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96 Cards in this Set
- Front
- Back
Inflammatory joint patterns (3)
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RA
SLE Gout |
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Noninflammatory joint patterns (1)
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OA
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Monoarticular joint patterns (3)
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Gout
Septic arthritis Lyme |
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2-4 joints affected (3)
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Reiter's
Psoriatic IBD |
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>5 joints affected (2)
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SLE
RA |
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DIPs affected (1)
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OA
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MCPs/Wrists affected (2)
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RA
SLE |
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1st MTP affected (1)
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Gout
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RA Dx test (2)
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CCP
RF |
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Normal color of synovial fluid
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Straw colored
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What does a very high LDH indicate?
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Tumors
Cell membranes are being lysed |
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Infection indicated by synovial fluid
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Gonorrhea
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Inflammatory response indicated by synovial fluid
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RA
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Acute onset, typically nocturnal
Hyperuricemia Tophi |
Gout
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Calcium pyrophosphate
Large joints, such as knees and wrists, affected |
Pseudogout
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Pseudogout Crystals (3 Ps)
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Calcium Pyrophosphate
Prism shaped crystals Positive birefringence |
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Gout Crystals
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Uric acid crystals
Needle shaped crystals Negative birefringence |
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Hyperuricemia treatment
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Allopurinol
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Pneumonic for Allopurinol v. Colchicine
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Patients with gout take Allopurinol ALL the time (prevents attacks)
Colchicine is for acute treatment |
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Acute Treatment of Gout
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NSAIDs: Indomethacin 25-50mgm every 8 hours (any Cox 1 or Cox 2)
Colchicine Corticosteroids for pts unable to take NSAIDs |
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Management of Gout (4)
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Low-purine diet
Manage obesity Decrease ETOH Stop offending meds |
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Medications that aggrevate gout (4)
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Thiazides
Loops INCREASE low dose ASA Niacin |
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Drugs used to prevent gouty attacks (2)
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Probenicid
Allopurinol |
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Probenicid Contraindications
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Pts must have urinary output >2 liters/day
Avoid in pts with uric acid lithiasis |
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Allopurinol Contraindications
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May cause rash with toxic epidermal necrolysis
Can kill kidney and liver |
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Major SE of Colchicine
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Gastro problems (diarrhea)
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Symmetric joint swelling with redness, warmth, tenderness and pain with movement
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RA
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Joints affected by RA (5)
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PIPs
MCPs Knees Ankles Toes |
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3 RA deformaties
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Ulnar deviation
Boutonnaire's Swan neck |
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RA X-ray changes
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Earliest changes in wrists or feet
Juxta-articular demineralization Erosions |
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RA Tx Options (2)
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NSAIDs
DMARDs |
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Types of DMARDs (4)
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Methotrexate
Tumor necrosis factor inhibitors Corticosteroids Azathioprine |
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Treatment of choice for RA after NSAIDs
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Methotrexate
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4 SEs of Methotrexate
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Gastritis
Stomatitis Interstitial pneumonitis Folate antagonis (not for pregnancy) |
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Use after failure of or in combo with Methotrexate in treatment of RA
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Tumor necrosis factor inhibitors
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2 types of Tumor necrosis factor inhibitors
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Etanercept (only one that doesn't end in -imab)
Infliximab |
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Tumor necrosis factor inhibitor SEs (2)
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Leukopenia
Reactivation of latent TB |
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SEs of longterm corticosteroid use (6)
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Avascular necrosis
Gastritis/ulcers Cataracts Immunosuppression Cushing's syndrome Osteoporosis |
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Discoid skin lesions
Pericarditis, pleuritis Renal disease Neurologic disease Joint pain, swelling Malar rash |
SLE
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Best SLE lab
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ANA
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SLE management
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Antimalarials (hydroxychloroquine)
Prednisone |
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Mainstay of SLE therapy
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Prednisone
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Antimalarial used to treat SLE
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Hydroxychloroquine
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SE of Hydroxychloroquine
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Pigmentary retinitis (opth exam every 6-12 months)
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3 drugs that induce SLE
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Procainamide
Hydralazine Isoniazid |
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SLE + anemia
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Anemia of chronic disease
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SLE + VDRL
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May be false positive
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Usually associated with RA, SLE, or other connective tissue disease
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Sjogren's
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4 positive lab tests in Sjogren's syndrome
