Rheumatology

A

• Acute Gout Flare - Treatment Algorithm

  Treat acute gout with monotherapy at appropriate anti inflammatory doses using NSAID, colchicine, or steroid; avoid starting urate lowering therapy during the flare unless already on it.
• Adult‑Onset Still Disease — Treatment Escalation (IL‑1/IL‑6)

  Inflammatory syndrome with quotidian fevers, evanescent salmon rash, and arthritis; ferritin often very high. Treat with NSAIDs/steroids; early IL‑1/IL‑6 inhibitors for steroid‑sparing; monitor for MAS.
• ANCA Vasculitis - Pulmonary Renal Syndrome Initial Management

  Hemoptysis or rapidly progressive glomerulonephritis suggests life threatening vasculitis; stabilize airway and oxygenation, obtain labs and serologies, and start high dose steroids with urgent specialty input.
• Antiphospholipid Syndrome — Diagnosis & Anticoagulation

  APS requires clinical events (thrombosis or pregnancy morbidity) plus persistent aPL antibodies ≥12 weeks apart. Treat with anticoagulation (warfarin preferred for high‑risk) and manage pregnancy with LMWH + aspirin.

C

• Calcium Pyrophosphate Disease - Acute Arthritis Management

  Treat acute CPPD with NSAID, colchicine, or steroid after excluding septic arthritis; consider joint aspiration and evaluate for metabolic associations.

G

• Giant Cell Arteritis - High Dose Steroids and Vision Protection

  New headache, scalp tenderness, jaw claudication, or vision symptoms in older adults warrant urgent steroids and diagnostic confirmation to prevent blindness.
• Giant Cell Arteritis — High-Dose Glucocorticoids, Temporal Artery Biopsy, and Steroid-Sparing

  Age ≥50 with new headache, scalp tenderness, jaw claudication, or visual symptoms. Start high‑dose glucocorticoids immediately to prevent vision loss; confirm with temporal artery biopsy or vascular imaging; consider tocilizumab or methotrexate as steroid‑sparing agents and monitor for large‑vessel involvement.
• Giant Cell Arteritis — Immediate High‑Dose Steroids, Biopsy/Imaging, and Vision Protection

  In patients ≥50 with headache, scalp tenderness, jaw claudication, or visual symptoms, start high‑dose glucocorticoids immediately to prevent vision loss, then confirm with temporal artery biopsy (within 1–2 weeks) or vascular imaging. Consider steroid‑sparing tocilizumab in relapsing disease.
• Giant Cell Arteritis — Rapid Steroids, Imaging/Biopsy, and Vision Protection

  Age ≥50 with new headache, scalp tenderness, jaw claudication, or vision symptoms. Start high‑dose glucocorticoids immediately to protect vision; obtain temporal artery biopsy within 1–2 weeks and consider vascular imaging; add tocilizumab in selected patients.
• Gout - Urate Lowering Therapy Initiation and Titration

  Start allopurinol or febuxostat for frequent flares, tophi, or urate nephrolithiasis; titrate to serum urate target with flare prophylaxis and lifestyle counseling.
• Gout Flare — ED Treatment

  Treat acute inflammatory arthritis with NSAIDs, colchicine, or corticosteroids depending on comorbidities and timing; aspirate joint when septic arthritis is a concern.
• Gout — Treat‑to‑Target Urate‑Lowering Therapy

  Chronic gout requires urate‑lowering therapy to a serum urate target <6 mg/dL (<5 if tophaceous). Allopurinol is first‑line for all CKD stages; use prophylaxis during initiation and escalate doses as needed.

H

• Hypermobility Spectrum Disorders — Evaluation & Management

  Assess generalized joint hypermobility (Beighton score) and classify hypermobility spectrum disorders vs hypermobile EDS. Management focuses on core/hip stabilizer strengthening, pain rehabilitation, and joint protection.

I

• IgG4‑Related Disease — Multiorgan Presentation & Management

  Systemic fibroinflammatory condition affecting pancreas, biliary tree, salivary glands, kidneys, etc. Characterized by tumefactive lesions, storiform fibrosis, and elevated IgG4+ plasma cells. Treat with glucocorticoids and consider rituximab for relapse or maintenance.
• Inflammatory Myositis - Initial Workup

  Proximal muscle weakness with elevated muscle enzymes warrants evaluation with autoantibodies, electromyography, imaging, and biopsy planning with specialty teams.

P

• Polymyalgia Rheumatica - Initial Management

  Bilateral shoulder and hip girdle pain with morning stiffness in older adults improves with low to moderate dose glucocorticoids; evaluate for associated giant cell arteritis.
• Polymyositis & Dermatomyositis — Diagnosis & Treatment

  Idiopathic inflammatory myopathies cause proximal weakness (± rash in DM). Confirm with muscle enzymes, myositis antibodies, MRI/EMG, and biopsy when needed. Treat with glucocorticoids plus steroid‑sparing agents; screen for malignancy and ILD.

R

• Relapsing Polychondritis — Recognition & Treatment

  Autoimmune inflammation of cartilaginous structures (ears, nose, laryngotracheal tree). Diagnose clinically; treat with NSAIDs/steroids and disease‑modifying agents; airway involvement is life‑threatening.
• Rheumatoid Arthritis - Initial DMARD Strategy

  Start conventional synthetic DMARD therapy early with treat to target strategy, add short term steroid bridge only when necessary, and monitor disease activity and toxicity.

S

• Sarcoidosis — Extrapulmonary Manifestations & Care

  Beyond pulmonary disease, sarcoidosis affects eyes, heart, skin, liver, and nervous system. Screen key organs and treat when organ‑threatening or symptomatic; use steroid‑sparing agents for chronic disease.
• Scleroderma (Systemic Sclerosis) — Organ Screening & Management

  Multisystem autoimmune disease; early organ screening is essential (ILD, PAH, renal crisis). Manage with targeted therapies: mycophenolate for ILD/skin, vasodilators for PAH/Raynaud, ACE inhibitors for renal crisis.
• Scleroderma Renal Crisis - ACE Inhibitor Urgency

  Sudden hypertension and acute kidney injury in systemic sclerosis require immediate ACE inhibitor therapy and close monitoring, with avoidance of high dose steroid when possible.
• Systemic Lupus Flare - Evaluation and Initial Treatment

  Differentiate flare from infection, obtain targeted labs, treat based on organ involvement severity, and coordinate specialty care.

V

• Vasculitis — Large Vessel Imaging & Steroid‑Sparing Agents

  Large‑vessel vasculitis (GCA/Takayasu): use vascular imaging (US, CTA/MRA, PET) and prompt glucocorticoids; add steroid‑sparing agents (tocilizumab) to reduce relapse and exposure.