{"id":36960,"date":"2026-06-06T09:18:16","date_gmt":"2026-06-06T03:48:16","guid":{"rendered":"https:\/\/atsixty.com\/?p=36960"},"modified":"2026-06-06T11:02:33","modified_gmt":"2026-06-06T05:32:33","slug":"rheumatology-summative-revision-notes","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-summative-revision-notes\/","title":{"rendered":"Rheumatology: Summative Revision Notes"},"content":{"rendered":"\n\n\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n\/* Namespaced to #rrev01 *\/\n#rrev01 *,#rrev01 *::before,#rrev01 *::after{box-sizing:border-box;margin:0;padding:0}\n#rrev01{\n  --ter:#8B3D20;--ter-dark:#6B2D14;--ter-pale:#FDF0EB;--ter-mid:#B85A38;\n  --slate:#3D5A80;--slate-pale:#E8EFF7;--slate-mid:#5B7FA6;\n  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.rv-sec-title{font-size:1rem}\n  #rrev01 table{font-size:0.76rem}\n  #rrev01 td,#rrev01 th{padding:6px 8px}\n}\n<\/style>\n\n<div id=\"rrev01\">\n\n  <div class=\"rv-header\">\n    <div class=\"rv-eyebrow\">Morning Rounds &middot; Rheumatology Series<\/div>\n    <div class=\"rv-title\">Rheumatology<br><em>Summative Revision Notes<\/em><\/div>\n    <div class=\"rv-subtitle\">Seven rounds &middot; NEET-PG and UPSC CMS &middot; Key facts, tables, and diagrams<\/div>\n    <div class=\"rv-chips\">\n      <span class=\"rv-chip\">RA<\/span>\n      <span class=\"rv-chip\">SLE &amp; APS<\/span>\n      <span class=\"rv-chip\">Spondyloarthropathies<\/span>\n      <span class=\"rv-chip\">Crystal Arthropathies<\/span>\n      <span class=\"rv-chip\">Vasculitides<\/span>\n      <span class=\"rv-chip\">Myopathies &amp; Scleroderma<\/span>\n      <span class=\"rv-chip\">Mixed High-Yield<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"rv-body\">\n\n    <div class=\"rv-intro\">\n      <p>These notes consolidate the seven Morning Rounds in the Rheumatology series. They are written for rapid pre-exam revision, not first-time learning. Each section is self-contained and mirrors the quiz content. Read the debrief panels in the quizzes for full clinical reasoning; use these notes to consolidate what you already know and to cross-reference patterns across diseases.<\/p>\n      <p>Rheumatology is examined through <strong>two lenses<\/strong> in NEET-PG and UPSC CMS: clinical vignette recognition (which disease fits this presentation) and antibody-to-disease mapping (which antibody predicts which complication). Both are covered here.<\/p>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 1 \u2014 RHEUMATOID ARTHRITIS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 01 &middot; Rheumatology<\/div>\n        <div class=\"rv-sec-title\">Rheumatoid Arthritis<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">ACR\/EULAR 2010 Classification Criteria<\/div>\n        <p>Score &ge;6\/10 classifies as RA. Domains: <strong>joint involvement<\/strong> (1 large joint = 0; 2&ndash;10 large joints = 1; 1&ndash;3 small joints = 2; 4&ndash;10 small joints = 3; &gt;10 joints including at least one small = 5); <strong>serology<\/strong> (negative RF and anti-CCP = 0; low-positive = 2; high-positive &ge;3&times;ULN = 3); <strong>acute-phase reactants<\/strong> (normal CRP and ESR = 0; abnormal = 1); <strong>duration<\/strong> (&lt;6 weeks = 0; &ge;6 weeks = 1).<\/p>\n\n        <div class=\"rv-sub\">Key autoantibodies<\/div>\n        <p><strong>Rheumatoid factor (RF):<\/strong> IgM anti-IgG. Sensitivity ~70%, specificity ~85%. Also positive in: Sjogren's, SLE, cryoglobulinaemia, chronic infections, elderly normals. <strong>Anti-CCP (anti-citrullinated protein antibody):<\/strong> specificity &gt;95% for RA; predicts erosive disease and poor prognosis; can precede symptoms by years. High titre of either = poor prognostic marker.<\/p>\n\n        <div class=\"rv-sub\">EULAR 2022 treatment strategy<\/div>\n        <p>Treat-to-target: aim DAS28 remission (&lt;2.6) or low disease activity (&lt;3.2). <strong>Step 1:<\/strong> methotrexate (MTX) &plusmn; short-term glucocorticoids as bridge. <strong>Step 2 (poor prognosis markers present):<\/strong> add biologic DMARD (TNF inhibitor preferred) to MTX. <strong>Poor prognostic markers:<\/strong> high RF\/anti-CCP titre, elevated CRP\/ESR, early erosions, high DAS28, functional limitation. cDMARD triple therapy (MTX + HCQ + sulfasalazine) is an alternative when biologics are unavailable.<\/p>\n\n        <div class=\"rv-sub\">Extra-articular features \u2014 exam essentials<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>System<\/th><th>Feature<\/th><th>Key Point<\/th><\/tr>\n            <tr><td><strong>Pulmonary<\/strong><\/td><td>ILD (UIP\/NSIP); pleural effusion; Caplan's<\/td><td>Pleural fluid: exudate, very low glucose, low complement<\/td><\/tr>\n            <tr><td><strong>Cardiac<\/strong><\/td><td>Pericarditis (most common); accelerated atherosclerosis<\/td><td>CV risk management is part of RA care<\/td><\/tr>\n            <tr><td><strong>Ocular<\/strong><\/td><td>Episcleritis; scleritis; secondary Sjogren's (30%)<\/td><td>Scleritis = severe systemic disease; sight-threatening<\/td><\/tr>\n            <tr><td><strong>Haematological<\/strong><\/td><td>Felty's (RA + splenomegaly + neutropaenia)<\/td><td>LGL leukaemia must be excluded; G-CSF for infections<\/td><\/tr>\n            <tr><td><strong>Neurological<\/strong><\/td><td>C1&ndash;C2 atlantoaxial subluxation; peripheral neuropathy<\/td><td>Lateral cervical X-ray before any GA\/intubation in RA<\/td><\/tr>\n            <tr><td><strong>Vasculitis<\/strong><\/td><td>Digital infarcts; leg ulcers; mononeuritis multiplex<\/td><td>High RF titre + long disease duration<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <p><span class=\"rv-pill\">Anti-CCP: &gt;95% specific<\/span> <span class=\"rv-pill\">DAS28 target &lt;2.6<\/span> <span class=\"rv-pill\">Biologics need TB screen<\/span> <span class=\"rv-pill-slate\">C1&ndash;C2 subluxation pre-GA<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 2 \u2014 SLE AND APS\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 02 &middot; Rheumatology<\/div>\n        <div class=\"rv-sec-title\">SLE &amp; Antiphospholipid Syndrome<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">2019 ACR\/EULAR Classification Criteria<\/div>\n        <p>Positive ANA (&ge;1:80) is the <strong>mandatory entry criterion<\/strong>. Seven weighted domains follow: constitutional, haematological, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, and renal. Plus immunological domain (anti-dsDNA, anti-Sm, antiphospholipid antibodies, complement, direct Coombs). <strong>Score &ge;10 = SLE.<\/strong> Each domain counts only its highest-scoring item.<\/p>\n\n        <div class=\"rv-sub\">SLE antibodies \u2014 disease-specific vs disease-active<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Antibody<\/th><th>Significance<\/th><th>Tracks Activity?<\/th><\/tr>\n            <tr><td><strong>Anti-dsDNA<\/strong><\/td><td>Specific for SLE; correlates with nephritis<\/td><td>Yes \u2014 rises with flares<\/td><\/tr>\n            <tr><td><strong>Anti-Sm<\/strong><\/td><td>Most specific for SLE (&gt;99%)<\/td><td>No<\/td><\/tr>\n            <tr><td><strong>Anti-histone<\/strong><\/td><td>Drug-induced lupus (anti-dsDNA absent in DIL)<\/td><td>No<\/td><\/tr>\n            <tr><td><strong>Anti-SSA (Ro)<\/strong><\/td><td>Neonatal lupus; congenital heart block; subacute cutaneous LE<\/td><td>No<\/td><\/tr>\n            <tr><td><strong>Anti-SSB (La)<\/strong><\/td><td>Sjogren's overlap; neonatal lupus (with anti-SSA)<\/td><td>No<\/td><\/tr>\n            <tr><td><strong>C3\/C4 low<\/strong><\/td><td>Classical pathway consumption; active nephritis<\/td><td>Yes \u2014 fall with flares<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">ISN\/RPS lupus nephritis classes<\/div>\n        <p><strong>Class I:<\/strong> minimal mesangial. <strong>Class II:<\/strong> mesangial proliferative. <strong>Class III:<\/strong> focal proliferative (&lt;50% glomeruli). <strong>Class IV:<\/strong> diffuse proliferative (&gt;50% glomeruli) &mdash; worst prognosis; low C3\/C4 reflects classical pathway consumption. <strong>Class V:<\/strong> membranous (heavy proteinuria; complement may be normal). <strong>Class VI:<\/strong> advanced sclerosis. Classes III and IV: induction with MMF (2&ndash;3 g\/day) or IV cyclophosphamide + high-dose corticosteroids.<\/p>\n\n        <div class=\"rv-sub\">Antiphospholipid Syndrome (APS)<\/div>\n        <p>Diagnosis: thrombosis or pregnancy morbidity (recurrent miscarriage &ge;3 &lt;10 weeks; one loss &ge;10 weeks; premature birth &lt;34 weeks) PLUS positive antiphospholipid antibody on <strong>two occasions &ge;12 weeks apart.<\/strong> Tests: lupus anticoagulant; anti-cardiolipin IgG\/IgM &gt;40 GPL\/MPL units; anti-&beta;2-GPI IgG\/IgM &gt;99th centile. <strong>Triple positivity<\/strong> (all three positive) = highest thrombosis risk. Treatment: venous thrombosis &rarr; warfarin INR 2&ndash;3. Avoid DOACs in triple-positive APS. Arterial thrombosis &rarr; warfarin INR 2&ndash;3 &plusmn; aspirin. Obstetric APS &rarr; aspirin + LMWH.<\/p>\n\n        <div class=\"rv-sub\">Neonatal lupus<\/div>\n        <p>Anti-SSA (Ro) crosses placenta &rarr; <strong>congenital heart block (CHB)<\/strong>, risk ~2% (rises to 15&ndash;20% after previously affected pregnancy). Surveillance: <strong>fetal echocardiography weekly\/fortnightly from 16&ndash;26 weeks<\/strong>. Transient neonatal rash, cytopaenias resolve as maternal antibodies clear. CHB often requires permanent pacing; mortality 15&ndash;20%.<\/p>\n\n        <p><span class=\"rv-pill\">Anti-dsDNA tracks activity<\/span> <span class=\"rv-pill\">Anti-Sm most specific<\/span> <span class=\"rv-pill\">APS: 12 weeks apart<\/span> <span class=\"rv-pill-slate\">CHB: echo 16&ndash;26 weeks<\/span> <span class=\"rv-pill-green\">HCQ: continue in pregnancy<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 3 \u2014 SERONEGATIVE SPONDYLOARTHROPATHIES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 03 &middot; Rheumatology<\/div>\n        <div class=\"rv-sec-title\">Seronegative Spondyloarthropathies<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <!-- SVG: SpA comparison table -->\n        <div class=\"rv-figure\">\n          <svg viewBox=\"0 0 680 200\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:680px;display:block;margin:0 auto\">\n            <rect width=\"680\" height=\"200\" fill=\"#FFFDF9\" rx=\"6\"\/>\n            <!