?S?????? ?ST????S ?? ???S????????/???S???G??? ?????????? ??

1
?S?????? ?ST????S ?? ???S????????/???S???G???
?????????? ??µ?t???? ?. ?p??µpa?
2
???S???????? / ???S???G??? ??????????

• ?e??p?? 1 st?? 7 ep?s???e?? as?e??? st??
  p??t?ß??µ?a f???t?da ?fe??eta? se ????? ?
  d?s?e?t?????a t?? µ??s?e?et???? s?st?µat??.
• ?a?? t? ?e????? ?t? ?? pe??ss?te??? ap? a?t???
  t??? as?e?e?? ????? ?a????e??, a?t?pe???????µe?e?
  ?atast?se??, ? a????t?da ?a? ta ?????a
  µ??s?e?et??? ??s?µata e??a? s????? a?t?e?
  a?ap???a? ?a? ap??e?a? e??at????? ?a? se sp???e?
  pe??pt?se?? µp??e? ?a ape???s??? t? ???.
• ? ?a????sµ?? e?? t? s?µpt?µa ?fe??eta? se t?p???
  ß??ß? ? f?e?µ???, se µ??a???? p??ß??µa, ? se
  s?st?µat??? ??s?µa ?a apa?t?se? pe?a?t???
  a???????s? ?a? ?e?ape?a.

3
?a ?e?µat??????? p??ß??µata ?a? ? µ? e?d????
?at???

• S????-15-25 ep?s???e?? st??? ?at????
• ?e?µat???????? e?d???se?? s?st?µat???? ??s?µ?t??
  ?p?ß?????? t? d?????s?/?e?ape?a
• F???t?da as?e??? µe ?p??e?µe?a ?e?µat??? ??s?µata

4
?e?µat??????
?a??????? t?? µ??s?e?et???? s?st?µat?? - ?st?,
a????se??, pe??a?????? µ???a, µ?e? ?a??????? t??
a??s???????? s?st?µat?? - S?st?µat??? a?t????sa
??s?µata - ??t?f?e?µ???d?
5
?e?µat??????? p??ß??µata

• ???s?e?et???
• ?????, ?e?t??????? ??pt?s?
• ???s???????
• Ge???? s?µpt?µata (p??et??, ap??e?a ß?????,
  ?a?????a)
• ??s?e?t?????a/??pt?s? ???????

6
?st????? (1)

• ? s??t??pt??? p?e????f?a t?? ?e?µat???? ??s?µ?t??
  µp??e? ?a d?a???s?e? µe t? ?st????? ?a? t??
  ??????? e??tas?.
• ? pa?a???????? ??e???? s?????? µ??? ep?ßeßa???e?
  t? d?????s?.

7
S?µa?t??? st???e?a ap? t? ?st?????

• ??µ???af??? ?????a, f???
• ?????e?e?a?? ?st????? ?.?. ????as?
• ???s?p??? st???e?a ep???e?µa, a???pa?d???
• ?t?µ??? a?aµ??st??? t?a?µat?sµ??
• S?µpt?µata

8
S?µpt?µata (Ge????)

• ????a???e? vs a????t?de? vs pe??a????t?de?
• ??a???e? vs µ???? ad??aµ?a
• S?st?µat??? ?a?????a, a???e??a/ap??e?a ß?????,
  p??et??, e????? ??p?s?,d?s??µ?a
• Aches and pains

9
S?µpt?µata/S?µe?a (??d??? 1)

• ?????? vs espe???? d?s?aµ??a
• ????, ?????, p???a????t?da
• ??a???µata ????as???/e????µata/????
  st?µat??-?e???t???? ???????
• ?p?pef???t?da/???d??????t?da/?pt???
  ?e???t?da/????f?a?µ?a
• ???????? vs pe??fe????? s?e?et??
• ???????t?da, a?µat????a
• ???es?p??e?a, a?a?t?e?d? d??t??a

10
S?µpt?µata (??d??? 2)

• Fa???µe?? Raynaud's
• F?t?e?a?s??s?a/f?t?e?a?s??ta e?a???µata
• ???????t?de? (p?e???t?da, pe???a?d?t?da)
• T??µß?se??, ap?ß????
• ?st?a?? ?e????????? e???µata se ????? as?e?e??

