Morning Rounds \u00b7 Rheumatology<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#mrq01 *,#mrq01 *::before,#mrq01 *::after{box-sizing:border-box;margin:0;padding:0}\n#mrq01{\n --ter:#B85A38;--ter-light:#D4735A;--ter-pale:#FDF0EB;--ter-dark:#8B3D20;\n --correct:#2D6B47;--correct-bg:#EAF6EF;--correct-border:#3A9960;\n --wrong:#B83232;--wrong-bg:#FDF0F0;--wrong-border:#E53935;\n --ink:#2C1810;--ink-mid:#5A3D30;--ink-soft:#9A7060;\n --line:#E8DDD8;--cream:#FAF6F2;--warm:#FFFDF9;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;color:var(--ink);background:var(--cream);\n line-height:1.7;padding:0 0 64px;\n}\n#mrq01 .mr-header{\n background:var(--ter);color:#FFFDF9;\n padding:34px 24px 28px;text-align:center;\n}\n#mrq01 .mr-eyebrow{\n font-size:0.68rem;letter-spacing:0.18em;text-transform:uppercase;\n 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.mr-stem{font-size:0.9rem}\n #mrq01 .mr-opt-text{font-size:0.86rem}\n}\n<\/style>\n<\/head>\n<body>\n\n\n<div id=\"mrq01-img1\" style=\"display:none\">\n <figure class=\"mr-img-wrap\">\n <svg viewBox=\"0 0 520 200\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:520px;display:block;margin:0 auto\">\n <rect x=\"0\" y=\"0\" width=\"250\" height=\"200\" rx=\"8\" fill=\"#0a0a1a\"\/>\n <rect x=\"270\" y=\"0\" width=\"250\" height=\"200\" rx=\"8\" fill=\"#0a0a1a\"\/>\n <text x=\"125\" y=\"18\" text-anchor=\"middle\" fill=\"#aaaaaa\" font-size=\"10\" font-family=\"Georgia,serif\">GOUT \u00b7 MSU<\/text>\n <text x=\"395\" y=\"18\" text-anchor=\"middle\" fill=\"#aaaaaa\" font-size=\"10\" font-family=\"Georgia,serif\">PSEUDOGOUT \u00b7 CPPD<\/text>\n <text x=\"125\" y=\"190\" text-anchor=\"middle\" fill=\"#666666\" font-size=\"9\">\u2190 slow axis \u2192<\/text>\n <text x=\"395\" y=\"190\" text-anchor=\"middle\" fill=\"#666666\" font-size=\"9\">\u2190 slow axis \u2192<\/text>\n <line x1=\"38\" y1=\"80\" x2=\"202\" y2=\"88\" stroke=\"#F0C040\" stroke-width=\"5\" stroke-linecap=\"round\" opacity=\"0.95\"\/>\n <line x1=\"52\" y1=\"108\" x2=\"192\" y2=\"114\" stroke=\"#F0C040\" stroke-width=\"3.5\" stroke-linecap=\"round\" opacity=\"0.82\"\/>\n <line x1=\"62\" y1=\"132\" x2=\"178\" y2=\"138\" stroke=\"#D4A020\" stroke-width=\"3\" stroke-linecap=\"round\" opacity=\"0.7\"\/>\n <line x1=\"156\" y1=\"46\" x2=\"161\" y2=\"155\" stroke=\"#5090E8\" stroke-width=\"3\" stroke-linecap=\"round\" opacity=\"0.65\"\/>\n <text x=\"120\" y=\"66\" text-anchor=\"middle\" fill=\"#F0C040\" font-size=\"9\" font-family=\"Georgia,serif\">yellow (parallel)<\/text>\n <text x=\"176\" y=\"150\" text-anchor=\"middle\" fill=\"#6888D0\" font-size=\"8.5\" font-family=\"Georgia,serif\">blue (perp)<\/text>\n <text x=\"125\" y=\"175\" text-anchor=\"middle\" fill=\"#888888\" font-size=\"8\" font-family=\"Georgia,serif\" font-style=\"italic\">Negative birefringence<\/text>\n <polygon points=\"318,76 360,64 382,92 340,104\" fill=\"none\" stroke=\"#5090E8\" stroke-width=\"3\" opacity=\"0.9\"\/>\n <polygon points=\"354,102 400,92 416,118 370,128\" fill=\"none\" stroke=\"#5090E8\" stroke-width=\"2.5\" opacity=\"0.8\"\/>\n <polygon points=\"294,118 330,110 346,132 310,140\" fill=\"none\" stroke=\"#6898DC\" stroke-width=\"2\" opacity=\"0.7\"\/>\n <polygon points=\"402,54 432,78 422,102 392,78\" fill=\"none\" stroke=\"#D4A828\" stroke-width=\"2.5\" opacity=\"0.6\"\/>\n <text x=\"395\" y=\"158\" text-anchor=\"middle\" fill=\"#5090E8\" font-size=\"9\" font-family=\"Georgia,serif\">blue (parallel)<\/text>\n <text x=\"395\" y=\"175\" text-anchor=\"middle\" fill=\"#888888\" font-size=\"8\" font-family=\"Georgia,serif\" font-style=\"italic\">Weakly positive birefringence<\/text>\n <\/svg>\n <figcaption>Polarised light microscopy with red compensator. MSU (gout): needle-shaped, <strong>negatively birefringent<\/strong> \u2014 yellow when parallel to the slow axis. CPPD (pseudogout): rhomboid, <strong>weakly positively birefringent<\/strong> \u2014 blue when parallel.