-- Headers -->\n            <rect x=\"4\" y=\"4\" width=\"124\" height=\"20\" rx=\"3\" fill=\"#8B3D20\" opacity=\"0.85\"\/>\n            <rect x=\"132\" y=\"4\" width=\"124\" height=\"20\" rx=\"3\" fill=\"#3D5A80\" opacity=\"0.85\"\/>\n            <rect x=\"260\" y=\"4\" width=\"124\" height=\"20\" rx=\"3\" fill=\"#2D6B47\" opacity=\"0.85\"\/>\n            <rect x=\"388\" y=\"4\" width=\"124\" height=\"20\" rx=\"3\" fill=\"#C07828\" opacity=\"0.85\"\/>\n            <rect x=\"516\" y=\"4\" width=\"160\" height=\"20\" rx=\"3\" fill=\"#7B5EA7\" opacity=\"0.85\"\/>\n            <text x=\"66\" y=\"18\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"9\" font-family=\"Georgia,serif\" font-weight=\"bold\">Feature<\/text>\n            <text x=\"194\" y=\"18\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"9\" font-family=\"Georgia,serif\" font-weight=\"bold\">AS<\/text>\n            <text x=\"322\" y=\"18\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"9\" font-family=\"Georgia,serif\" font-weight=\"bold\">Reactive Arthritis<\/text>\n            <text x=\"450\" y=\"18\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"9\" font-family=\"Georgia,serif\" font-weight=\"bold\">Psoriatic Arthritis<\/text>\n            <text x=\"596\" y=\"18\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"9\" font-family=\"Georgia,serif\" font-weight=\"bold\">IBD-SpA<\/text>\n            <!-- Row data -->\n            <text x=\"8\" y=\"38\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">HLA-B27<\/text>\n            <text x=\"136\" y=\"38\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">90%<\/text>\n            <text x=\"264\" y=\"38\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">60&ndash;80%<\/text>\n            <text x=\"392\" y=\"38\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">axial: 50&ndash;70%<\/text>\n            <text x=\"520\" y=\"38\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">axial: 25&ndash;75%<\/text>\n            <text x=\"8\" y=\"56\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Sacroiliitis<\/text>\n            <text x=\"136\" y=\"56\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Bilateral, symmetric<\/text>\n            <text x=\"264\" y=\"56\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Bilateral or unilateral<\/text>\n            <text x=\"392\" y=\"56\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Unilateral, asymmetric<\/text>\n            <text x=\"520\" y=\"56\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Bilateral<\/text>\n            <text x=\"8\" y=\"74\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Trigger<\/text>\n            <text x=\"136\" y=\"74\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">None identified<\/text>\n            <text x=\"264\" y=\"74\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">GI \/ urogenital infxn<\/text>\n            <text x=\"392\" y=\"74\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Psoriasis (80%)<\/text>\n            <text x=\"520\" y=\"74\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">IBD (Crohn's\/UC)<\/text>\n            <text x=\"8\" y=\"92\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Skin\/nails<\/text>\n            <text x=\"136\" y=\"92\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">None<\/text>\n            <text x=\"264\" y=\"92\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Keratoderma blen.; circ. balanitis<\/text>\n            <text x=\"392\" y=\"92\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Psoriasis; nail pitting<\/text>\n            <text x=\"520\" y=\"92\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Pyoderma; EN<\/text>\n            <text x=\"8\" y=\"110\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Biologic<\/text>\n            <text x=\"136\" y=\"110\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">TNF-i or IL-17-i<\/text>\n            <text x=\"264\" y=\"110\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">NSAIDs first<\/text>\n            <text x=\"392\" y=\"110\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">TNF-i or IL-17-i<\/text>\n            <text x=\"520\" y=\"110\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">TNF-i (not IL-17-i in CD)<\/text>\n            <text x=\"8\" y=\"128\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">cDMARD axial?<\/text>\n            <text x=\"136\" y=\"128\" fill=\"#B83232\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">No (ineffective)<\/text>\n            <text x=\"264\" y=\"128\" fill=\"#B83232\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">No<\/text>\n            <text x=\"392\" y=\"128\" fill=\"#B83232\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">No<\/text>\n            <text x=\"520\" y=\"128\" fill=\"#B83232\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">No<\/text>\n            <!-- Dividers -->\n            <line x1=\"4\" y1=\"24\" x2=\"676\" y2=\"24\" stroke=\"#E8DDD8\" stroke-width=\"0.8\"\/>\n            <line x1=\"4\" y1=\"44\" x2=\"676\" y2=\"44\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"62\" x2=\"676\" y2=\"62\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"80\" x2=\"676\" y2=\"80\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"98\" x2=\"676\" y2=\"98\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"116\" x2=\"676\" y2=\"116\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"128\" y1=\"4\" x2=\"128\" y2=\"138\" stroke=\"#E8DDD8\" stroke-width=\"0.8\"\/>\n            <line x1=\"256\" y1=\"4\" x2=\"256\" y2=\"138\" stroke=\"#E8DDD8\" stroke-width=\"0.8\"\/>\n            <line x1=\"384\" y1=\"4\" x2=\"384\" y2=\"138\" stroke=\"#E8DDD8\" stroke-width=\"0.8\"\/>\n            <line x1=\"512\" y1=\"4\" x2=\"512\" y2=\"138\" stroke=\"#E8DDD8\" stroke-width=\"0.8\"\/>\n            <!