, thoracic pain/stiffness, ↓…
Low fever, fatigue, wt loss, anemia, amyloidosis, osteopenia/…
AS mostly effects (Sex, age)
Men age 20-40
Suspect AS
<40 yo with NOC back pain, FH
110 terms
Rheum Arthridities
Rheumatoid arthritis MC in which people?
Common chronic arthritis seen in adult…
MC form of arthritis in USA
MC location of osteoarthritis
predominately women ages 20-50
GROuPP PASS... Osteoarthritis... RA... Gout... Calcium pyrophosphate dep…
Osteoarthritis
hands, hips, back, neck, knees (HHBNK)
Rheumatoid arthritis MC in which people?
predominately women ages 20-50
Common chronic arthritis seen in adult…
GROuPP PASS... Osteoarthritis... RA... Gout... Calcium pyrophosphate dep…
38 terms
Rheum Pictures
Osteoarthritis (cracking)
OA (fibrocartilage)
OA (subchondral cyst)
OA (stages)
Osteoarthritis (cracking)
OA (fibrocartilage)
35 terms
misc rheum
complex regional pain syndrome is defi…
sx associated w/ complex regional pain…
complex regional pain syndrome typical…
the two types of CRPS are type I (__)…
diffuse burning or throbbing pain in one entire limb
hyperalgesia, vasomotor instability, dystrophic changes
edematous, atrophy/contracture
idiopathic, following nerve injury
complex regional pain syndrome is defi…
diffuse burning or throbbing pain in one entire limb
sx associated w/ complex regional pain…
hyperalgesia, vasomotor instability, dystrophic changes
19 terms
rheum drugs
methotrexate MOA
methotrexate is often given with
methotrexate is administered
methotrexate SE (6)
stimulate adenosine release
folic acid
PO, SQ (1/week)
liver, marrow, GI, hair, oral (ulcer), lung
methotrexate MOA
stimulate adenosine release
methotrexate is often given with
folic acid
89 terms
Rheum Pharm
DOC for RA
MOA of methotrexate
Methotrexate onset of action
How often is methotrexate dosed
methotrexate (Trexall)
-competitively inhibits dihydrofolate reductase (DHF)... -anti-i…
2-3 weeks
weekly
DOC for RA
methotrexate (Trexall)
MOA of methotrexate
-competitively inhibits dihydrofolate reductase (DHF)... -anti-i…
Rheum a
Rheum gen info
Hands
Keep own hands behind back while exami…
Describing rheum
Don't shake hand... Cross arms to start w to see nodules, tophi…
Scars from tendon releases... "The nails look normal" don't men…
Vgg
"Bilateral symmetrical polyarthropathy" before saying specifi…
Rheum gen info
Don't shake hand... Cross arms to start w to see nodules, tophi…
Hands
Scars from tendon releases... "The nails look normal" don't men…
38 terms
rheum cases
normal interface between cartilage and…
RA... circle: pannus eroding into cartila…
RA... star: pannus... triple arrow: fragment…
rheumatoid nodule (RA)
Case 1
Case 1
Case 1
Case 1
normal interface between cartilage and…
Case 1
RA... circle: pannus eroding into cartila…
Case 1
24 terms
Rheum Tx
OA
Avascular Necrosis
Acute Septic Arthritis
Disseminated Neisseria Gonorrhea
Rest... WL... ROM strengthening... Walking aids to dec weight bearing…
- avoid weight bearing on affected joint for several weeks... -…
I&D... IV Abx empirically (staph, pneumococcai, gram -) until cu…
Admit to r/o infective endocarditis... **CEFTRIAXONE IV (switch…
OA
Rest... WL... ROM strengthening... Walking aids to dec weight bearing…
Avascular Necrosis
- avoid weight bearing on affected joint for several weeks... -…
37 terms
Rheum Labs
ANA: antinuclear antibody
Anti DNA
RA factor
ESR + CRP
SLE... progressive systemic sclerosis
SLE
RA... Hep C
Inflammation
ANA: antinuclear antibody
SLE... progressive systemic sclerosis
Anti DNA
SLE
11 terms
Rheum Tests
OA
Avascular Necrosis
Acute Septic Arthritis
Disseminated Neisseria Gonorrhea
Plain XR
XR initially... MRI and CT more sensitive
Joint aspiration if no cellulitis... Blood cultures ... XR
Culture
OA
Plain XR
Avascular Necrosis
XR initially... MRI and CT more sensitive
110 terms
Rheum & Derm
REVIEW: What drug category has each of…
REVIEW: Which alpha-adrenergic antagon…
Why do the kidneys retain fluid in hea…
Where does new bone formation take pla…
-olol = beta blocker... -oxin = Cardiac Glycoside... -pril = ACE In…
Phenoxybenzamine - an irreversible alpha-blocker used preoper…
Hypoperfusion of the kidneys causes the release of renin whic…
In the Epiphyseal plate where the cartilage is being formed a…
REVIEW: What drug category has each of…
-olol = beta blocker... -oxin = Cardiac Glycoside... -pril = ACE In…
REVIEW: Which alpha-adrenergic antagon…
Phenoxybenzamine - an irreversible alpha-blocker used preoper…
22 terms
Random rheum
How is SLE diagnosed?