<\/figcaption>\n <\/figure>\n<\/div>\n\n<div id=\"mrq01\">\n\n <div class=\"mr-header\">\n <div class=\"mr-eyebrow\">Morning Rounds \u00b7 Daily Clinical Quiz<\/div>\n <div class=\"mr-title\">Rheumatology<br><em>Clinical Reasoning<\/em><\/div>\n <div class=\"mr-subtitle\">Five cases · Read carefully · Trust your instinct<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Cases<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"mr-sentinel\" id=\"mrq01-sentinel\"><\/div>\n\n <div class=\"mr-progress\" id=\"mrq01-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"mrq01-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n <div id=\"mrq01-cases\"><\/div>\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"mrq01-submit\">Submit for Debrief<\/button>\n <\/div>\n <div class=\"mr-score\" id=\"mrq01-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Round Complete<\/div>\n <div class=\"mr-ring\" id=\"mrq01-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"mrq01-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"mrq01-net\"><\/div>\n <div class=\"mr-verdict\" id=\"mrq01-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"mrq01-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"mrq01-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"mrq01-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"mrq01-retry\">↻ New Round<\/button>\n <\/div>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function () {\n 'use strict';\n\n var NS = 'mrq01';\n var TOTAL = 5;\n var MAX = 20;\n var LTRS = ['A','B','C','D'];\n\n \/* \u2500\u2500 Questions \u2500\u2500 *\/\n var QS = [\n {\n id: 1,\n tag: 'Crystal Arthropathy',\n stem: 'A <strong>68-year-old man<\/strong> presents with a 12-hour history of an acutely swollen, erythematous, exquisitely tender <strong>first metatarsophalangeal joint<\/strong>. He has been on hydrochlorothiazide for five years. Synovial fluid is aspirated and examined under polarised light with a red compensator. Which finding confirms the diagnosis?',\n correct: 'Needle-shaped crystals appearing yellow when aligned parallel to the slow axis',\n opts: [\n 'Needle-shaped crystals appearing yellow when aligned parallel to the slow axis',\n 'Rhomboid crystals appearing blue when aligned parallel to the slow axis',\n 'Needle-shaped crystals appearing blue when aligned parallel to the slow axis',\n 'Rhomboid crystals appearing yellow when aligned parallel to the slow axis'\n ],\n exp: 'Monosodium urate (MSU) crystals are <strong>needle-shaped<\/strong> and <strong>negatively birefringent<\/strong> \u2014 yellow when the long axis lies <em>parallel<\/em> to the compensator slow axis, blue when perpendicular. CPPD crystals (pseudogout) are <strong>rhomboid<\/strong> and <strong>weakly positively birefringent<\/strong> \u2014 blue parallel, yellow perpendicular. Hydrochlorothiazide reduces renal uric acid excretion and is a classic pharmacological precipitant of gout.',\n imgId: 'mrq01-img1'\n },\n {\n id: 2,\n tag: 'RA \u2014 Treatment Escalation',\n stem: 'A <strong>44-year-old woman<\/strong> has had symmetric polyarthritis of MCP and PIP joints for nine months. She has been on <strong>methotrexate 20 mg\/week<\/strong> for four months. Current assessment: morning stiffness 90 min, DAS28-CRP 5.4, anti-CCP antibody 3× upper limit of normal, CRP 28 mg\/L. What is the most appropriate next step?',\n correct: 'Add a TNF inhibitor to methotrexate',\n opts: [\n 'Add a TNF inhibitor to methotrexate',\n 'Switch methotrexate to leflunomide',\n 'Add hydroxychloroquine and sulfasalazine (triple therapy)',\n 'Increase methotrexate to 25 mg\/week and reassess in 3 months'\n ],\n exp: 'Per <strong>EULAR 2022<\/strong> recommendations: if a cDMARD at adequate dose and duration fails <em>and<\/em> poor prognostic markers are present \u2014 high anti-CCP, elevated CRP, high DAS28, erosions \u2014 a <strong>biologic DMARD or JAK inhibitor should be added<\/strong>. A TNF inhibitor combined with methotrexate is the preferred first biologic strategy. Dose-escalating methotrexate beyond 20 mg\/week is not appropriate once poor-prognosis markers are established; switching within cDMARDs loses critical time.',\n imgId: null\n },\n {\n id: 3,\n tag: 'SLE \u2014 Lupus Nephritis',\n stem: 'A <strong>27-year-old woman<\/strong> with known SLE presents with proteinuria 2.8 g\/day and haematuria. Creatinine has risen from 72 to 118 μmol\/L over 8 weeks. Anti-dsDNA markedly elevated; C3 and C4 both <em>low<\/em>. Renal biopsy shows endocapillary proliferation in >50% of glomeruli with subendothelial immune deposits. What is the ISN\/RPS class, and what does the complement pattern signify?',\n correct: 'Class IV; low C3\/C4 reflects classical pathway consumption by immune complexes',\n opts: [\n 'Class IV; low C3\/C4 reflects classical pathway consumption by immune complexes',\n 'Class III; hypocomplementaemia is a non-specific acute-phase response',\n 'Class V; low complement confirms immune-mediated membranous disease',\n 'Class II; low complement indicates mesangial lupus with activity'\n ],\n exp: '<strong>ISN\/RPS Class IV<\/strong> (diffuse proliferative lupus nephritis) is defined by involvement of >50% of glomeruli and carries the worst renal prognosis. Low <strong>C3 and C4<\/strong> reflect activation of the <strong>classical complement pathway<\/strong> by circulating immune complexes, with resultant consumption \u2014 complement levels mirror disease activity and are used in longitudinal monitoring alongside anti-dsDNA titres. <strong>Induction therapy<\/strong>: mycophenolate mofetil 2–3 g\/day or IV cyclophosphamide (Euro-Lupus protocol) combined with high-dose corticosteroids.',\n imgId: null\n },\n {\n id: 4,\n tag: 'Giant Cell Arteritis',\n stem: 'A <strong>74-year-old woman<\/strong> presents with a 4-week history of right temporal headache and jaw claudication. ESR 108 mm\/hr, CRP 62 mg\/L. She reports <strong>two episodes of transient visual blurring<\/strong> in the right eye over the past week. What is the correct immediate management?',\n correct: 'Start prednisolone 60 mg\/day immediately; arrange temporal artery biopsy within 2 weeks',\n opts: [\n 'Start prednisolone 60 mg\/day immediately; arrange temporal artery biopsy within 2 weeks',\n 'Arrange urgent temporal artery biopsy before starting any treatment',\n 'Start low-dose aspirin and await biopsy result before committing to steroids',\n 'Order PET-CT to confirm large vessel involvement before treatment'\n ],\n exp: 'In GCA with <strong>visual symptoms<\/strong>, high-dose prednisolone (60 mg\/day; IV methylprednisolone 500 mg–1 g daily for 3 days if acute visual loss has occurred) must be started <em>immediately without waiting for biopsy<\/em>. The threat is <strong>anterior ischaemic optic neuropathy<\/strong>, which can progress to permanent blindness within hours of a warning episode. <strong>Biopsy diagnostic accuracy is preserved for 2–4 weeks<\/strong> after steroid initiation \u2014 obtaining histology must never delay treatment. This principle is explicitly stated in BSR 2020 and ACR\/EULAR 2021 guidelines.',\n imgId: null\n },\n {\n id: 5,\n tag: 'Axial Spondyloarthritis',\n stem: 'A <strong>31-year-old HLA-B27 positive man<\/strong> has had low back pain for 20 months. Pain wakes him in the second half of the night, is accompanied by 75 minutes of morning stiffness, and notably <em>improves with exercise but not with rest<\/em>. Onset was insidious before age 40. Pelvic X-ray shows bilateral grade II sacroiliitis. Which one correctly characterises the pain pattern?',\n correct: 'ASAS inflammatory back pain criteria — he satisfies all five features',\n opts: [\n 'ASAS inflammatory back pain criteria — he satisfies all five features',\n 'Modified New York criteria — bilateral grade II sacroiliitis with one clinical feature',\n 'BASDAI ≥4 indicating high disease activity requiring biologic therapy',\n 'Calin criteria — he meets only 4 of the 5 required features'\n ],\n exp: 'The <strong>ASAS criteria for inflammatory back pain<\/strong> require ≥4 of 5 features: age of onset <40; insidious onset; improvement with exercise; <em>no improvement with rest<\/em>; nocturnal pain improving on getting up. This patient satisfies <strong>all five<\/strong>. He also satisfies the <strong>modified New York criteria for radiographic axial SpA<\/strong> (bilateral grade II sacroiliitis + ≥1 clinical feature) \u2014 but the question asks about characterising the pain pattern, which is the ASAS criteria. BASDAI measures disease activity and is not a diagnostic criterion for back pain characterisation.',\n imgId: null\n }\n ];\n\n \/* \u2500\u2500 State \u2500\u2500 *\/\n var answers = {};\n var answered = 0;\n var shuffled = {};\n var done = false;\n\n \/* \u2500\u2500 Helpers \u2500\u2500 *\/\n function byId(id) { return document.getElementById(id); }\n function gid(suffix) { return byId(NS + '-' + suffix); }\n\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, tmp;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n tmp = a[i]; a[i] = a[j]; a[j] = tmp;\n }\n return a;\n }\n\n function countVal(val) {\n var k, n = 0;\n for (k in answers) {\n if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n }\n return n;\n }\n\n \/* \u2500\u2500 Build pips \u2500\u2500 *\/\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n \/* \u2500\u2500 Build cases \u2500\u2500 *\/\n function build() {\n var cont = gid('cases'), i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, imgDiv, imgSrc, j, optEl, ltrSpan, txtSpan;\n\n cont.innerHTML = '';\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts);\n shuffled[q.id] = opts;\n\n card = document.createElement('div');\n card.className = 'mr-case';\n\n \/* top section *\/\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? 