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Systemic juvenile idiopathic arthritis

Tue, 27 Sep 2016 23:42:19 GMT

wikify ← Older revision Revision as of 23:42, 27 September 2016 Line 2: Line 2: {{SubjectBox}} {{SubjectBox}} -[[George Frederic Still]] described 22 children with systemic-onset idiopathic juvenile arthritis (SJIA, Juvenile Still's disease) in [[1897]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=20896907  Still GF. On a Form of Chronic Joint Disease in Children. Medico-chirurgical transactions. 1897; 80:47-60.9.].+[[George Frederic Still]] described 22 children with systemic-onset idiopathic juvenile arthritis (SJIA, Juvenile [[Still's disease]]) in [[1897]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=20896907  Still GF. On a Form of Chronic Joint Disease in Children. Medico-chirurgical transactions. 1897; 80:47-60.9.]. ===Diagnosis=== ===Diagnosis=== While [[juvenile idiopathic arthritis]] (JIA) is an umbrella term covering multiple distinct conditions a subset affecting just over 10% is SJIA and often in the early course of this subset the systemic features necessary for diagnosis are lacking. Currently it is defined as an arthritis of unknown aetiology presenting before the 16th birthday and lasting at least six weeks. Systemic juvenile idiopathic arthritis is the subset characterised by[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=24782683  Stoll ML, Cron RQ. Treatment of juvenile idiopathic arthritis: a revolution in care. Pediatric rheumatology online journal. 2014; 12:13.](Epub) ([http://dx.doi.org/10.1186/1546-0096-12-13 Link to article] – subscription may be required.): While [[juvenile idiopathic arthritis]] (JIA) is an umbrella term covering multiple distinct conditions a subset affecting just over 10% is SJIA and often in the early course of this subset the systemic features necessary for diagnosis are lacking. Currently it is defined as an arthritis of unknown aetiology presenting before the 16th birthday and lasting at least six weeks. Systemic juvenile idiopathic arthritis is the subset characterised by[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=24782683  Stoll ML, Cron RQ. Treatment of juvenile idiopathic arthritis: a revolution in care. Pediatric rheumatology online journal. 2014; 12:13.](Epub) ([http://dx.doi.org/10.1186/1546-0096-12-13 Link to article] – subscription may be required.): [...]



Anti Nuclear Antibody

Tue, 27 Sep 2016 23:40:35 GMT

redirect

New page

#redirect[[antinuclear antibody]]