What are 4 antibody tests used in SLE…
How is SLE generally managed? What are…
What are the 2 patterns of mortality i…
4/11 of: Malar, discoid rash; serositis; oral ulcers; arthrit…
ANA positive in 98% (could be MCTD, sjorgens, crest, other AI…
HCQ good, sun protection, Vit D replace. Arthritis - NSAIDS,…
Early - active disease/nephritis & infections. Late - atheros…
How is SLE diagnosed?
4/11 of: Malar, discoid rash; serositis; oral ulcers; arthrit…
What are 4 antibody tests used in SLE…
ANA positive in 98% (could be MCTD, sjorgens, crest, other AI…
16 terms
rheum pharm
DMARDS
DMARDS main 3 for RA
Methotrexate
Sulfasalazine
Disease modifying Anti-Rheumatic Drugs
Methotrexate ... Sulfasalazine... Prednisone
(-) THF Red (-) purine synth... Drug of choice in RA: pO 1/week…
decreases RF: IgM + IgA, T,B cells + cytokines... orally/daily…
DMARDS
Disease modifying Anti-Rheumatic Drugs
DMARDS main 3 for RA
Methotrexate ... Sulfasalazine... Prednisone
Rheum therapeutics
COX-1 vs. COX-2
COX-1 side effects/COX-2 side effects
CS effects on bone health?
Ways to decrease CS effects on bone?
Cox 1 is constitutive while COX 2 is reversible. COX-1 leads…
COX1: GI bleeding/dystress; platelet disfunction / COX2: Card…
Can cause osteoporosis and significant morbidity and mortalit…
Give bisphosphonates in post-menopausal pts, consider screening
COX-1 vs. COX-2
Cox 1 is constitutive while COX 2 is reversible. COX-1 leads…
COX-1 side effects/COX-2 side effects
COX1: GI bleeding/dystress; platelet disfunction / COX2: Card…
36 terms
Rheum Vercel
Acute Inflammatory Arthropathy
Crystalline
Gout
Gout Pathophysiology
-Crystalline... -Septic... -Viral... -Reactive
-Acute, one joint, relapse & remit... -Gout/Pseudogout
-sudden severe pain/swelling of ONE joint... -followed by high p…
-Monosodium Urate crystals within synovium-precipitate (burst…
Acute Inflammatory Arthropathy
-Crystalline... -Septic... -Viral... -Reactive
Crystalline
-Acute, one joint, relapse & remit... -Gout/Pseudogout
64 terms
EOR Rheum
autoimmune dz attack exocrine glands:…
Primay sxs occur alone
What is the diagnostic TOC for sjogren…
What dx test is most specific for sjog…
Sjogrens
Secondary sxs are associated with SLE, RA
ANA: antiSS-A (Ro) and antiSS-B (La)... + RF, Schirmer test - sh…
anti SSB (La)
autoimmune dz attack exocrine glands:…
Sjogrens
Primay sxs occur alone
Secondary sxs are associated with SLE, RA
106 terms
Rheum Pharm
List the non-biologic DMARDs
Review the guideline recommendations f…
Review the guideline recommendations f…
Review the guideline recommendations f…
Methotrexate (Texall)... Leflunomide (Arava)... Sulfasalazine (Azul…
methotrexate, leflunomide, sulfasalazine or combination DMARD
hydroxychloroquine or minocycline
methotrexate, leflunomide, sulfasalazine, or combination DMARD
List the non-biologic DMARDs
Methotrexate (Texall)... Leflunomide (Arava)... Sulfasalazine (Azul…
Review the guideline recommendations f…
methotrexate, leflunomide, sulfasalazine or combination DMARD
28 terms
Rheum Mabee
Genes associated with RA
bouchard nodes
Heberden nodes
Ankylosis
HLA-DR4 genes
PIPJ
DIPJ
Destruction of joint by fibrosis and loss of articular cartil…
Genes associated with RA
HLA-DR4 genes
bouchard nodes
PIPJ
18 terms
Rheum3
saddle nose deformity for upper respir…
kidney biopsy is easiest to obtain
same as GPA minus involvement
antibody is P-ANCA
GPA
GPA
MPA
MPA
saddle nose deformity for upper respir…
GPA
kidney biopsy is easiest to obtain
GPA
77 terms
Rheum Tx
non biologic disease modifying tx exam…
biologic disease modifying tx examples
corticosteroids as tx basics
corticosteroids- dosing for different…
- methotrexate... - sulfasalazine... - hydroxychloroquine... - lefluno…