-- Critical note -->\n            <rect x=\"4\" y=\"148\" width=\"672\" height=\"44\" rx=\"5\" fill=\"#FDF0EB\"\/>\n            <text x=\"340\" y=\"163\" text-anchor=\"middle\" fill=\"#8B3D20\" font-size=\"9\" font-family=\"Georgia,serif\" font-weight=\"bold\">IL-17 INHIBITORS ARE CONTRAINDICATED IN CROHN'S DISEASE<\/text>\n            <text x=\"340\" y=\"178\" text-anchor=\"middle\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Prefer TNF inhibitors (adalimumab, infliximab) in all SpA patients with concurrent IBD. Axial disease runs independently of bowel activity.<\/text>\n          <\/svg>\n          <div class=\"rv-fig-cap\">Seronegative spondyloarthropathy comparison. The row marked in red &mdash; cDMARDs have no efficacy for axial disease in any SpA subtype &mdash; is the single most tested distinction between SpA and RA treatment algorithms.<\/div>\n        <\/div>\n\n        <div class=\"rv-sub\">Modified New York Criteria for AS<\/div>\n        <p>Radiological criterion: bilateral sacroiliitis grade &ge;2 OR unilateral grade &ge;3. Plus at least one clinical criterion: inflammatory back pain &ge;3 months; limitation of lumbar motion in both planes; reduced chest expansion. <strong>Radiological criterion alone is insufficient.<\/strong> Schober's test: increase &lt;5 cm on forward flexion indicates lumbar restriction.<\/p>\n\n        <div class=\"rv-sub\">ASAS criteria for biologic therapy in axial SpA<\/div>\n        <p><strong>BASDAI &ge;4<\/strong> (0&ndash;10 scale) + assessor agrees disease is active + failure of two NSAIDs at maximum tolerated dose for &ge;4 weeks each. No requirement for elevated CRP or MRI evidence (though supportive). cDMARDs are not a required bridge step &mdash; go directly to biologic after NSAID failure.<\/p>\n\n        <p><span class=\"rv-pill\">BASDAI &ge;4 &rarr; biologic<\/span> <span class=\"rv-pill\">No cDMARDs for axial SpA<\/span> <span class=\"rv-pill\">HLA-B27: 90% in AS<\/span> <span class=\"rv-pill-slate\">IL-17-i: avoid in Crohn's<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 4 \u2014 CRYSTAL ARTHROPATHIES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 04 &middot; Rheumatology<\/div>\n        <div class=\"rv-sec-title\">Crystal Arthropathies<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Crystal comparison \u2014 the definitive table<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Feature<\/th><th>MSU (Gout)<\/th><th>CPPD (Pseudogout)<\/th><th>BCP\/Hydroxyapatite<\/th><\/tr>\n            <tr><td><strong>Crystal shape<\/strong><\/td><td>Needle<\/td><td>Rhomboid<\/td><td>Non-crystalline aggregates<\/td><\/tr>\n            <tr><td><strong>Birefringence<\/strong><\/td><td>Negative (strong)<\/td><td>Weakly positive<\/td><td>None &mdash; invisible on PLM<\/td><\/tr>\n            <tr><td><strong>Colour parallel to slow axis<\/strong><\/td><td>Yellow<\/td><td>Blue<\/td><td>Not applicable<\/td><\/tr>\n            <tr><td><strong>Commonest joint<\/strong><\/td><td>MTP1 (podagra)<\/td><td>Knee<\/td><td>Shoulder (rotator cuff)<\/td><\/tr>\n            <tr><td><strong>Identification<\/strong><\/td><td>Polarised light microscopy<\/td><td>Polarised light microscopy<\/td><td>Alizarin red S stain; EM<\/td><\/tr>\n            <tr><td><strong>X-ray<\/strong><\/td><td>Punched-out erosions; tophi<\/td><td>Chondrocalcinosis<\/td><td>Calcific tendinitis; joint destruction<\/td><\/tr>\n            <tr><td><strong>Associations<\/strong><\/td><td>Hyperuricaemia; thiazides; low-dose aspirin<\/td><td>HATCH: Hyperparathyroidism, Ageing, Thyroid (hypo), Chondrocalcinosis hereditary, Haemochromatosis<\/td><td>Elderly women; rotator cuff tear<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Gout management \u2014 key principles<\/div>\n        <p><strong>Acute attack:<\/strong> NSAIDs, colchicine, or corticosteroids (all equally effective). Do not start or stop ULT during an acute attack. <strong>ULT indication:<\/strong> &ge;2 attacks\/year; tophi; urate nephropathy; uric acid stones. <strong>Target SUA:<\/strong> &lt;6 mg\/dL (&lt;360 &mu;mol\/L); &lt;5 mg\/dL in tophaceous gout. <strong>Allopurinol:<\/strong> start at 50&ndash;100 mg\/day; titrate slowly; can uptitrate in CKD with monitoring (old dose-cap guidelines are outdated). <strong>Prophylaxis:<\/strong> colchicine 0.5 mg\/day for first 3&ndash;6 months of ULT to cover mobilisation flares.