Systemic juvenile idiopathic arthritis

Tue, 27 Sep 2016 23:38:57 GMT

wikify ← Older revision Revision as of 23:38, 27 September 2016 (One intermediate revision not shown)Line 6: Line 6: While [[juvenile idiopathic arthritis]] (JIA) is an umbrella term covering multiple distinct conditions a subset affecting just over 10% is SJIA and often in the early course of this subset the systemic features necessary for diagnosis are lacking. Currently it is defined as an arthritis of unknown aetiology presenting before the 16th birthday and lasting at least six weeks. Systemic juvenile idiopathic arthritis is the subset characterised by[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=24782683  Stoll ML, Cron RQ. Treatment of juvenile idiopathic arthritis: a revolution in care. Pediatric rheumatology online journal. 2014; 12:13.](Epub) ([http://dx.doi.org/10.1186/1546-0096-12-13 Link to article] – subscription may be required.): While [[juvenile idiopathic arthritis]] (JIA) is an umbrella term covering multiple distinct conditions a subset affecting just over 10% is SJIA and often in the early course of this subset the systemic features necessary for diagnosis are lacking. Currently it is defined as an arthritis of unknown aetiology presenting before the 16th birthday and lasting at least six weeks. Systemic juvenile idiopathic arthritis is the subset characterised by[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=24782683  Stoll ML, Cron RQ. Treatment of juvenile idiopathic arthritis: a revolution in care. Pediatric rheumatology online journal. 2014; 12:13.](Epub) ([http://dx.doi.org/10.1186/1546-0096-12-13 Link to article] – subscription may be required.): *Intermittent high fever *Intermittent high fever  +*Salmon pink maculopapular faint rash *Peak age of onset 2 years *Peak age of onset 2 years *Equal sex incidence *Equal sex incidence Line 14: Line 15: * Prolonged pyrexia (see below) * Prolonged pyrexia (see below) * Intermittent characteristic rash (see below) * Intermittent characteristic rash (see below) -* Raised CRP, ESR, [[ferritin]] (esp over 1000 - but no specific, also seen in [[haemophagocytic syndromes]], [[haemochromatosis]], liver disorders, malignancy)+* Raised CRP, ESR, [[ferritin]] (esp over 1000 - but no specific, also seen in [[haemophagocytic syndrome]], [[haemochromatosis]], liver disorders, malignancy) -* Poor response to IVIG (cf [[Kawasakis disease]])+* Poor response to IVIG (cf [[Kawasaki disease]]) * [[Leucocytosis]] (neutrophilia, can be leukaemoid) * [[Leucocytosis]] (neutrophilia, can be leukaemoid) * [[Thrombocytosis]] * [[Thrombocytosis]] Line 23: Line 24: * [[Pericarditis]] * [[Pericarditis]] -Can be systemically very unwell and potentially life threatening complications may occur early in the disease course (eg pericarditis, macrophage activation syndrome or [[haemophagocytic syndrome]]/lymphohistiocytosis (HLH), sepsis). Start high dose corticosteroids after careful exclusion of other diagnoses, especially infection, [[Kawasakis disease]], and malignancy - difficult when arthritis is absent.+Can be systemically very unwell and potentially life threatening complications may occur early in the disease course (eg pericarditis, macrophage activation syndrome or [[haemophagocytic syndrome]]/lymphohistiocytosis (HLH), sepsis). Start high dose corticosteroids after careful exclusion of other diagnoses, especially infection, [[Kawasaki disease]], and malignancy - difficult when arthritis is absent. Systemic features may predate the arthritis by several weeks and occasionally longer. Typically involves small joints of the hands and wrists, ankles, hips, knees, and cervical spine - about 30% ultimately develop severe polyarthritis.[...]