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'correct' : 'wrong');\n if (qid > 1) {\n var pl = gid('pl' + qid);\n if (pl) pl.className = 'mr-pip-line done';\n }\n\n }\n\n \/* \u2500\u2500 Score \u2500\u2500 *\/\n function showScore() {\n var c, w, s, net, pct, disp, verdicts, vi, sc;\n if (done) return;\n done = true;\n\n c = countVal('c');\n w = countVal('w');\n s = TOTAL - answered;\n net = (c * 4) - w;\n pct = Math.max(0, Math.round((net \/ MAX) * 100));\n disp = Math.min(100, Math.max(0, pct));\n\n gid('ring').style.background =\n 'conic-gradient(#B85A38 ' + disp + '%, #E8DDD8 0%)';\n gid('pct').textContent = pct + '%';\n gid('net').textContent = 'Net Score: ' + net + ' \/ ' + MAX;\n\n verdicts = [\n [5, 'Perfect round. Exceptional clinical reasoning.'],\n [4, 'Strong \\u2014 one nuance to revisit.'],\n [3, 'Solid base \\u2014 consolidate the finer distinctions.'],\n [2, 'Halfway there \\u2014 review the missed cases carefully.'],\n [0, 'These cases repay close reading. 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MSU (gout): needle-shaped, negatively birefringent \u2014 yellow when parallel to the slow axis. CPPD (pseudogout): rhomboid, weakly positively birefringent \u2014… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[24],"tags":[],"class_list":["post-36651","post","type-post","status-publish","format-standard","hentry","category-neet-pg"],"yoast_head":"\n<title>Rheumatology Clinical - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rheumatology Clinical - atsixty\" \/>\n<meta property=\"og:description\" content=\"Morning Rounds \u00b7 Rheumatology GOUT \u00b7 MSU PSEUDOGOUT \u00b7 CPPD \u2190 slow axis \u2192 \u2190 slow axis \u2192 yellow (parallel) blue (perp) Negative birefringence blue (parallel) Weakly positive birefringence Polarised light microscopy with red compensator. MSU (gout): needle-shaped, negatively birefringent \u2014 yellow when parallel to the slow axis. 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CPPD (pseudogout): rhomboid, weakly positively birefringent \u2014… ","og_url":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/","og_site_name":"atsixty","article_published_time":"2026-04-20T21:42:39+00:00","article_modified_time":"2026-04-22T01:10:55+00:00","author":"Avi","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Avi","Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/#article","isPartOf":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/"},"author":{"name":"Avi","@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"headline":"Rheumatology Clinical","datePublished":"2026-04-20T21:42:39+00:00","dateModified":"2026-04-22T01:10:55+00:00","mainEntityOfPage":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/"},"wordCount":83,"commentCount":0,"publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"articleSection":["NEET PG"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/","url":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/","name":"Rheumatology Clinical - atsixty","isPartOf":{"@id":"https:\/\/atsixty.com\/#website"},"datePublished":"2026-04-20T21:42:39+00:00","dateModified":"2026-04-22T01:10:55+00:00","breadcrumb":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/atsixty.com\/"},{"@type":"ListItem","position":2,"name":"Rheumatology Clinical"}]},{"@type":"WebSite","@id":"https:\/\/atsixty.com\/#website","url":"https:\/\/atsixty.com\/","name":"At Sixty","description":"The Option Taken","publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/atsixty.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d","name":"Avi","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","url":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","contentUrl":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","width":200,"height":200,"caption":"Avi"},"logo":{"@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png"},"sameAs":["https:\/\/atsixty.com"],"url":"https:\/\/atsixty.com\/index.php\/author\/avinaux\/"}]}},"_links":{"self":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/comments?post=36651"}],"version-history":[{"count":5,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36651\/revisions"}],"predecessor-version":[{"id":36659,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36651\/revisions\/36659"}],"wp:attachment":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/media?parent=36651"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/categories?post=36651"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/tags?post=36651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

