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• Biological treatments for rheumatoid arthritis, especially TNF-inhibitors, have been shown to increase the chances of reactivation of tuberculosis. Hence, it is necessary to perform a chest X-ray before beginning the treatment. 
• Full blood count and liver function test are used as an essential monitoring tool for DMARDs but is not indicated to perform them before the beginning of the treatment. This is due to the risk of myelosuppression and liver cirrhosis.
• Urea and electrolytes testing is performed before the prescription of ACE inhibitors and lithium.
• Pseudogout, also known as calcium pyrophosphate deposition (CPPD), is caused by an excess of calcium pyrophosphate levels in the body. Risk factors include haemochromatosis, hyperparathyroidism, hypophosphataemia, hypothyroidism and hypomagnesemia. Also old age is a big risk factor.
• desferioxamine is an iron chelating agent
• The first line treatment for pseudogout is NSAIDs and colchicine. Methotrexate can be used for chronic pseudogout, however it isn't first line.
• Capsaicin can be used for osteoarthritis
• Keratoderma blennorrhagica is a skin condition that is associated with reactive arthritis, formerly known as Reiter's syndrome. The patient's history of diarrhoea could suggest a preceding infection which can trigger reactive arthritis. In addition to the rash, the symptoms of joint pain and dysuria (pain on passing water) are typical features of this syndrome.
• The clinical presentation is of diffuse cutaneous systemic sclerosis with interstitial lung disease (ILD) i.e. ground glass changes present in the lower lobes on HRCT. The most specific antibody for this subtype is anti Scl-70.
• A normal calcium and phosphate combined with a raised alkaline phosphate points to a diagnosis of Paget's
• Osteomalacia blood tests show a low calcium and phosphate and a high alkaline phosphatase.
• Intravenous fluids and bisphosphonates are the management for hypercalcaemia, not hypocalcaemia. 
• Levothyroxine is used to manage hypothyroidism.
• Oral bisphosphonates are used in the management of osteoporosis
• Vitamin D supplementation is commonly used to treat osteomalacia. Calcium supplementation may also be prescribed if the dietary intake of calcium is inadequate.
• Sjogren's syndrome is an autoimmune disorder affecting exocrine glands resulting in dry mucosal surfaces. It may be primary (PSS) or secondary to rheumatoid arthritis or other connective tissue disorders, where it usually develops around 10 years after the initial onset. Sjogren's syndrome is much more common in females (ratio 9:1). There is a marked increased risk of lymphoid malignancy (40-60 fold).
• De Quervain's tenosynovitis is a common condition in which the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed. It typically affects females aged 30-50 years old. Finkelstein's test is positive (on grasping the patient's thumb and abducting the hand to the ulnar side, there is pain over the radial styloid process).
• The T-score is a measure of the bone mineral density compared to a healthy young adult. The T-score can be used to diagnose osteoporosis (if less than -2.5), or osteopenia (if between -1 and -2.5).The Z-score is a measure of bone mineral density compared to the average of those of the same age, ethnicity, and gender. The Z-score is not used to diagnose osteoporosis, but is still useful in males under the age of 50 or premenopausal women, as a score of less than -2 suggests bone mineral density below the expected range.
• Onycholysis has an association with psoriatic arthritis; nail changes occur in approximately 80-90% of patients. It is important to note that psoriatic skin rashes may not always be present and can manifest either before or after the development of psoriatic arthritis.
• L3 nerve root compression - Sensory loss over anterior thighWeak hip flexion, knee extension and hip adductionReduced knee reflexPositive femoral stretch test
• L4 nerve root compression - Sensory loss anterior aspect of knee and medial malleolusWeak knee extension and hip adductionReduced knee reflexPositive femoral stretch test
• L5 nerve root compression - Sensory loss dorsum of footWeakness in foot and big toe dorsiflexionReflexes intactPositive sciatic nerve stretch test
• S1 nerve root compression - Sensory loss posterolateral aspect of leg and lateral aspect of footWeakness in plantar flexion of footReduced ankle reflexPositive sciatic nerve stretch test
• Alport syndrome is a genetic condition caused by the defective production of type IV collagen. Features include glomerulonephritis, end-stage kidney disease, and hearing loss, and it is managed using ACE inhibitors and haemodialysis.