Juvenile idiopathic arthritis

Tue, 27 Sep 2016 23:35:22 GMT

move out stills ← Older revision Revision as of 23:35, 27 September 2016 Line 8: Line 8: *'''Polyarthritis''' (rheumatoid factor positive) - This subtype accounts for 7% of cases and is characterised by a symmetrical polyarthritis, nodules, and IgM [[rheumatoid factor]] being identified at least twice, three months apart. Patients are typically adolescent girls of 10yrs+ and the prognosis is guarded as early joint damage often occurs. *'''Polyarthritis''' (rheumatoid factor positive) - This subtype accounts for 7% of cases and is characterised by a symmetrical polyarthritis, nodules, and IgM [[rheumatoid factor]] being identified at least twice, three months apart. Patients are typically adolescent girls of 10yrs+ and the prognosis is guarded as early joint damage often occurs. -*'''[[Systemic juvenile idiopathic arthritis|Systemic onset]]''' (systemic juvenile idiopathic arthritis, SJIA, SOJIA, formally Still's disease) accounts for 11% of cases of JIA. It can occur at any age, often in pre-school children although rarely in infancy. Similar incidence rates are seen in males and females.+*'''[[Systemic juvenile idiopathic arthritis|Systemic onset]]''' ([[systemic juvenile idiopathic arthritis]], SJIA, SOJIA, formally Still's disease) accounts for 11% of cases of JIA. It can occur at any age, often in pre-school children although rarely in infancy. Similar incidence rates are seen in males and females. *Enthesitis related arthritis - This term is used for arthritis and enthesitis (inflammation of tendon insertions eg sternum, around knee (at 2,6 and 10 o'clock positions), tibial tubercle, achilles/plantar, tibialis anterior, flexor digitorum insertion in foot). Often give history of dactylitis. Asymmetric, distal large joints in the lower limbs are commonly affected and there is a high risk of these patients developing [[ankylosing spondylitis]] in early adulthood - spine rarely affected early on. '''BASMI''' score consists of 5 measurements of spinal mobility. The group also includes arthritis or enthesitis with at least two of: *Enthesitis related arthritis - This term is used for arthritis and enthesitis (inflammation of tendon insertions eg sternum, around knee (at 2,6 and 10 o'clock positions), tibial tubercle, achilles/plantar, tibialis anterior, flexor digitorum insertion in foot). Often give history of dactylitis. Asymmetric, distal large joints in the lower limbs are commonly affected and there is a high risk of these patients developing [[ankylosing spondylitis]] in early adulthood - spine rarely affected early on. '''BASMI''' score consists of 5 measurements of spinal mobility. The group also includes arthritis or enthesitis with at least two of: Line 54: Line 54: * US: good but operator dependent.   * US: good but operator dependent.   * MRI probably better - can even predict extension in mono, up to 11 months before clinical signs. * MRI probably better - can even predict extension in mono, up to 11 months before clinical signs. -  -==Systemic onset JIA==  -  -Features:  -* Prolonged pyrexia (see below)  -* Intermittent characteristic rash (see below)  -* Raised CRP, ESR, [[ferritin]] (esp over 1000 - but no specific, also seen in [[haemophagocytic syndromes]], [[haemochromatosis]], liver disorders, malignancy)  -* Poor response to IVIG (cf [[Kawasakis disease]])  -* [[Leucocytosis]] (neutrophilia, can be leukaemoid)  -* [[Thrombocytosis]]  -* [[Arthritis]]  -* Hepatosplenomegaly  -* Generalised lymphadenopathy  -* [[Pericarditis]]  -  -Can be systemically very unwell and potentially life threatening complications may occur early in the disease course (eg pericarditis, macrophage activation syndrome or [[haemophagocytic syndrome]]/lymphohistiocytosis (HLH), sepsis). Start high dose corticosteroids after careful exclusion of other diagnoses, especially infection, [[Kawasakis disease]], and malignancy - diffi[...]



Systemic juvenile idiopathic arthritis

Tue, 27 Sep 2016 23:35:10 GMT

include from prev article ← Older revision Revision as of 23:35, 27 September 2016 Line 11: Line 11: *No [[enthesitis]] or [[dactylitis]] *No [[enthesitis]] or [[dactylitis]] *ANA sometimes positive, [[rheumatoid factor]] -ive *ANA sometimes positive, [[rheumatoid factor]] -ive  +====Features====  +* Prolonged pyrexia (see below)  +* Intermittent characteristic rash (see below)  +* Raised CRP, ESR, [[ferritin]] (esp over 1000 - but no specific, also seen in [[haemophagocytic syndromes]], [[haemochromatosis]], liver disorders, malignancy)  +* Poor response to IVIG (cf [[Kawasakis disease]])  +* [[Leucocytosis]] (neutrophilia, can be leukaemoid)  +* [[Thrombocytosis]]  +* [[Arthritis]]  +* Hepatosplenomegaly  +* Generalised lymphadenopathy  +* [[Pericarditis]]  +  +Can be systemically very unwell and potentially life threatening complications may occur early in the disease course (eg pericarditis, macrophage activation syndrome or [[haemophagocytic syndrome]]/lymphohistiocytosis (HLH), sepsis). Start high dose corticosteroids after careful exclusion of other diagnoses, especially infection, [[Kawasakis disease]], and malignancy - difficult when arthritis is absent.  +  +Systemic features may predate the arthritis by several weeks and occasionally longer. Typically involves small joints of the hands and wrists, ankles, hips, knees, and cervical spine - about 30% ultimately develop severe polyarthritis.  +  +There are no [[pathognomonic]] tests or agreed diagnostic criteria for SOJIA! Exclude other conditions, look for classic features:  +  +* [[Quotidian]] (=daily) evening spiking temperature, that returns to or falls below baseline by the morning.  +* Rash is faint, salmon pink maculopapular, most obvious during pyrexia. Usually not on the face so easily missed - typically on the trunk, inner thigh and axillae, especially on areas of trauma or pressure ([[Koebner phenomenon]]).  + ===Treatment=== ===Treatment=== *[[NSAID|Non-steroidal anti-inflammatory drugs]] and [[corticosteroids]] are now largely used as bridge or adjunctive therapies. *[[NSAID|Non-steroidal anti-inflammatory drugs]] and [[corticosteroids]] are now largely used as bridge or adjunctive therapies. [...]