{"id":36651,"date":"2026-04-21T03:12:39","date_gmt":"2026-04-20T21:42:39","guid":{"rendered":"https:\/\/atsixty.com\/?p=36651"},"modified":"2026-04-22T06:40:55","modified_gmt":"2026-04-22T01:10:55","slug":"rheumatology-clinical","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/","title":{"rendered":"Rheumatology Clinical"},"content":{"rendered":"\n\n\n\n\n\n\n\nMorning Rounds \u00b7 Rheumatology<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n#mrq01 *,#mrq01 *::before,#mrq01 *::after{box-sizing:border-box;margin:0;padding:0}\n#mrq01{\n --ter:#B85A38;--ter-light:#D4735A;--ter-pale:#FDF0EB;--ter-dark:#8B3D20;\n --correct:#2D6B47;--correct-bg:#EAF6EF;--correct-border:#3A9960;\n --wrong:#B83232;--wrong-bg:#FDF0F0;--wrong-border:#E53935;\n 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.mr-band-s{background:var(--ter-pale);color:var(--ter)}\n#mrq01 .mr-retry{\n display:block;margin:18px auto 4px;background:transparent;\n border:2px solid var(--ter);color:var(--ter);border-radius:8px;\n padding:9px 28px;font-family:'Playfair Display',serif;\n font-size:0.92rem;font-weight:700;cursor:pointer;\n}\n#mrq01 .mr-retry:hover{background:var(--ter);color:#FFFDF9}\n@media(max-width:480px){\n #mrq01 .mr-title{font-size:1.4rem}\n #mrq01 .mr-num{font-size:1.7rem}\n #mrq01 .mr-stem{font-size:0.9rem}\n #mrq01 .mr-opt-text{font-size:0.86rem}\n}\n<\/style>\n<\/head>\n<body>\n\n\n<div id=\"mrq01-img1\" style=\"display:none\">\n <figure class=\"mr-img-wrap\">\n <svg viewBox=\"0 0 520 200\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:520px;display:block;margin:0 auto\">\n <rect x=\"0\" y=\"0\" width=\"250\" height=\"200\" rx=\"8\" fill=\"#0a0a1a\"\/>\n <rect x=\"270\" y=\"0\" width=\"250\" height=\"200\" rx=\"8\" fill=\"#0a0a1a\"\/>\n <text x=\"125\" y=\"18\" text-anchor=\"middle\" fill=\"#aaaaaa\" font-size=\"10\" font-family=\"Georgia,serif\">GOUT \u00b7 MSU<\/text>\n <text x=\"395\" y=\"18\" text-anchor=\"middle\" fill=\"#aaaaaa\" font-size=\"10\" font-family=\"Georgia,serif\">PSEUDOGOUT \u00b7 CPPD<\/text>\n <text x=\"125\" y=\"190\" text-anchor=\"middle\" fill=\"#666666\" font-size=\"9\">\u2190 slow axis \u2192<\/text>\n <text x=\"395\" y=\"190\" text-anchor=\"middle\" fill=\"#666666\" font-size=\"9\">\u2190 slow axis \u2192<\/text>\n <line x1=\"38\" y1=\"80\" x2=\"202\" y2=\"88\" stroke=\"#F0C040\" stroke-width=\"5\" stroke-linecap=\"round\" opacity=\"0.95\"\/>\n <line x1=\"52\" y1=\"108\" x2=\"192\" y2=\"114\" stroke=\"#F0C040\" stroke-width=\"3.5\" stroke-linecap=\"round\" opacity=\"0.82\"\/>\n <line x1=\"62\" y1=\"132\" x2=\"178\" y2=\"138\" stroke=\"#D4A020\" stroke-width=\"3\" stroke-linecap=\"round\" opacity=\"0.7\"\/>\n <line x1=\"156\" y1=\"46\" x2=\"161\" y2=\"155\" stroke=\"#5090E8\" stroke-width=\"3\" stroke-linecap=\"round\" opacity=\"0.65\"\/>\n <text x=\"120\" y=\"66\" text-anchor=\"middle\" fill=\"#F0C040\" font-size=\"9\" font-family=\"Georgia,serif\">yellow (parallel)<\/text>\n <text x=\"176\" y=\"150\" text-anchor=\"middle\" fill=\"#6888D0\" font-size=\"8.5\" font-family=\"Georgia,serif\">blue (perp)<\/text>\n <text x=\"125\" y=\"175\" text-anchor=\"middle\" fill=\"#888888\" font-size=\"8\" font-family=\"Georgia,serif\" font-style=\"italic\">Negative birefringence<\/text>\n <polygon points=\"318,76 360,64 382,92 340,104\" fill=\"none\" stroke=\"#5090E8\" stroke-width=\"3\" opacity=\"0.9\"\/>\n <polygon points=\"354,102 400,92 416,118 370,128\" fill=\"none\" stroke=\"#5090E8\" stroke-width=\"2.5\" opacity=\"0.8\"\/>\n <polygon points=\"294,118 330,110 346,132 310,140\" fill=\"none\" stroke=\"#6898DC\" stroke-width=\"2\" opacity=\"0.7\"\/>\n <polygon points=\"402,54 432,78 422,102 392,78\" fill=\"none\" stroke=\"#D4A828\" stroke-width=\"2.5\" opacity=\"0.6\"\/>\n <text x=\"395\" y=\"158\" text-anchor=\"middle\" fill=\"#5090E8\" font-size=\"9\" font-family=\"Georgia,serif\">blue (parallel)<\/text>\n <text x=\"395\" y=\"175\" text-anchor=\"middle\" fill=\"#888888\" font-size=\"8\" font-family=\"Georgia,serif\" font-style=\"italic\">Weakly positive birefringence<\/text>\n <\/svg>\n <figcaption>Polarised light microscopy with red compensator. MSU (gout): needle-shaped, <strong>negatively birefringent<\/strong> \u2014 yellow when parallel to the slow axis. CPPD (pseudogout): rhomboid, <strong>weakly positively birefringent<\/strong> \u2014 blue when parallel.