<\/p>\n\n        <div class=\"rv-sub\">Drugs and uric acid \u2014 the critical list<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Raise SUA<\/th><th>Lower SUA<\/th><\/tr>\n            <tr><td>Thiazides; loop diuretics; low-dose aspirin; ciclosporin; pyrazinamide; ethambutol; nicotinic acid<\/td><td>Losartan; fenofibrate; SGLT2 inhibitors; high-dose aspirin (&gt;3 g\/day); allopurinol; febuxostat; probenecid<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <p><span class=\"rv-pill\">Normal SUA does not exclude gout<\/span> <span class=\"rv-pill\">ULT: start 2&ndash;4 wks post-attack<\/span> <span class=\"rv-pill\">Milwaukee: alizarin red S<\/span> <span class=\"rv-pill-slate\">Losartan is uricosuric<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 5 \u2014 VASCULITIDES\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 05 &middot; Rheumatology<\/div>\n        <div class=\"rv-sec-title\">Vasculitides<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Classification by vessel size<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Size<\/th><th>Disease<\/th><th>Key Distinguishing Features<\/th><\/tr>\n            <tr><td><strong>Large<\/strong><\/td><td>Takayasu arteritis<\/td><td>Women &lt;40; aorta + branches; BP asymmetry; MRA\/CTA; prednisolone<\/td><\/tr>\n            <tr><td><strong>Large<\/strong><\/td><td>Giant cell arteritis (GCA)<\/td><td>Age &gt;50; temporal artery; halo sign on USS; PMR overlap; visual threat &rarr; prednisolone 60 mg immediately<\/td><\/tr>\n            <tr><td><strong>Medium<\/strong><\/td><td>Polyarteritis nodosa (PAN)<\/td><td>No GN; no lung; ANCA negative; microaneurysms; HBV-associated &rarr; antivirals<\/td><\/tr>\n            <tr><td><strong>Medium<\/strong><\/td><td>Kawasaki disease<\/td><td>Children; fever &gt;5 days; coronary aneurysm; IV immunoglobulin + aspirin<\/td><\/tr>\n            <tr><td><strong>Small (AAV)<\/strong><\/td><td>GPA (Wegener's)<\/td><td>c-ANCA\/PR3; ENT + lung (cavitating) + kidney; pauci-immune crescentic GN; cyclophosphamide or rituximab<\/td><\/tr>\n            <tr><td><strong>Small (AAV)<\/strong><\/td><td>MPA<\/td><td>p-ANCA\/MPO; GN + pulmonary haemorrhage; no ENT; treat as AAV<\/td><\/tr>\n            <tr><td><strong>Small (AAV)<\/strong><\/td><td>EGPA (Churg-Strauss)<\/td><td>p-ANCA\/MPO (40%); asthma + eosinophilia + vasculitis; cardiac = leading cause of death; mepolizumab for relapsing disease<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">PAN vs MPA \u2014 the critical distinction<\/div>\n        <p>PAN: medium vessels; <strong>no glomerulonephritis; no pulmonary involvement; ANCA negative;<\/strong> microaneurysms on angiography; HBV association. MPA: small vessels; pauci-immune crescentic GN; pulmonary capillaritis; p-ANCA\/MPO positive. This distinction appears in almost every exam diet.<\/p>\n\n        <div class=\"rv-sub\">GCA \u2014 visual emergency protocol<\/div>\n        <p>Any visual symptoms (amaurosis fugax, diplopia, blurring) &rarr; <strong>start prednisolone 60 mg\/day immediately, before biopsy.<\/strong> Temporal artery biopsy remains accurate for 2&ndash;4 weeks after steroid initiation. Halo sign on USS (hypoechoic wall thickening) replaces biopsy in experienced centres. Tocilizumab (IL-6 receptor inhibitor): approved for relapsing\/refractory GCA; allows faster steroid tapering.<\/p>\n\n        <p><span class=\"rv-pill\">GCA visual Sx &rarr; steroids first<\/span> <span class=\"rv-pill\">PAN: no GN, no lung, ANCA-ve<\/span> <span class=\"rv-pill\">EGPA: cardiac = leading death<\/span> <span class=\"rv-pill-slate\">EGPA: mepolizumab (anti-IL-5)<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 6 \u2014 MYOPATHIES, SJOGREN'S & SCLERODERMA\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 06 &middot; Rheumatology<\/div>\n        <div class=\"rv-sec-title\">Myopathies, Sjogren&apos;s &amp; Scleroderma<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Myositis-specific antibodies (MSAs) \u2014 master table<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Antibody<\/th><th>Disease\/Syndrome<\/th><th>Key Clinical Point<\/th><\/tr>\n            <tr><td><strong>Anti-Jo-1<\/strong><\/td><td>Antisynthetase syndrome<\/td><td>ILD + myositis + arthritis + mechanic's hands + Raynaud's; ILD = leading cause of death<\/td><\/tr>\n            <tr><td><strong>Anti-Mi-2<\/strong><\/td><td>Classic dermatomyositis<\/td><td>Florid skin; good steroid response; low ILD risk<\/td><\/tr>\n            <tr><td><strong>Anti-MDA5<\/strong><\/td><td>Amyopathic DM<\/td><td>Rapidly progressive ILD (fatal within weeks); skin ulceration; CK may be normal<\/td><\/tr>\n            <tr><td><strong>Anti-TIF1-&gamma;<\/strong><\/td><td>Dermatomyositis<\/td><td>Strong malignancy association (adults &gt;40); screen for cancer<\/td><\/tr>\n            <tr><td><strong>Anti-SRP<\/strong><\/td><td>Immune-mediated necrotising myopathy<\/td><td>Very high CK; severe; poor steroid response; statins can trigger<\/td><\/tr>\n            <tr><td><strong>Anti-HMGCR<\/strong><\/td><td>Statin-associated IMNM<\/td><td>Persists after statin withdrawal; needs immunosuppression<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Steroid myopathy \u2014 the critical trap<\/div>\n        <p>Occurs after &ge;4&ndash;6 weeks on &ge;40 mg\/day prednisolone. <strong>CK is normal; ESR\/CRP are normal; EMG shows no spontaneous activity (no fibrillations).<\/strong> This distinguishes it from a PM\/DM flare (which gives elevated CK, elevated CRP, and fibrillations on EMG). Management: <strong>reduce the steroid dose<\/strong> &mdash; increasing steroids worsens the myopathy. Type II fibre atrophy on biopsy.