Juvenile idiopathic arthritis

Tue, 27 Sep 2016 23:30:29 GMT

typo ← Older revision Revision as of 23:30, 27 September 2016 (One intermediate revision not shown)Line 8: Line 8: *'''Polyarthritis''' (rheumatoid factor positive) - This subtype accounts for 7% of cases and is characterised by a symmetrical polyarthritis, nodules, and IgM [[rheumatoid factor]] being identified at least twice, three months apart. Patients are typically adolescent girls of 10yrs+ and the prognosis is guarded as early joint damage often occurs. *'''Polyarthritis''' (rheumatoid factor positive) - This subtype accounts for 7% of cases and is characterised by a symmetrical polyarthritis, nodules, and IgM [[rheumatoid factor]] being identified at least twice, three months apart. Patients are typically adolescent girls of 10yrs+ and the prognosis is guarded as early joint damage often occurs. -*'''Systemic onset''' (SOJIA) accounts for 11% of cases of JIA. It can occur at any age, often in pre-school children although rarely in infancy. Similar incidence rates are seen in males and females.+*'''[[Systemic juvenile idiopathic arthritis|Systemic onset]]''' (systemic juvenile idiopathic arthritis, SJIA, SOJIA, formally Still's disease) accounts for 11% of cases of JIA. It can occur at any age, often in pre-school children although rarely in infancy. Similar incidence rates are seen in males and females. *Enthesitis related arthritis - This term is used for arthritis and enthesitis (inflammation of tendon insertions eg sternum, around knee (at 2,6 and 10 o'clock positions), tibial tubercle, achilles/plantar, tibialis anterior, flexor digitorum insertion in foot). Often give history of dactylitis. Asymmetric, distal large joints in the lower limbs are commonly affected and there is a high risk of these patients developing [[ankylosing spondylitis]] in early adulthood - spine rarely affected early on. '''BASMI''' score consists of 5 measurements of spinal mobility. The group also includes arthritis or enthesitis with at least two of: *Enthesitis related arthritis - This term is used for arthritis and enthesitis (inflammation of tendon insertions eg sternum, around knee (at 2,6 and 10 o'clock positions), tibial tubercle, achilles/plantar, tibialis anterior, flexor digitorum insertion in foot). Often give history of dactylitis. Asymmetric, distal large joints in the lower limbs are commonly affected and there is a high risk of these patients developing [[ankylosing spondylitis]] in early adulthood - spine rarely affected early on. '''BASMI''' score consists of 5 measurements of spinal mobility. The group also includes arthritis or enthesitis with at least two of: -  ** tenderness of the sacroiliac joint and/ or inflammatory spinal pain - [[HLA B27]] positive (10% of normal population) - family history in a first or second degree relative of HLA B27 related disease (ie arthritis, IBD, Reiter's, uveitis) ** tenderness of the sacroiliac joint and/ or inflammatory spinal pain - [[HLA B27]] positive (10% of normal population) - family history in a first or second degree relative of HLA B27 related disease (ie arthritis, IBD, Reiter's, uveitis) ** anterior uveitis (usually symptomatic with redness, pain and blurred vision)   ** anterior uveitis (usually symptomatic with redness, pain and blurred vision)   [...]