<\/figcaption>\n <\/figure>\n<\/div>\n\n<div id=\"mrq01\">\n\n <div class=\"mr-header\">\n <div class=\"mr-eyebrow\">Morning Rounds \u00b7 Daily Clinical Quiz<\/div>\n <div class=\"mr-title\">Rheumatology<br><em>Clinical Reasoning<\/em><\/div>\n <div class=\"mr-subtitle\">Five cases · Read carefully · Trust your instinct<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Cases<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n <div class=\"mr-sentinel\" id=\"mrq01-sentinel\"><\/div>\n\n <div class=\"mr-progress\" id=\"mrq01-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"mrq01-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n <div id=\"mrq01-cases\"><\/div>\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"mrq01-submit\">Submit for Debrief<\/button>\n <\/div>\n <div class=\"mr-score\" id=\"mrq01-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Round Complete<\/div>\n <div class=\"mr-ring\" id=\"mrq01-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"mrq01-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"mrq01-net\"><\/div>\n <div class=\"mr-verdict\" id=\"mrq01-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"mrq01-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"mrq01-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"mrq01-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"mrq01-retry\">↻ New Round<\/button>\n <\/div>\n <\/div>\n <\/div>\n\n<\/div>\n\n<script>\n(function () {\n 'use strict';\n\n var NS = 'mrq01';\n var TOTAL = 5;\n var MAX = 20;\n var LTRS = ['A','B','C','D'];\n\n \/* \u2500\u2500 Questions \u2500\u2500 *\/\n var QS = [\n {\n id: 1,\n tag: 'Crystal Arthropathy',\n stem: 'A <strong>68-year-old man<\/strong> presents with a 12-hour history of an acutely swollen, erythematous, exquisitely tender <strong>first metatarsophalangeal joint<\/strong>. He has been on hydrochlorothiazide for five years. Synovial fluid is aspirated and examined under polarised light with a red compensator. Which finding confirms the diagnosis?',\n correct: 'Needle-shaped crystals appearing yellow when aligned parallel to the slow axis',\n opts: [\n 'Needle-shaped crystals appearing yellow when aligned parallel to the slow axis',\n 'Rhomboid crystals appearing blue when aligned parallel to the slow axis',\n 'Needle-shaped crystals appearing blue when aligned parallel to the slow axis',\n 'Rhomboid crystals appearing yellow when aligned parallel to the slow axis'\n ],\n exp: 'Monosodium urate (MSU) crystals are <strong>needle-shaped<\/strong> and <strong>negatively birefringent<\/strong> \u2014 yellow when the long axis lies <em>parallel<\/em> to the compensator slow axis, blue when perpendicular. CPPD crystals (pseudogout) are <strong>rhomboid<\/strong> and <strong>weakly positively birefringent<\/strong> \u2014 blue parallel, yellow perpendicular. Hydrochlorothiazide reduces renal uric acid excretion and is a classic pharmacological precipitant of gout.',\n imgId: 'mrq01-img1'\n },\n {\n id: 2,\n tag: 'RA \u2014 Treatment Escalation',\n stem: 'A <strong>44-year-old woman<\/strong> has had symmetric polyarthritis of MCP and PIP joints for nine months. She has been on <strong>methotrexate 20 mg\/week<\/strong> for four months. Current assessment: morning stiffness 90 min, DAS28-CRP 5.4, anti-CCP antibody 3× upper limit of normal, CRP 28 mg\/L. What is the most appropriate next step?',\n correct: 'Add a TNF inhibitor to methotrexate',\n opts: [\n 'Add a TNF inhibitor to methotrexate',\n 'Switch methotrexate to leflunomide',\n 'Add hydroxychloroquine and sulfasalazine (triple therapy)',\n 'Increase methotrexate to 25 mg\/week and reassess in 3 months'\n ],\n exp: 'Per <strong>EULAR 2022<\/strong> recommendations: if a cDMARD at adequate dose and duration fails <em>and<\/em> poor prognostic markers are present \u2014 high anti-CCP, elevated CRP, high DAS28, erosions \u2014 a <strong>biologic DMARD or JAK inhibitor should be added<\/strong>. A TNF inhibitor combined with methotrexate is the preferred first biologic strategy. Dose-escalating methotrexate beyond 20 mg\/week is not appropriate once poor-prognosis markers are established; switching within cDMARDs loses critical time.',\n imgId: null\n },\n {\n id: 3,\n tag: 'SLE \u2014 Lupus Nephritis',\n stem: 'A <strong>27-year-old woman<\/strong> with known SLE presents with proteinuria 2.8 g\/day and haematuria. Creatinine has risen from 72 to 118 μmol\/L over 8 weeks. Anti-dsDNA markedly elevated; C3 and C4 both <em>low<\/em>. Renal biopsy shows endocapillary proliferation in >50% of glomeruli with subendothelial immune deposits. What is the ISN\/RPS class, and what does the complement pattern signify?',\n correct: 'Class IV; low C3\/C4 reflects classical pathway consumption by immune complexes',\n opts: [\n 'Class IV; low C3\/C4 reflects classical pathway consumption by immune complexes',\n 'Class