1. anti-TNF agents (etanercept, infliximab, adalimumab, golim…
- rapid onset of effect... - anti inflammatory... - numerous and co…
1. low dose: jt inflammation in RA may improve... 2. high dose:…
non biologic disease modifying tx exam…
- methotrexate... - sulfasalazine... - hydroxychloroquine... - lefluno…
biologic disease modifying tx examples
1. anti-TNF agents (etanercept, infliximab, adalimumab, golim…
60 terms
Rheum3
Rheumatoid arthritis
RA systemic effects from inflammation
Mech of RA
Normal synovial lining
systemic, inflammatory erosive symmetric polyarthritis that l…
bc of increased inflammation... - MI, strokes... - infections ... - ly…
1. unknown antigen triggers disease in genetically susceptibl…
Type A synoviocytes: macrophage-like (majority), make cytokin…
Rheumatoid arthritis
systemic, inflammatory erosive symmetric polyarthritis that l…
RA systemic effects from inflammation
bc of increased inflammation... - MI, strokes... - infections ... - ly…
48 terms
Rheum2
Gout, who gets it
Manifestations secondary to hyperurice…
Enzymes in urate metabolism, excretion…
Underexcretion causes of gout
Deposition of monosodium urate crystals in soft tissue ... - M…
can be asymptomatic... - joint: acute intermittent arthritis, co…
PRPP synthetase: urate synthesis limiting step... Xanthine oxida…
90% of gout cases! ... - dehydration, starvation, ketosis... - rena…
Gout, who gets it
Deposition of monosodium urate crystals in soft tissue ... - M…
Manifestations secondary to hyperurice…
can be asymptomatic... - joint: acute intermittent arthritis, co…
83 terms
IM Rheum
joint pain acute vs chr... give 4 acute…
joint aspiration: describe quality, WB…
joint aspiration: describe quality, WB…
antibodies for the following diseases:…
acute - toxic (trauma, septic, crystal, reactive)... chr - if n…
normal: serous (clear), 5, 25%, neg, neg... OA: serous, 5, 25%,…
inflm: opaque (white), >5 but <50,000, 75%, neg, present... sep…
lupus - ANA... RA - antiCCP (better)... RA - RF... drug induced lupus…
joint pain acute vs chr... give 4 acute…
acute - toxic (trauma, septic, crystal, reactive)... chr - if n…
joint aspiration: describe quality, WB…
normal: serous (clear), 5, 25%, neg, neg... OA: serous, 5, 25%,…
29 terms
Rheum Vasculidites
Diagnosis features of Temporal Arterit…
Clinical feature of Temporal Arteritis…
what is the treatment for Temporal Art…
Discuss the etiology of Takayasus Arte…
-age group over 50,... - new headache... Palpable temporal arteries…
Malaise, fatique, weight loss, fever... Visual impairment (may l…
Prednisone (high dose) start immediately
Common in young asian women... Affect aortic arch and its branches
Diagnosis features of Temporal Arterit…
-age group over 50,... - new headache... Palpable temporal arteries…
Clinical feature of Temporal Arteritis…
Malaise, fatique, weight loss, fever... Visual impairment (may l…
63 terms
Rheum - Pharm
APAP
First line for OA
APAP ADEs
APAP Dose
Acetopinophen
APAP
Hepatotoxicity, interactions with warfarin, pregnancy B
≤1g QID
APAP
Acetopinophen
First line for OA
APAP
32 terms
Rheum Drugs
DMARDs
Hydroxychloroquine
Sulfasalazine
Methotrexate
- Hydroxychloroquine... - Sulfasalazine... - Methotrexate... - Azathio…
- DMARD used in RA and lupus... - In lupus, use before severe di…
- DMARD used for RA, PA, IBD... - Dosing: 2-4g ... - Efficacy: Mode…
- DMARD gold standard for RA and used in lymphoma... - Dosing: 5…
DMARDs
- Hydroxychloroquine... - Sulfasalazine... - Methotrexate... - Azathio…
Hydroxychloroquine
- DMARD used in RA and lupus... - In lupus, use before severe di…
Rheum Eval
- recorded in mm/hr ... - represents the…
true... also naturally higher in women >…
a relatively common chronic inflammato…
C-reactive protein
What even is a Sed Rate?