Adult-onset Still's disease

Tue, 27 Sep 2016 23:27:38 GMT

wikify ← Older revision Revision as of 23:27, 27 September 2016 Line 2: Line 2: ===Diagnosis=== ===Diagnosis=== -Adult-onset Still's disease (AOSD) is a rheumatic condition easy to confuse with [[rheumatoid arthritis]] but has the clinical phenotype of [[systemic juvenile idiopathic arthritis]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=25466605  Gerfaud-Valentin M, Sève P, Hot A, Broussolle C, Jamilloux Y. Pathophysiology, subtypes, and treatments of adult-onset Still's disease: An update.. La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne. 2015 May; 36(5):319-27.]([http://dx.doi.org/10.1016/j.revmed.2014.10.365 Link to article] – subscription may be required.):+Adult-onset Still's disease (AOSD) is a rheumatic condition easy to confuse with [[rheumatoid arthritis]] but has the clinical phenotype of [[systemic juvenile idiopathic arthritis]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=25466605  Gerfaud-Valentin M, Sève P, Hot A, Broussolle C, Jamilloux Y. Pathophysiology, subtypes, and treatments of adult-onset Still's disease: An update.. La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne. 2015 May; 36(5):319-27.]([http://dx.doi.org/10.1016/j.revmed.2014.10.365 Link to article] – subscription may be required.): *spiking fever (>39°C), - classic cause of a [[PUO]] *spiking fever (>39°C), - classic cause of a [[PUO]] *salmon-colored rash   *salmon-colored rash   Line 15: Line 15: **[[Infliximab]], [[etanercept]], and [[adalimumab]] have not proved as successful as more directed biologics **[[Infliximab]], [[etanercept]], and [[adalimumab]] have not proved as successful as more directed biologics **[[Anakinra]], [[canakinumab]], [[tocilizumab]] and to a degree [[rilonacept]] seem to be more active **[[Anakinra]], [[canakinumab]], [[tocilizumab]] and to a degree [[rilonacept]] seem to be more active -*Other [[:Category:DMARD|DMARDS]] are forth line and with evidence for effectiveness include:+*Other [[:Category:Disease modifying antirheumatic drugs|DMARDS]] are fourth line and with evidence for effectiveness include: **[[cyclosporin]] A **[[cyclosporin]] A **[[leflunomide]] **[[leflunomide]] [...]



Still's disease

Tue, 27 Sep 2016 23:25:55 GMT

subclude

New page

{{SubjectBox}}
==Systemic juvenile idiopathic arthritis==
{{:Systemic juvenile idiopathic arthritis}}
==Adult-onset Still's disease==
{{:Adult-onset Still's disease}}



Adult-onset Still's disease

Tue, 27 Sep 2016 23:24:38 GMT

make a start

New page

{{SubjectBox|adult-onset Still's disease}}

===Diagnosis===
Adult-onset Still's disease (AOSD) is a rheumatic condition easy to confuse with [[rheumatoid arthritis]] but has the clinical phenotype of [[systemic juvenile idiopathic arthritis]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=25466605 Gerfaud-Valentin M, Sève P, Hot A, Broussolle C, Jamilloux Y. Pathophysiology, subtypes, and treatments of adult-onset Still's disease: An update.. La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne. 2015 May; 36(5):319-27.]([http://dx.doi.org/10.1016/j.revmed.2014.10.365 Link to article] – subscription may be required.):
*spiking fever (>39°C), - classic cause of a [[PUO]]
*salmon-colored rash
*arthritis/arthralgia

It is a diagnosis of exclusion, being first defined as recently as [[1971]] and has two major subsets, systemic presentations and articular presentations. Criteria for diagnosis exist[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=25653531 Jamilloux Y, Gerfaud-Valentin M, Henry T, Sève P. Treatment of adult-onset Still's disease: a review. Therapeutics and clinical risk management. 2015; 11:33-43.](Epub) ([http://dx.doi.org/10.2147/TCRM.S64951 Link to article] – subscription may be required.). It is now understood that [[cytokine]] processing of [[Interleukin-1 beta|IL-1β]] and [[IL-18]] is abnormal with [[IL-6]] and to a lesser extent [[tumour necrosis factor alpha]] involved in the pathogenesis.
===Treatment===
*[[Nonsteroidal anti-inflammatory drugs]] control symptoms in less than 20%
*[[:Category:Corticosteroids|Corticosteroids]] are therefore first line agents
*[[Methotrexate]] is the second line agent of choice
*Biologics used include:
**[[Infliximab]], [[etanercept]], and [[adalimumab]] have not proved as successful as more directed biologics
**[[Anakinra]], [[canakinumab]], [[tocilizumab]] and to a degree [[rilonacept]] seem to be more active
*Other [[:Category:DMARD|DMARDS]] are forth line and with evidence for effectiveness include:
**[[cyclosporin]] A
**[[leflunomide]]
**[[Azathioprine]]
**[[Hydroxychloroquine]]
**[[D-penicillamine]]
**[[Tacrolimus]]
* Intravenous [[immunoglobulin]] should be considered in [[haemophagocytic syndrome]] and [[pregnancy]]

