Rheumatology and Clinical Immunology by coll.
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Extra info for Rheumatology and Clinical Immunology
Patients with lupus may be hypocomplementaemic as Station 2: History Taking 21 RAC_C01 12/15/10 11:01 Page 22 RHEUMATOLOGY AND CLINICAL IMMUNOLOGY: PACES STATIONS AND ACUTE SCENARIOS • C-reactive protein: marker of inflammation/infection. This is often normal in active uncomplicated lupus despite elevated erythrocyte sedimentation rate or plasma viscosity. Fig. 11 Mouth ulcers in a patient with active lupus. a result of active disease and/or possession of one or more C4 null alleles. Antiphospholipid antibodies Check for anticardiolipin antibodies and lupus anticoagulant.
Subacute insidious polyarthritis. 1). 4). • Infection: recent diarrhoea or urethritis. • Drug history: what analgesia has been tried so far? Has the patient taken any drugs that might have precipitated the problem, eg diuretics causing gout or drug-induced SLE (minocycline). It is important to explore the functional limitations caused by the arthritis, and the impact of these limitations on the particular patient. Ask ‘Can you wash and dress yourself without any difficulty? ’ Also enquire about examples of daily tasks that the patient struggles or needs help with (and what help is available to them).
General measures: patient education; advise patients to keep their hands warm. • Smoking cessation: this should be strongly encouraged. Dear Doctor, Re: Mrs Beth Stokes, aged 53 years Thank you for seeing this woman who has had dry eyes for over 6 months. It is uncomfortable Station 2: History Taking 25 RAC_C01 12/15/10 11:01 Page 26 RHEUMATOLOGY AND CLINICAL IMMUNOLOGY: PACES STATIONS AND ACUTE SCENARIOS TABLE 9 CAUSES and appears to be interfering OF BILATERAL PAROTID ENLARGEMENT with her work.