<\/p>\n\n        <div class=\"rv-sub\">Scleroderma subtypes and antibodies<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Feature<\/th><th>Limited SSc (lcSSc)<\/th><th>Diffuse SSc (dcSSc)<\/th><\/tr>\n            <tr><td><strong>Antibody<\/strong><\/td><td>Anti-centromere (ACA)<\/td><td>Anti-Scl-70 (topoisomerase I); anti-RNA pol III<\/td><\/tr>\n            <tr><td><strong>Skin<\/strong><\/td><td>Distal to elbows\/knees; face<\/td><td>Trunk, face, proximal limbs<\/td><\/tr>\n            <tr><td><strong>Organs<\/strong><\/td><td>PAH &gt;&gt; ILD; CREST<\/td><td>ILD (early, severe) &gt;&gt; PAH; renal crisis<\/td><\/tr>\n            <tr><td><strong>Leading cause of death<\/strong><\/td><td><strong>Pulmonary arterial hypertension<\/strong><\/td><td><strong>ILD<\/strong> (anti-Scl-70); renal crisis (anti-RNA pol III)<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Scleroderma renal crisis (SRC)<\/div>\n        <p>Emergency: acute hypertension + rapidly rising creatinine + microangiopathic haemolytic anaemia (schistocytes, thrombocytopaenia). Occurs in early dcSSc, typically first 4&ndash;5 years. Risk factor: <strong>prednisolone &ge;15 mg\/day<\/strong> (precipitates SRC). Treatment: <strong>ACE inhibitor (captopril) immediately<\/strong>, regardless of degree of renal impairment. Do not withhold. Up to 50% still require dialysis; 50% of those can discontinue after 1&ndash;2 years of continued ACE inhibition.<\/p>\n\n        <div class=\"rv-sub\">Primary Sjogren's syndrome<\/div>\n        <p>ACR\/EULAR 2016 criteria: positive ANA entry; then scored items including <strong>focal lymphocytic sialadenitis (focus score &ge;1\/4mm&sup2;) = 3 points<\/strong> (highest single item); anti-SSA = 3 points; threshold &ge;4. Most important long-term complication: <strong>NHL (MALT lymphoma)<\/strong> &mdash; 15&ndash;44&times; increased risk. Lymphoma risk predictors: persistent parotid enlargement, palpable purpura, cryoglobulinaemia, <strong>low C4, monoclonal IgM band<\/strong>. Extraglandular: distal RTA type 1 (urine pH &gt;5.5 despite acidosis; hypokalaemia &rarr; paralysis).<\/p>\n\n        <p><span class=\"rv-pill\">Steroid myopathy: normal CK<\/span> <span class=\"rv-pill\">SRC: captopril immediately<\/span> <span class=\"rv-pill\">Prednisolone &ge;15 mg precipitates SRC<\/span> <span class=\"rv-pill-slate\">Sjogren's: lymphoma risk<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n         SECTION 7 \u2014 CROSS-CUTTING HIGH-YIELD\n    \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 -->\n    <div class=\"rv-section\">\n      <div class=\"rv-sec-head\">\n        <div class=\"rv-sec-num\">Round 07 &middot; Rheumatology<\/div>\n        <div class=\"rv-sec-title\">Cross-Cutting High-Yield: Autoantibodies, Pharmacology &amp; Prognosis<\/div>\n      <\/div>\n      <div class=\"rv-sec-body\">\n\n        <div class=\"rv-sub\">Leading cause of death by CTD \u2014 the essential table<\/div>\n        <div class=\"rv-table-wrap\">\n          <table>\n            <tr><th>Disease<\/th><th>Leading Cause of Death<\/th><th>Key Note<\/th><\/tr>\n            <tr><td><strong>SLE<\/strong><\/td><td>Infection; cardiovascular disease; renal failure<\/td><td>CV risk from accelerated atherosclerosis + steroids<\/td><\/tr>\n            <tr><td><strong>Limited SSc (ACA+)<\/strong><\/td><td><strong>Pulmonary arterial hypertension<\/strong><\/td><td>Annual echo surveillance; endothelin antagonists<\/td><\/tr>\n            <tr><td><strong>Diffuse SSc (Scl-70+)<\/strong><\/td><td><strong>Interstitial lung disease<\/strong><\/td><td>HRCT + PFT at diagnosis; nintedanib\/MMF for ILD<\/td><\/tr>\n            <tr><td><strong>MCTD (U1-RNP+)<\/strong><\/td><td><strong>Pulmonary arterial hypertension<\/strong><\/td><td>Annual echo mandatory in all MCTD patients<\/td><\/tr>\n            <tr><td><strong>Antisynthetase (Jo-1+)<\/strong><\/td><td><strong>Interstitial lung disease<\/strong><\/td><td>NSIP pattern; aggressive immunosuppression<\/td><\/tr>\n            <tr><td><strong>EGPA<\/strong><\/td><td><strong>Cardiac involvement<\/strong><\/td><td>Eosinophilic myocarditis; echo at diagnosis<\/td><\/tr>\n            <tr><td><strong>GPA\/MPA<\/strong><\/td><td>Infection (treatment era); historically renal failure<\/td><td>Rituximab for maintenance reduces infection risk<\/td><\/tr>\n          <\/table>\n        <\/div>\n\n        <div class=\"rv-sub\">Hydroxychloroquine \u2014 the key facts<\/div>\n        <p>Continue <strong>indefinitely<\/strong> in SLE &mdash; do not stop in remission. Maximum safe dose: <strong>&le;5 mg\/kg\/day of actual body weight<\/strong> (not ideal body weight &mdash; this is the exam trap; old guideline was 6.5 mg\/kg ideal). Retinal toxicity risk rises sharply after 5 years. Annual retinal screening from year 5: automated visual fields + SD-OCT. Bull's-eye maculopathy = <strong>stop HCQ<\/strong>. Retinal damage is largely irreversible. Safe in pregnancy (reduces flare risk; do not stop).<\/p>\n\n        <div class=\"rv-sub\">Methotrexate pneumonitis vs RA-ILD<\/div>\n        <p><strong>MTX pneumonitis:<\/strong> idiosyncratic hypersensitivity; any dose; any time; upper-lobe ground glass on HRCT; BAL CD4+ lymphocytosis. <strong>Not prevented by folic acid.<\/strong> Stop MTX immediately; corticosteroids for moderate-severe disease; <strong>do not restart.