[[Category: Rheumatology]]
[[Category:Autoimmune diseases]]

{{refsec}}



Systemic juvenile idiopathic arthritis

Tue, 27 Sep 2016 23:23:05 GMT

make a start

New page


{{SubjectBox}}

[[George Frederic Still]] described 22 children with systemic-onset idiopathic juvenile arthritis (SJIA, Juvenile Still's disease) in [[1897]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=20896907 Still GF. On a Form of Chronic Joint Disease in Children. Medico-chirurgical transactions. 1897; 80:47-60.9.].
===Diagnosis===
While [[juvenile idiopathic arthritis]] (JIA) is an umbrella term covering multiple distinct conditions a subset affecting just over 10% is SJIA and often in the early course of this subset the systemic features necessary for diagnosis are lacking. Currently it is defined as an arthritis of unknown aetiology presenting before the 16th birthday and lasting at least six weeks. Systemic juvenile idiopathic arthritis is the subset characterised by[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=24782683 Stoll ML, Cron RQ. Treatment of juvenile idiopathic arthritis: a revolution in care. Pediatric rheumatology online journal. 2014; 12:13.](Epub) ([http://dx.doi.org/10.1186/1546-0096-12-13 Link to article] – subscription may be required.):
*Intermittent high fever
*Peak age of onset 2 years
*Equal sex incidence
*Uveitis rare
*No [[enthesitis]] or [[dactylitis]]
*ANA sometimes positive, [[rheumatoid factor]] -ive
===Treatment===
*[[NSAID|Non-steroidal anti-inflammatory drugs]] and [[corticosteroids]] are now largely used as bridge or adjunctive therapies.
*[[Methotrexate]] now first-line therapy for most
*[[Anakinra]] is standard second line
*[[Canakinumab]] and [[tocilizumab]] are more effective than [[rilonacept]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=26628580 Tarp S, Amarilyo G, Foeldvari I, Christensen R, Woo JM, Cohen N, Pope TD, Furst DE. Efficacy and safety of biological agents for systemic juvenile idiopathic arthritis: a systematic review and meta-analysis of randomized trials. Rheumatology (Oxford, England). 2016 Apr; 55(4):669-79.]([http://dx.doi.org/10.1093/rheumatology/kev382 Link to article] – subscription may be required.)

{{refsec}}
[[Category:Paediatrics]]

[[Category:Rheumatology]]



Reactive haemophagocytic lymphohistiocytosis

Tue, 27 Sep 2016 22:46:52 GMT

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#redirect[[Haemophagocytic syndrome]]



D-penicillamine

Tue, 27 Sep 2016 22:45:16 GMT

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#redirect[[penicillamine]]



Nonsteroidal anti-inflammatory drugs

Tue, 27 Sep 2016 22:44:52 GMT

redirect

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#redirect[[NSAID]]