11
??????? ???tas?

• St?? ??????? e??tas? ?a p??pe? ?a d?e?e???ta? a?
  ? p???? ?fe??eta? st?? ?????s? , ta pe??a??????
  µ???a, t??? µ?e? ? t? ?st???.
• ? p???? p?? ?fe??eta? st?? ?????s? s??????
  ?f?eta? µe t?? a??pa?s? ?a? ep?de????eta? µe t??
  ????s? µe t? f??t?s? t?? a????se??.
• ? p???? st?? ?????s? ?p?? ? p??se?t??? ???????
  e??tas? de? ap??a??pte? a??µa??e?, ?s?? ?fe??eta?
  se a?afe??µe?? p??? ? ß??ß? t?? ?st??.
• ?? ?st???? ß??ße? a??et? s???? p???a???? p??? p??
  de? ?f?eta? µet? t?? ?at????s?.
• Se ?e????? ??aµµ?? ete??p?e???? p???? s??????
  ?fe??eta? se t?p??? p??ß??µata, ?p?? a????t?da,
  te???t?t?da ? s?µp?est??? ?e???p??e?a.

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???ast???a?? e???µata

• F?e?µ???de? s??d??µ?
• ??a?µ?a ?????a? f?e?µ????
• T??µß???tt???s?
• ?p??e???µat??a?µ?a
• ????s? ???, CRP (C3, ???d?????)
• ?????µ???? ??e????
• ??eat?????, ?e???µat???
• ?pat???tta????/????stat??? ß??ß?
• ???a???? f?sfat?s?
• ?sß?st??
• ????s? CK (SGOT/SGPT)
• ??e??? ???µa ?????
• ???s???????? ??e????
• ANA, ANCA, ??t?f?sf???p?d??? PF, C3

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?a?a??????? e???µata

• Sp?????????f?µa µe a???µ??? p??????
• ??e????t? ?ste?p???s?
• ?a????p?t?da
• ???µes? p?e?µ????? ??s??/p?e???t???
  s??????/???d?a/e????a ????? ?a???
• ??aß??se??, st???s? µesa?????? d?ast?µ?t??,
  ?ste???t???? ß??ße?
• ?e???a?d?t?da

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??t?µ?s? ?e?t???????? a?a???? (Activities of
daily living)

• ?p???
• ?t?s?µ?
• ???s?µ?
• ?e??p???s? (????sµa/?t???sµa)
• ??d?s?/µeta????s?
• ????te?a ?????/??p?????

• ???s? s?s?e???
• ???ef????
• ??e?d???/?e????aß??
• S???p?sµa
• ?d???s? a?t?????t??

15
??t?µ?s? ?e?t?????????at?stas??

• ? ?e?t??????? ?at?stas? t?? as?e???? ?a p??pe? ?a
  d?e?e???ta? µe e??t?se?? ?p??
• ?? d?s???e?este ?a ???ete t??a s?????t??? µe t?
  pa?e????
• ??? t? t????? p??ß??µa ep??e??e? t??
  ?a??µe????? sa? d?ast????t?te?.

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?e?t??????? ?at?stas? ?at? ACR

• Class I F?s????????
• Class II ???ß??µata µ??? se ???a???????
• d?ast????t?te? (?.?. a???pa?d???)
• Class III ???ß??µata st?? ?s??s? t??
• epa????µat??
• Class IV ?d??aµ?a a?t?e??p???t?s??