III; hypocomplementaemia is a non-specific acute-phase response',\n 'Class V; low complement confirms immune-mediated membranous disease',\n 'Class II; low complement indicates mesangial lupus with activity'\n ],\n exp: '<strong>ISN\/RPS Class IV<\/strong> (diffuse proliferative lupus nephritis) is defined by involvement of >50% of glomeruli and carries the worst renal prognosis. Low <strong>C3 and C4<\/strong> reflect activation of the <strong>classical complement pathway<\/strong> by circulating immune complexes, with resultant consumption \u2014 complement levels mirror disease activity and are used in longitudinal monitoring alongside anti-dsDNA titres. <strong>Induction therapy<\/strong>: mycophenolate mofetil 2–3 g\/day or IV cyclophosphamide (Euro-Lupus protocol) combined with high-dose corticosteroids.',\n imgId: null\n },\n {\n id: 4,\n tag: 'Giant Cell Arteritis',\n stem: 'A <strong>74-year-old woman<\/strong> presents with a 4-week history of right temporal headache and jaw claudication. ESR 108 mm\/hr, CRP 62 mg\/L. She reports <strong>two episodes of transient visual blurring<\/strong> in the right eye over the past week. What is the correct immediate management?',\n correct: 'Start prednisolone 60 mg\/day immediately; arrange temporal artery biopsy within 2 weeks',\n opts: [\n 'Start prednisolone 60 mg\/day immediately; arrange temporal artery biopsy within 2 weeks',\n 'Arrange urgent temporal artery biopsy before starting any treatment',\n 'Start low-dose aspirin and await biopsy result before committing to steroids',\n 'Order PET-CT to confirm large vessel involvement before treatment'\n ],\n exp: 'In GCA with <strong>visual symptoms<\/strong>, high-dose prednisolone (60 mg\/day; IV methylprednisolone 500 mg–1 g daily for 3 days if acute visual loss has occurred) must be started <em>immediately without waiting for biopsy<\/em>. The threat is <strong>anterior ischaemic optic neuropathy<\/strong>, which can progress to permanent blindness within hours of a warning episode. <strong>Biopsy diagnostic accuracy is preserved for 2–4 weeks<\/strong> after steroid initiation \u2014 obtaining histology must never delay treatment. This principle is explicitly stated in BSR 2020 and ACR\/EULAR 2021 guidelines.',\n imgId: null\n },\n {\n id: 5,\n tag: 'Axial Spondyloarthritis',\n stem: 'A <strong>31-year-old HLA-B27 positive man<\/strong> has had low back pain for 20 months. Pain wakes him in the second half of the night, is accompanied by 75 minutes of morning stiffness, and notably <em>improves with exercise but not with rest<\/em>. Onset was insidious before age 40. Pelvic X-ray shows bilateral grade II sacroiliitis. Which one correctly characterises the pain pattern?',\n correct: 'ASAS inflammatory back pain criteria — he satisfies all five features',\n opts: [\n 'ASAS inflammatory back pain criteria — he satisfies all five features',\n 'Modified New York criteria — bilateral grade II sacroiliitis with one clinical feature',\n 'BASDAI ≥4 indicating high disease activity requiring biologic therapy',\n 'Calin criteria — he meets only 4 of the 5 required features'\n ],\n exp: 'The <strong>ASAS criteria for inflammatory back pain<\/strong> require ≥4 of 5 features: age of onset <40; insidious onset; improvement with exercise; <em>no improvement with rest<\/em>; nocturnal pain improving on getting up. This patient satisfies <strong>all five<\/strong>. He also satisfies the <strong>modified New York criteria for radiographic axial SpA<\/strong> (bilateral grade II sacroiliitis + ≥1 clinical feature) \u2014 but the question asks about characterising the pain pattern, which is the ASAS criteria. BASDAI measures disease activity and is not a diagnostic criterion for back pain characterisation.',\n imgId: null\n }\n ];\n\n \/* \u2500\u2500 State \u2500\u2500 *\/\n var answers = {};\n var answered = 0;\n var shuffled = {};\n var done = false;\n\n \/* \u2500\u2500 Helpers \u2500\u2500 *\/\n function byId(id) { return document.getElementById(id); }\n function gid(suffix) { return byId(NS + '-' + suffix); }\n\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, tmp;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n tmp = a[i]; a[i] = a[j]; a[j] = tmp;\n }\n return a;\n }\n\n function countVal(val) {\n var k, n = 0;\n for (k in answers) {\n if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n }\n return n;\n }\n\n \/* \u2500\u2500 Build pips \u2500\u2500 *\/\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n \/* \u2500\u2500 Build cases \u2500\u2500 *\/\n function build() {\n var cont = gid('cases'), i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, imgDiv, imgSrc, j, optEl, ltrSpan, txtSpan;\n\n cont.innerHTML = '';\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts);\n shuffled[q.id] = opts;\n\n card = document.createElement('div');\n card.className = 'mr-case';\n\n \/* top section *\/\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? 