Rheumatology Pathways

DMARD initiation, DAS28 monitoring, and biologic escalation for RA

Acute gout attack management and urate-lowering therapy initiation

Diagnosis and induction therapy for ANCA vasculitis — GPA, MPA, EGPA

Diagnosis, hydroxychloroquine backbone therapy, and organ-specific management of SLE

BSR 2020 — recognise red flags, urgent prednisolone (do not delay for biopsy/USS), tocilizumab, GCA fast-track clinic.

BSR / BOA — joint aspiration BEFORE antibiotics, empirical IV antibiotics, surgical washout.

Pattern recognition — symmetric / asymmetric, acute / chronic, large / small joint — directs investigation and onward referral.

NICE NG65 — inflammatory back pain ASAS criteria, HLA-B27, MRI sacroiliac joints, NSAIDs, biologics (TNF / IL-17), comorbidities.

CASPAR criteria, distinguish PsA patterns, NSAIDs / DMARDs / biologics, treat skin + joints + comorbidities together.

Acute hypertension + AKI in systemic sclerosis — urgent ACE-I (lifesaving), avoid steroids >15 mg/day.

BSR — diagnostic criteria, exclude mimics, low-dose prednisolone, slow taper, monitor for GCA.

Post-infectious asymmetric oligoarthritis — GU / GI trigger, NSAIDs, address infection, screen STI.

Yamaguchi criteria — quotidian fever + salmon rash + arthritis + ferritin ↑↑ — exclude infection / malignancy first.

Recurrent oral + genital ulcers + uveitis + skin lesions — variable systemic involvement (vascular, neuro, GI), corticosteroid + steroid-sparing.

Sicca symptoms + autoantibodies (anti-Ro/La) + Schirmer / salivary gland biopsy — symptomatic + lymphoma surveillance.

Beighton score, distinguish hypermobility spectrum from hEDS / classical / vascular EDS, multidisciplinary management.