True or False: sed rates increase with age
What is polymyalgia rheumatica?
Which responds more quickly to changes in disease state: CRP…
- recorded in mm/hr ... - represents the…
What even is a Sed Rate?
true... also naturally higher in women >…
True or False: sed rates increase with age
171 terms
Ortho/ Rheum
What ortho issues worry parent?
What are causes of in-toeing?
What are causes of out toeing?
What is metatarsus varus/ adductus?
In-toeing & out-toeing
Metatarsus varus... Tibial torsion... Femoral anteversion
Less common... Lateral rotation of hips
Common congenital foot deformity of metatarsal bones with inw…
What ortho issues worry parent?
In-toeing & out-toeing
What are causes of in-toeing?
Metatarsus varus... Tibial torsion... Femoral anteversion
64 terms
rheum dz
RA ssx
RA DX
Ra Tx
Felty syndrome
MTP, MCP, PIP... Swan neck (PIP hyperflex), boutonniere deformit…
Labs: + RF, anti-CCP... Symmetric joint space narrowing, erosion…
1st line = MTX (then anti-TNF,... mild/ pregnant = Plaquenil -…
RA, splenomegaly, neutropenia... MC rheum dz
RA ssx
MTP, MCP, PIP... Swan neck (PIP hyperflex), boutonniere deformit…
RA DX
Labs: + RF, anti-CCP... Symmetric joint space narrowing, erosion…
89 terms
Rheum Pharm
DOC for RA
MOA of methotrexate
Methotrexate onset of action
How often is methotrexate dosed
methotrexate (Trexall)
-competitively inhibits dihydrofolate reductase (DHF)... -anti-i…
2-3 weeks
weekly
DOC for RA
methotrexate (Trexall)
MOA of methotrexate
-competitively inhibits dihydrofolate reductase (DHF)... -anti-i…
36 terms
UWorld Rheum
DMARDS... MECH & SE... MTX... Leflunomide... Hydro…
Polymyalgia rheumatic... Viral arthritis…
Flip... Pyoderma gangrenosum... cause? dx? t…
Flip... Ecythyma gangrenosum... Psuedomonas
DMARDS... MECH & SE... MTX... Leflunomide... Hydro…
Polymyalgia rheumatic... Viral arthritis…
60 terms
Rheum and Derm
Primary bone tumors: Osteochondroma
Primary bone tumors: Osteoclastoma
Primary bone tumors: Osteosarcoma
Primary bone tumors: Ewing Sarcoma
- Benign... - Males <25yo... - Characteristics on XRAY: Cartilagin…
- "Giant cell tumor" ... - Locally aggressive benign tumor ... - Lo…
- Malignant and aggressive: 2nd most common primary malignant…
- Malignant and very aggressive... - Location: Disphysis of long…
Primary bone tumors: Osteochondroma
- Benign... - Males <25yo... - Characteristics on XRAY: Cartilagin…
Primary bone tumors: Osteoclastoma
- "Giant cell tumor" ... - Locally aggressive benign tumor ... - Lo…
51 terms
CM Rheum
can gout destroy joints?
what is the classic onset of gout?
how do you diagnose gout?
where is gout most often found? pseudo…
yes, in chronic form
acute, asymmetric, monoarticular, early evening or AM. often…
aspiration of joint: see monosodium rate crystals in soft tis…
gout: MPJ of 1st toe. Also extremeities--where the body is co…
can gout destroy joints?
yes, in chronic form
what is the classic onset of gout?
acute, asymmetric, monoarticular, early evening or AM. often…
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