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'c' : 'w';\n answered++;\n\n for (i = 0; i < opts.length; i++) {\n el = byId(NS + '-o' + qid + '-' + i);\n if (opts[i] === q.correct) {\n el.className = 'mr-opt correct locked';\n } else if (i === oi) {\n el.className = 'mr-opt wrong locked';\n } else {\n el.className = 'mr-opt dimmed locked';\n }\n }\n\n byId(NS + '-exp' + qid).style.display = 'block';\n\n \/* pip *\/\n var pip = gid('pip' + qid);\n pip.className = 'mr-pip ' + (correct ? 'correct' : 'wrong');\n if (qid > 1) {\n var pl = gid('pl' + qid);\n if (pl) pl.className = 'mr-pip-line done';\n }\n\n }\n\n \/* \u2500\u2500 Score \u2500\u2500 *\/\n function showScore() {\n var c, w, s, net, pct, disp, verdicts, vi, sc;\n if (done) return;\n done = true;\n\n c = countVal('c');\n w = countVal('w');\n s = TOTAL - answered;\n net = (c * 4) - w;\n pct = Math.max(0, Math.round((net \/ MAX) * 100));\n disp = Math.min(100, Math.max(0, pct));\n\n gid('ring').style.background =\n 'conic-gradient(#B85A38 ' + disp + '%, #E8DDD8 0%)';\n gid('pct').textContent = pct + '%';\n gid('net').textContent = 'Net Score: ' + net + ' \/ ' + MAX;\n\n verdicts = [\n [5, 'Perfect round. Exceptional clinical reasoning.'],\n [4, 'Strong \\u2014 one nuance to revisit.'],\n [3, 'Solid base \\u2014 consolidate the finer distinctions.'],\n [2, 'Halfway there \\u2014 review the missed cases carefully.'],\n [0, 'These cases repay close reading. Come back tomorrow.']\n ];\n gid('verdict').textContent = verdicts[4][1];\n for (vi = 0; vi < verdicts.length; vi++) {\n if (c >= verdicts[vi][0]) {\n gid('verdict').textContent = verdicts[vi][1];\n break;\n }\n }\n\n gid('ct-c').textContent = '\\u2705 ' + c + ' Correct';\n gid('ct-w').textContent = '\\u274C ' + w + ' Wrong';\n gid('ct-s').textContent = '\\u23ED ' + s + ' Skipped';\n\n sc = gid('score');\n sc.style.display = 'block';\n sc.scrollIntoView({ behavior: 'smooth', block: 'center' });\n }\n\n \/* \u2500\u2500 Sticky bar \u2500\u2500 *\/\n function initObserver() {\n var sentinel = gid('sentinel'), bar = gid('progress');\n if (!sentinel || !bar || !window.IntersectionObserver) return;\n new IntersectionObserver(function (entries) {\n if (!entries[0].isIntersecting) {\n bar.className = 'mr-progress visible';\n } else {\n bar.className = 'mr-progress';\n }\n }, { threshold: 0 }).observe(sentinel);\n }\n\n \/* \u2500\u2500 Init \u2500\u2500 *\/\n function init() {\n gid('submit').addEventListener('click', showScore);\n gid('retry').addEventListener('click', function () {\n build();\n window.scrollTo(0, 0);\n });\n initObserver();\n build();\n }\n\n if (document.readyState === 'loading') {\n document.addEventListener('DOMContentLoaded', init);\n } else {\n init();\n }\n\n}());\n<\/script>\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>Morning Rounds \u00b7 Rheumatology GOUT \u00b7 MSU PSEUDOGOUT \u00b7 CPPD \u2190 slow axis \u2192 \u2190 slow axis \u2192 yellow (parallel) blue (perp) Negative birefringence blue (parallel) Weakly positive birefringence Polarised light microscopy with red compensator. MSU (gout): needle-shaped, negatively birefringent \u2014 yellow when parallel to the slow axis. CPPD (pseudogout): rhomboid, weakly positively birefringent \u2014… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[24],"tags":[],"class_list":["post-36651","post","type-post","status-publish","format-standard","hentry","category-neet-pg"],"yoast_head":"\n<title>Rheumatology Clinical - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/21\/rheumatology-clinical\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rheumatology Clinical - atsixty\" \/>\n<meta property=\"og:description\" content=\"Morning Rounds \u00b7 Rheumatology GOUT \u00b7 MSU PSEUDOGOUT \u00b7 CPPD \u2190 slow axis \u2192 \u2190 slow axis \u2192 yellow (parallel) blue (perp) Negative birefringence blue (parallel) Weakly positive birefringence Polarised light microscopy with red compensator. MSU (gout): needle-shaped, negatively birefringent \u2014 yellow when parallel to the slow axis. 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MSU (gout): needle-shaped, negatively birefringent \u2014 yellow when parallel to the slow axis. 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