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ANA
RF AntiSSA AntiSSB |
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Dry eyes, burning, and dryness of the mouth
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Sjogren's
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Lymphocytic invasion of lacrimal and salvary glands
increased incidence of lymphoma |
Sjogren's
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Systemic sclerosis
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Scleroderma
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Autoimmune squamous cell destruction
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Scleroderma
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Skin becomes so thick pt cannot close eyes
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Scleroderma
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Scleroderma of face and hands only
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CREST:
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerydactyly Telangiectasias |
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RF negative
ANA negaitive HLA-B27 positive |
Seronegative Spondyloarthropathies
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Seronegative Spondyloarthropathies (4)
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Ankylosing spondylitis
Reiter's syndrome Psoriatic arthritis Colitic arthritis |
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Reiter's syndrome pneumonic
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Can't sleep
Can't see Can't pee Can't sleep with me |
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Urethritis
Conjunctivitis/uveitis Arthritis Follows GI infection or Chlamydia |
Reiter's syndrome
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Assymmetric, sausage appearance of fingers and toes
SI joint disease common |
Psoriatic arthritis
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RF negative
ESR elevated |
Psoriatic arthritis
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Common in patients with IBD
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Colitic arthritis
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Most common extra-intestinal manifestation of IBD after anemia
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Colitic arthritis
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Colitic arthritis Tx
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Treat intestinal inflammation to help control arthritis pain
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Large artery syndromes (temporal arteries, aorta)
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Giant cell/temporal artritis
Takyasu's |
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Medium artery syndromes (not lungs)
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Polyarteritis nodosa
Kawasaki's disease |
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Small artery syndromes (kindeys and lungs)
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Wegener's
Microscopic polyangitis Behcet's syndrome |
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Fever, malaise, anorexia, HA, jaw claudication, scalp tenderness
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Termporal arteritis/giant cell arteritis
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Temporal arteritis/giant cell arteritis associated with
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Polymyalgia rheumatica
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Tender, inflamed, cordlike temporal arteries
Absent pulse Optic neuropathy (monocular blindness) |
Temporal arteritis
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Temporal arteritis Dx
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Temporal artery biopsy
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Temporal arteritis Tx
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Prednisone 60-120 mgm PO QD
Do not delay for biopsy |
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17x more common in patients with history of temporal arteritis
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Thoracic aneurysm
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Young women whose arteries become mush
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Takyasu's arteritis
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Aortic arch and abdominal aorta (including renal arteries) affected
Fever, malaise, weight loss, arthralgias, erythema multiforme Pulseless disease |
Takyasu's arteritis
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Takyasu's arteritis Tx
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Steroids
|
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Medium sized muscular vessels (not lungs) imflamed
Common in middle aged men with Hep B |
Polyarteritis Nodosa
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Meds that can cause Polyarteritis nodosa (3)
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Sulfa
Gold Peniciamine |
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All organ systems but lungs inflammed
Acute MI, HTN, abdominal pain, GI hemorrhage/infarct Elevated ESR Normochromic, normocytic anemia |
Polyarteritis nodosa
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Polyarteritis nodosa Dx
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Biopsy specimen
|
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c-ANCA positive
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Wegener's granulomatosis
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Middle aged caucasian with necrotizing granulomatous vasculitis of small arterioles and capillaries
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Wegener's granulomatosis
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Wegener's granulomatosis Triad
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Upper respiratory symptoms
Lower respiratory symptoms Focal segmental glomerulonephritis |
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Epistaxis
Recurrent sinusitis Rhinorrhea refractory to treatment Crusting ulcerceration of nasal mucosa Granulomas on CXR |
Wegener's granulomatosis
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Saddle nose deformity
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Wegener's granulomatosis
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Iritis v. optic neuritis
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Autoimmune disease = iritis
MS = optic neuritis |
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Oral and genital ulcers
Iritis Polyarthralgias Dementia, parkinsonism |
Behcet's Disease
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Behcet's disease Tx
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Prednisone
|
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Elder with pain and stiffness of shoulder and pelvic girdle but no weakness
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Polymalgia rheumatica
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Disease associated with Polymyalgia rheumatica
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Giant cell arteritis
|
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Inflammatory myopathies (dermopathies)
Heliotrope rash (purple rash over eyelids and chest) Proximal muscle weakness Elevated CK Increased risk of malignancy |
Polymyositis/dermatomyositis
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Purple rash over eyelids and chest
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Heliotrope rash
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Heliotrope rash
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Polymyositis/Dermatomyositis
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Polymyositis/Dermatomyositis Tx
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Steroids
|
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Chronic, widespread muscular pain in 11 of 18 documented sites
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Fibromyalgia
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Fibromyalgia Tx (3)
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Exercise
Pregabalin (Lyrica) Duloxetine HCl (Cymbalta) |