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19.11.6 Large vessel vasculitis 4546 Raashid Luqmani and Cristina Ponte section 19  Rheumatological disorders 4546 Meyer A, et  al. (2015). Incidence and prevalence of inflamma- tory myopathies:  a systematic review. Rheumatology (Oxford), 54, 50–​63. Miller S...

19.11.7 ANCA- associated vasculitis 4556 David Jayne section 19  Rheumatological disorders 4556 FURTHER READING Alibaz-​Oner F, Direskeneli H (2015). Update on Takayasu’s arteritis. Presse Med, 44, e259–​65. Dasgupta B, et  al.; BSR and BHPR Standards, Guideli...

19.11.8 Polyarteritis nodosa 4569 Loïc Guillevin 19.11.8  Polyarteritis nodosa 4569 Groh M, et al. (2015). Eosinophilic granulomatosis with polyangiitis (Churg-​Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. Eur J Intern Me...

19.11.9 Small vessel vasculitis 4573 Richard A. Watts 19.9  Osteoarthritis 4473 Epidemiology and risk factors The epidemiology of osteoarthritis is complex, which reflects the variation in the applied definition, the specific joint involved, and the heterogene...

19.12 Miscellaneous conditions presenting to rheumatologist 4598

19.2 Clinical presentation and diagnosis of rheumatological disorders 4386 Christopher Deighton and Fiona Pearce ESSENTIALS Most rheumatological diagnoses are made through effective history taking and physical examination rather than investigation. Systemic sy...

19.3 Clinical investigation 4395 Michael Doherty and Peter C. Lanyon ESSENTIALS Laboratory and imaging markers are an adjunct to competent clin- ical assessment and should not be used as a substitute. Tests should only be ordered if the results will alter diag...

19.4 Back pain and regional disorders 4406 Carlo Ammendolia and Danielle Southerst ESSENTIALS Low back pain Over 70% of people in industrialized countries suffer from low back pain at some time, and it is one of the main reasons for visits to phys- icians. Ris...

19.5 Rheumatoid arthritis 4415 Kenneth F. Baker and John D. Isaacs ESSENTIALS Rheumatoid arthritis is a common, painful, and disabling auto- immune disease affecting 0.5 to 1.0% of adults, with a female:male ratio of 2.5:1. Clinical features Rheumatoid arthrit...

19.6 Spondyloarthritis and related conditions 4441 Jürgen Braun and Joachim Sieper ESSENTIALS The spondyloarthritides are a group of common inflammatory rheum- atic diseases with predominant involvement of axial and peripheral joints and entheses, together wit...

19.7 Infection and arthritis 4457 Graham Raftery and Muddassir Shaikh ESSENTIALS Bacterial causes of arthritis—​Septic arthritis is the most serious cause of one or more hot swollen joints. A causative organism can be iden- tified in about 80% of cases, with S...

19.8 Reactive arthritis 4464 Carmel B. Stober and Hill Gaston ESSENTIALS Reactive arthritis a subset of post-​infectious arthritis, and causative or- ganisms are usually localized to the gastrointestinal or genitourinary tracts. Following infection, organisms ...

19.9 Osteoarthritis 4470 Andrew J. Barr and Philip G. Conaghan ESSENTIALS Clinical osteoarthritis is a syndrome of joint pain associated with structural deterioration of synovial joints that over time involves the whole joint organ. It is the most common form ...

2.1 Science in medicine: When, how, and what 33 ESSENTIALS Science has always been part of Western medicine, although what counts as scientific has changed over the centuries, as have the con- tent of medical knowledge, the tools of medical investigation, and ...

2.10 Medicine quality, physicians, and patients 124 ESSENTIALS Poor-​quality medicines negate the enormous advantages of modern pharmaceuticals and lead to avoidable morbidity and mortality; loss of confidence in medicines and healthcare systems; economic loss...

2.11 Preventive medicine 127 ESSENTIALS Causes of death Most deaths before age 80  years are preventable but preventive medicine cannot offer immortality. Childhood and early adult life Deaths from infectious diseases and trauma usually reflect poverty and pol...

2.12 Medical screening 137 ESSENTIALS Medical screening is the systematic application of a test or inquiry to identify individuals at sufficient risk of a specific disorder to benefit from further investigation or direct preventive action (these individ- uals ...

2.13 Health promotion 152 ESSENTIALS The ‘Ottawa Charter for Health Promotion’ (1986) remains a bench- mark for the global health promotion community, but the context for health promotion has changed with increasing recognition of the significance of inequitie...