<\/strong> RA-ILD: UIP pattern (basal honeycombing); slowly progressive; occurs independent of MTX use.<\/p>\n\n        <div class=\"rv-sub\">Raynaud's phenomenon \u2014 primary vs secondary<\/div>\n        <p><strong>Primary:<\/strong> young women; symmetric; no ulcers; normal nail-fold capillaroscopy; ANA negative; benign. <strong>Secondary:<\/strong> asymmetric; digital ulcers; <strong>abnormal nail-fold capillaroscopy<\/strong> (giant capillaries, avascular areas = scleroderma pattern); ANA positive; specific antibodies. Nail-fold capillaroscopy is the single best test to distinguish primary from secondary and predict CTD development. Treatment: CCBs (nifedipine) first-line for both.<\/p>\n\n        <!-- SVG: Autoantibody master reference -->\n        <div class=\"rv-figure\">\n          <svg viewBox=\"0 0 680 230\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:680px;display:block;margin:0 auto\">\n            <rect width=\"680\" height=\"230\" fill=\"#FFFDF9\" rx=\"6\"\/>\n            <text x=\"340\" y=\"18\" text-anchor=\"middle\" fill=\"#8B3D20\" font-size=\"12\" font-family=\"Georgia,serif\" font-weight=\"bold\">Rheumatology Autoantibody Master Reference<\/text>\n            <!-- Column headers -->\n            <rect x=\"4\" y=\"24\" width=\"200\" height=\"16\" rx=\"2\" fill=\"#8B3D20\" opacity=\"0.85\"\/>\n            <rect x=\"208\" y=\"24\" width=\"230\" height=\"16\" rx=\"2\" fill=\"#3D5A80\" opacity=\"0.85\"\/>\n            <rect x=\"442\" y=\"24\" width=\"234\" height=\"16\" rx=\"2\" fill=\"#2D6B47\" opacity=\"0.85\"\/>\n            <text x=\"104\" y=\"35\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Antibody<\/text>\n            <text x=\"323\" y=\"35\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Disease<\/text>\n            <text x=\"559\" y=\"35\" text-anchor=\"middle\" fill=\"#fff\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Key Point \/ Complication<\/text>\n            <!-- Data rows -->\n            <text x=\"8\" y=\"56\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-dsDNA<\/text>\n            <text x=\"212\" y=\"56\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">SLE (specific; tracks activity)<\/text>\n            <text x=\"446\" y=\"56\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Correlates with nephritis; C3\/C4 fall<\/text>\n            <text x=\"8\" y=\"72\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-Sm<\/text>\n            <text x=\"212\" y=\"72\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">SLE (most specific; &gt;99%)<\/text>\n            <text x=\"446\" y=\"72\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Does not track activity<\/text>\n            <text x=\"8\" y=\"88\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-histone<\/text>\n            <text x=\"212\" y=\"88\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Drug-induced lupus (DIL)<\/text>\n            <text x=\"446\" y=\"88\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Anti-dsDNA absent; reversible on stopping drug<\/text>\n            <text x=\"8\" y=\"104\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-SSA (Ro)<\/text>\n            <text x=\"212\" y=\"104\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Sjogren's; SLE; subacute CLE<\/text>\n            <text x=\"446\" y=\"104\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Neonatal lupus; congenital heart block<\/text>\n            <text x=\"8\" y=\"120\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-centromere<\/text>\n            <text x=\"212\" y=\"120\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Limited SSc (CREST)<\/text>\n            <text x=\"446\" y=\"120\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">PAH is leading cause of death<\/text>\n            <text x=\"8\" y=\"136\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-Scl-70<\/text>\n            <text x=\"212\" y=\"136\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Diffuse SSc<\/text>\n            <text x=\"446\" y=\"136\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Early severe ILD; ILD = leading cause of death<\/text>\n            <text x=\"8\" y=\"152\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-RNA pol III<\/text>\n            <text x=\"212\" y=\"152\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Diffuse SSc<\/text>\n            <text x=\"446\" y=\"152\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Scleroderma renal crisis; associated malignancy<\/text>\n            <text x=\"8\" y=\"168\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-Jo-1<\/text>\n            <text x=\"212\" y=\"168\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">Antisynthetase syndrome<\/text>\n            <text x=\"446\" y=\"168\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">ILD + myositis + arthritis + mechanic's hands<\/text>\n            <text x=\"8\" y=\"184\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Anti-U1-RNP<\/text>\n            <text x=\"212\" y=\"184\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">MCTD (defining antibody)<\/text>\n            <text x=\"446\" y=\"184\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">PAH leading cause of death; annual echo<\/text>\n            <text x=\"8\" y=\"200\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">c-ANCA \/ PR3<\/text>\n            <text x=\"212\" y=\"200\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">GPA (Wegener's)<\/text>\n            <text x=\"446\" y=\"200\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">ENT + cavitating lung + pauci-immune GN<\/text>\n            <text x=\"8\" y=\"216\" fill=\"#8B3D20\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">p-ANCA \/ MPO<\/text>\n            <text x=\"212\" y=\"216\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">MPA; EGPA (~40%)<\/text>\n            <text x=\"446\" y=\"216\" fill=\"#5A3D30\" font-size=\"8.5\" font-family=\"Georgia,serif\">EGPA: asthma + eosinophilia; cardiac = leading death<\/text>\n            <!