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  <head>
    <title>033-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Musculoskeletal and rheumatic foundations">
      <outline text="Orientation">
        <outline text="Trauma, degeneration, infection, crystals, immunity"/>
        <outline text="First: urgent versus non-urgent">
          <outline text="Threatened limb, open fracture, compartment syndrome"/>
          <outline text="Septic joint, spinal compression, vasculitis"/>
        </outline>
        <outline text="Second: inflammatory versus mechanical">
          <outline text="Pattern and tempo beat antibody panels"/>
        </outline>
      </outline>
      <outline text="Acute soft-tissue injury">
        <outline text="Bleeding, inflammation, pain, swelling"/>
        <outline text="Inflammation, proliferation, remodelling">
          <outline text="Remodelling aligns tissue with load"/>
        </outline>
        <outline text="Balance protection and movement">
          <outline text="Too little protection: repeated disruption"/>
          <outline text="Prolonged immobilisation: stiffness, atrophy"/>
        </outline>
        <outline text="Tendon rupture: gap and weakness, modest pain"/>
        <outline text="Dislocation needs urgent reduction"/>
      </outline>
      <outline text="Fractures and limb emergencies">
        <outline text="Fragility fracture: reduced bone strength"/>
        <outline text="Pathological fracture: through focal disease"/>
        <outline text="Open fracture">
          <outline text="Antibiotics, tetanus, debridement, stabilisation"/>
          <outline text="Do not repeatedly probe the wound"/>
        </outline>
        <outline text="Occult fracture on a normal early radiograph"/>
        <outline text="Compartment syndrome">
          <outline text="Closed fascial pressure impairs perfusion"/>
          <outline text="Pain out of proportion, passive stretch pain"/>
          <outline text="Pulses may remain present"/>
          <outline text="Delay: necrosis, kidney injury, limb loss"/>
        </outline>
      </outline>
      <outline text="Osteoarthritis">
        <outline text="Whole-joint failure">
          <outline text="Osteophytes, remodelling, intermittent synovitis"/>
        </outline>
        <outline text="Radiographs correlate imperfectly with pain"/>
        <outline text="Activity pain, brief stiffness after rest"/>
        <outline text="Long stiffness or systemic features: rethink"/>
        <outline text="Exercise, weight, pacing, topical therapy"/>
        <outline text="Replacement for severe disease">
          <outline text="Arthroscopy does not reverse degeneration"/>
        </outline>
      </outline>
      <outline text="Crystal arthritis">
        <outline text="Gout: urate supersaturation and deposition">
          <outline text="Serum urate may be normal in a flare"/>
          <outline text="Needle-shaped, negatively birefringent"/>
          <outline text="Crystals do not exclude infection"/>
        </outline>
        <outline text="Early flare treatment: NSAID, colchicine, steroid"/>
        <outline text="Long-term urate lowering">
          <outline text="Start low, titrate, give prophylaxis"/>
          <outline text="Usually continue during a flare"/>
        </outline>
        <outline text="Calcium pyrophosphate deposition">
          <outline text="Rhomboid, weakly positive crystals"/>
          <outline text="No therapy removes the crystal burden"/>
        </outline>
      </outline>
      <outline text="Septic arthritis and osteomyelitis">
        <outline text="Hot swollen joint: septic until assessed">
          <outline text="Fever may be absent"/>
          <outline text="Blood cultures and urgent synovial fluid"/>
        </outline>
        <outline text="Osteomyelitis: blood, contiguity, surgery, trauma">
          <outline text="Chronic: necrotic bone, sinus, biofilm"/>
          <outline text="Deep tissue microbiology often needed"/>
        </outline>
        <outline text="Source control plus targeted antimicrobials"/>
      </outline>
      <outline text="Inflammatory arthritis">
        <outline text="Rheumatoid arthritis">
          <outline text="Symmetric small joints, long morning stiffness"/>
          <outline text="Anti-citrullinated antibodies more specific"/>
          <outline text="Negative antibodies do not exclude synovitis"/>
          <outline text="Early disease-modifying therapy for remission"/>
        </outline>
        <outline text="Spondyloarthritis">
          <outline text="Enthesitis, dactylitis, uveitis, psoriasis"/>
          <outline text="HLA-B27 supports risk, not diagnosis"/>
          <outline text="Back pain eases with movement"/>
          <outline text="MRI sacroiliitis precedes radiographic change"/>
        </outline>
      </outline>
      <outline text="Lupus and connective-tissue disease">
        <outline text="Lupus: lost tolerance, immune complexes"/>
        <outline text="ANA sensitive, poorly specific">
          <outline text="Specific antibodies, complement, urine"/>
        </outline>
        <outline text="Kidney biopsy guides nephritis treatment"/>
        <outline text="Hydroxychloroquine; steroids accumulate toxicity"/>
        <outline text="Systemic sclerosis: vasculopathy and fibrosis"/>
        <outline text="Sjogren disease: dryness, lymphoma risk"/>
      </outline>
      <outline text="Vasculitis and inflammatory myopathy">
        <outline text="Vessel wall injury: ischaemia, haemorrhage"/>
        <outline text="Jaw claudication, purpura, mononeuritis"/>
        <outline text="Biopsy or vascular imaging establishes diagnosis"/>
        <outline text="Myopathy: subacute proximal weakness">
          <outline text="Creatine kinase not always raised"/>
        </outline>
      </outline>
      <outline text="Immunomodulatory safety">
        <outline text="Screen latent infection before treatment"/>
        <outline text="Update non-live vaccines"/>
        <outline text="Fever: infection, flare, or both">
          <outline text="Exclude infection before escalating"/>
        </outline>
        <outline text="Monitor counts, organs, bone, adherence"/>
        <outline text="Shared decisions: benefit time, cost, fertility"/>
      </outline>
    </outline>
  </body>
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