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?a?a???????? ??e???? (1)

• Pre-test probability, e?a?s??s?a, e?d???t?ta,
  p?????st??? a??a post-test probability
• Post-test probability (PPV) Sensitivity x
  Disease Prevalence
• Sensitivity x Prevalence
• (1-specificity) x (1-Prevalence)
• High pre-test probability-a???t??? ap?t??esµa
• de?
  ap???e?e? t? d?????s?
• Low pre-test probability- ?et??? ap?t??esµa
  a???p?st? µ??? a?
• ?
  e?d???t?ta t?? d???µas?a? ?????

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?a?a???????? ??e????Ge????? ?a???e? (2)

• ?p? asaf??? d?a???se?? ap?f??? d???µas???
  screening
• ????µas?e? p?? af????? t?? p???? p??a???
  d?a???se??
• ??a??? µe t?? ????te?? epeµßat???? d???µas?e?
• ?p????? t?? d???µas??? µe t?? ?????te??
  e?d???t?ta
• ?? ep?µe?e? d???µas?e? ?a p??pe? ?a ?p?ß??????
  t?? pe?a?t??? e?e?d??e?s? t?? d?????s??, t??
  ??e??? t?? p???d?? t?? ?a? e?asfa?????? t??
  asf??e?a t?? ?e?ape?a?

19
?a?a???????? ??e???? (3)

• ???tas? a??????? ?????
• ???te??e? ??e?a? f?se??
• ???s???????? d???µas?e?
• ?pe?????st???? ??e????
• ?p??? a?t?????af?e? - Sp?????????f?µa
• ??????? t?µ???af?a - ?st??? p????t?ta
• ?a???t??? t?µ???af?a - ???e????af?a

20
????????S????S ??T????

• MRI
• ??es? µ?e???/µ?e??t?da
• Sp??d???d?s??t?da/?ste?µ?e??t?da
• ???d???, ?st? t????te?, µ???s???
• ???e??t?da
• ?ad???s?t?p???? µ???d??
• ?at??µata
• ???µ??e??
• ?????
• F?e?µ???

21
????????S????S ??T????

• ?p?? a?t?????af?a
• ???ß??s? ???d???/?st??, pa?aµ??f?se??
• ?????
• ?at??µata
• Poor Mans view ?? ?/? ?e????/p?d?? ?? p?????
• ??????? t?µ???af?a
• ?e???a????e?
• Sp??d????? st???s?
• Poor Mans view ?? ?/? ?e????/p?d?? -?? p?????

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S?st?µat??? f?e?µ???d? ??s?µata (S?st?µat???
F?e?µ???de? s??d??µ?)

• S?????? p???s?st?µat??? p??sß???-a????se??,
  d??µa, p?e?µ??e?, ?ef??? ??p
• S?st?µat??? s?µt?µata ?a?????a, a???e??a/ap??e?a
  ß?????, p??et??, e????? ??p?s?, d?s??µ?a
• ???ast???a?? e???µata ?e???e?µ???? f?e?µ????
• -??a?µ?a ?????a? f?e?µ????
• T??µß???tt???s?
• ?p??e???µat??a?µ?a
• ????s? ???, CRP (C3, ???d?????)

23
S?st?µat???? ???e?t?de?
24
Ge????? a???? ?e?ape?a? (1)

• ?????? ? ??? ??s?µa
• F?s??? ?st???a ?fes?, ?f?se?? - e???se??,
• s??e??? e?e???t?ta
• ??p?? ??????? ?a? s?ßa??t?ta p??sß????

25
Ge????? a???? ?e?ape?a? (2)

• ?p?? pa?s?p??a ??etaµ???fa???/pa?a?etaµ???
• ?S?F
• ??t???e?µat??? f??µa?a (DMARDS)
• ???t???e?d?
• ???s??atasta?t???/a??s????µ?st???
• ?????????? ?e?ape?e?
• F?s????e?ape?a/e??as???e?ape?a/????t???
• ?e?????????