-- Grid lines -->\n            <line x1=\"4\" y1=\"40\" x2=\"676\" y2=\"40\" stroke=\"#C8D8D4\" stroke-width=\"0.8\"\/>\n            <line x1=\"4\" y1=\"58\" x2=\"676\" y2=\"58\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"74\" x2=\"676\" y2=\"74\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"90\" x2=\"676\" y2=\"90\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"106\" x2=\"676\" y2=\"106\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"122\" x2=\"676\" y2=\"122\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"138\" x2=\"676\" y2=\"138\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"154\" x2=\"676\" y2=\"154\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"170\" x2=\"676\" y2=\"170\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"186\" x2=\"676\" y2=\"186\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"4\" y1=\"202\" x2=\"676\" y2=\"202\" stroke=\"#E8DDD8\" stroke-width=\"0.5\"\/>\n            <line x1=\"204\" y1=\"24\" x2=\"204\" y2=\"222\" stroke=\"#C8D8D4\" stroke-width=\"0.8\"\/>\n            <line x1=\"438\" y1=\"24\" x2=\"438\" y2=\"222\" stroke=\"#C8D8D4\" stroke-width=\"0.8\"\/>\n          <\/svg>\n          <div class=\"rv-fig-cap\">Complete autoantibody reference for the Rheumatology series. Commit the antibody&ndash;disease pair first, then the complication each antibody predicts. Anti-centromere &rarr; PAH; anti-Scl-70 &rarr; ILD; anti-U1-RNP &rarr; PAH; anti-Jo-1 &rarr; ILD; anti-RNA pol III &rarr; renal crisis. These five pairings resolve the majority of rheumatology pharmacology and prognosis questions.<\/div>\n        <\/div>\n\n        <p><span class=\"rv-pill\">HCQ: &le;5 mg\/kg actual wt<\/span> <span class=\"rv-pill\">MTX pneumonitis: stop, don't restart<\/span> <span class=\"rv-pill\">Nail-fold cap: best Raynaud's test<\/span> <span class=\"rv-pill-slate\">Anti-centromere &rarr; PAH<\/span> <span class=\"rv-pill-green\">Anti-Scl-70 &rarr; ILD<\/span><\/p>\n\n      <\/div>\n    <\/div>\n\n    <!-- Footer -->\n    <div style=\"margin-top:32px;text-align:center;font-size:0.80rem;color:#9A7060;font-style:italic;line-height:1.6\">\n      Rheumatology Summative Revision &middot; atsixty.com &middot; Morning Rounds Series<br>\n      For clinical reasoning practice, return to the seven Morning Rounds quizzes linked in the series index.\n    <\/div>\n\n  <\/div>\n<\/div>\n\n\n<ul class=\"wp-block-latest-posts__list wp-block-latest-posts\"><li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-summative-revision-notes\/\">Rheumatology: Summative Revision Notes<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-mixed-high-yield\/\">Rheumatology Series: Mixed High-Yield Round<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-myopathies-sjogrens-scleroderma\/\">Myopathies, Sjogren's &amp; Scleroderma<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/rheumatology-vasculitides\/\">Vasculitides<\/a><\/li>\n<li><a class=\"wp-block-latest-posts__post-title\" href=\"https:\/\/atsixty.com\/index.php\/neet-pg\/crystal-arthropathies\/\">Crystal Arthropathies<\/a><\/li>\n<\/ul>","protected":false},"excerpt":{"rendered":"<p>Morning Rounds &middot; Rheumatology Series RheumatologySummative Revision Notes Seven rounds &middot; NEET-PG and UPSC CMS &middot; Key facts, tables, and diagrams RA SLE &amp; APS Spondyloarthropathies Crystal Arthropathies Vasculitides Myopathies &amp; Scleroderma Mixed High-Yield These notes consolidate the seven Morning Rounds in the Rheumatology series. They are written for rapid pre-exam revision, not first-time learning.&hellip;&nbsp;<\/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":[74,24,64],"tags":[],"class_list":["post-36960","post","type-post","status-publish","format-standard","hentry","category-morning-rounds","category-neet-pg","category-orthopaedics"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Rheumatology: Summative Revision Notes - 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\/neet-pg\/rheumatology-summative-revision-notes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rheumatology: Summative Revision Notes - atsixty\" \/>\n<meta property=\"og:description\" content=\"Morning Rounds &middot; Rheumatology Series RheumatologySummative Revision Notes Seven rounds &middot; NEET-PG and UPSC CMS &middot; Key facts, tables, and diagrams RA SLE &amp; APS Spondyloarthropathies Crystal Arthropathies Vasculitides Myopathies &amp; Scleroderma Mixed High-Yield These notes consolidate the seven Morning Rounds in the Rheumatology series. 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