• Conversion of vitamin D to its biologically active form, 1,25-dihydroxycholecalciferol, occurs in the kidneys. This function is impaired in chronic renal diseases, such as Alport syndrome. The bones of these individuals are therefore more susceptible to fracture.
• Ehler-Danlos syndrome is a genetic collagen disorder, which results in widespread elasticity of tissue. There are many differing subtypes, but most commonly it is an autosomal dominant condition affecting type III collagen. A diastolic murmur means that mitral stenosis and aortic regurgitation are most likely. It is valvular incompetence that individuals with Ehler-Danlos are most likely to suffer with, due to the connective tissue pathology. Aortic dissection is another complication of Ehler-Danlos.Atrial and ventricular septal defects are not commonly associated with Ehler-Danlos syndrome.
• Dermatomyositis is usually an autoimmune condition, being most common in women aged 50-70. However, it can also be a paraneoplastic disease, with ovarian, breast and lung tumours being the most common underlying cancers. 
• normal reflexes excludes L3,L4 (knee) and S1,S2 (ankle)
• Antiphospholipid syndrome leads to a raised APTT and normal PT and can result in thrombocytopenia.
• While plain radiographs may be normal in the early stages of AS, classic radiographic features include syndesmophytes - bony growths originating from inside a spinal ligament or of the annulus fibrosus.Other features may include erosions and sclerosis of the sacroiliac joints, vertebral body squaring, bone fusion and eventually, the appearance of a 'bamboo spine'.Lytic bone lesions in the spine are caused by bone destruction, usually secondary to malignancies such as myeloma.
• Primary hyperparathyroidism. Parathyroid hormone (PTH) is raised as it is being over-produced by the parathyroid glands. Subsequently, calcium is high as PTH works to increase free calcium by increasing renal reabsorption, reducing phosphate reabsorption (hence phosphate is low) and increasing calcium reabsorption from the bones (hence ALP is raised). The bone pain, low mood and constipation in the brief are typical symptoms of hypercalcaemia
• Anticardiolipin antibodies, as well as lupus anticoagulant, are commonly seen in patients with antiphospholipid syndrome. 
• Limited cutaneous systemic sclerosis. Scleroderma is limited to the distal extremities only, however, the face may also be involved. Limited systemic sclerosis is associated with anti-centromere antibodies.
• Anti-Scl-70 antibodies are associated with diffuse systemic sclerosis. In diffuse systemic sclerosis, scleroderma involves the trunk and proximal limbs.
• Anti-dsDNA antibodies are associated with systemic lupus erythematosus (SLE). SLE generally presents with non-specific symptoms such as, fatigue, fever, oral ulcers, joint pain and a rash.
• Anti-mitochondrial (AMA) is associated with primary biliary cirrhosis (PBC). PBC is often asymptomatic in the early stages but may present as fatigue, pruritus and jaundice.
• A meniscal tear is usually caused by twisting of the knee and on examination, McMurrays test will be positive. To perform McMurrays test, the knee is held in one hand, which is placed along the joint line, and flexed while the sole of the foot is held with the other hand. One hand is placed on the medial side of the knee to pull the knee towards a varus position. The other hand is used to rotate the leg internally whilst extending the knee. If pain or a 'click' is felt, this constitutes a 'positive McMurray test'.
• Patients with rib fractures can find their deep breathing limited by pain. This causes susceptibility to chest infections as they cannot cough adequately to clear secretions. Chest physiotherapy with breathing exercises, accompanied by adequate analgesia can help to prevent this.
• CPAP at nighttime is used in patients with obstructive sleep apnoea to keep the airway open whilst sleeping.
• Adult-onset Still's disease - triad of fever, polyarthralgia and rash. Raised ferritin is anothe as ferritin is the acute phase protein of choice for monitoring disease activity in these patients. Adult-onset Still's disease can lead to severe flares that mimic sepsis. A range of biologic therapies can be used to treat these flares such as anti-TNFs and anakinra along with more traditional disease modifying anti rheumatic drugs (DMARDs) and non-steroidal anti inflammatories.