Sortsofmother

Tue, 27 Sep 2016 22:17:26 GMT

these are SF tropes, but only because SF considers things before they happen. ← Older revision Revision as of 22:17, 27 September 2016 Line 1: Line 1: -Mother used to be a more simple and certain concept than father, and for the most part remains so, however with various technical improvements or possibilities since the first test-tube baby there are a number of decomposable aspects of biological motherhood.   +Mother used to be a more simple and certain concept than father, and for the most part remains so, however with various technical improvements or possibilities since the first test-tube baby there are a number of decomposable aspects of biological and other motherhood.    * [[Birth mother]]: the baby came out of this woman; * [[Birth mother]]: the baby came out of this woman; Line 6: Line 6: * [[Host mother]]:  the baby came out of this woman, it is implied she is not the nuclear mother; * [[Host mother]]:  the baby came out of this woman, it is implied she is not the nuclear mother; * [[Cytoplasmic system mother]] (Cytoplasmic mother): the ovum, except for the nucleus, which made this baby came from this woman; (this is probably original work, and may be better-phrased) * [[Cytoplasmic system mother]] (Cytoplasmic mother): the ovum, except for the nucleus, which made this baby came from this woman; (this is probably original work, and may be better-phrased)  +* [[Care mother]] This woman looks after and raises the baby (most usually and redundantly the birth mother) * and [[adoptive mother]]: Becomes a mother after someone else has been the [[birth mother]] * and [[adoptive mother]]: Becomes a mother after someone else has been the [[birth mother]] [...]



Familial cold urticaria

Tue, 27 Sep 2016 21:16:48 GMT

redirect

New page

#redirect[[Familial cold autoinflammatory syndrome]]
[[Category:CAPS]]



Familial cold autoinflammatory syndrome

Tue, 27 Sep 2016 21:15:15 GMT

typo

← Older revision Revision as of 21:15, 27 September 2016
Line 14: Line 14:
#FCAS2 ({{OMIM|611762}})
#FCAS2 ({{OMIM|611762}})
#* mutation of [[NLRP12]] gene at 19q13.42
#* mutation of [[NLRP12]] gene at 19q13.42
-
#FCAS3 ({{PLCG2-associated antibody deficiency and immune dysregulation, PLAID, OMIM|614468}})
+
#FCAS3 (PLCG2-associated antibody deficiency and immune dysregulation, PLAID, {{OMIM|614468}})
#* heterozygous deletion within the [[PLCG2]] gene at 16q23.3
#* heterozygous deletion within the [[PLCG2]] gene at 16q23.3
#FCAS4 ({{OMIM|616115}})
#FCAS4 ({{OMIM|616115}})
#* mutation of [[NLRC4]] gene at 2p22
#* mutation of [[NLRC4]] gene at 2p22
[[Category:CAPS]]
[[Category:CAPS]]



NLRP

Tue, 27 Sep 2016 21:14:23 GMT

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#redirect[[CIAS1]]
[[Category:Genes]]



Familial cold autoinflammatory syndrome

Tue, 27 Sep 2016 21:13:35 GMT

update ← Older revision Revision as of 21:13, 27 September 2016 Line 1: Line 1: {{GeneticsBox}} {{GeneticsBox}} -A [[periodic syndrome]] ([[:Category:CAPS|CAPS]]) associated with:+Familial cold autoinflammatory syndrome (FCAS, FCU, familial cold urticaria ) is a [[periodic syndrome]] ([[:Category:CAPS|CAPS]]) associated with: -*[[Cryopyrin]] defect because of mutation at the [[CIAS1]] gene at 1q44 (type 1) or the [[NLRP12]] at 19q13.4 (type 2)+*[[Cryopyrin]] defect   *Exposure to cold precipates: *Exposure to cold precipates: **Maculopapular rash **Maculopapular rash Line 9: Line 9: **Swelling of the extremities **Swelling of the extremities Treatment is with antibodies that block [[IL-1|IL-1β]] such as [[rilonacept]] and [[canakinumab]] Treatment is with antibodies that block [[IL-1|IL-1β]] such as [[rilonacept]] and [[canakinumab]]  +The genetic subtypes are:  +#FCAS1 ({{OMIM|120100}})  +#* mutation of [[NLRP]] ([[CIAS1]]) gene at 1q44 which codes for [[cryopyrin]]  +#FCAS2 ({{OMIM|611762}})  +#* mutation of [[NLRP12]] gene at 19q13.42  +#FCAS3 ({{PLCG2-associated antibody deficiency and immune dysregulation, PLAID, OMIM|614468}})  +#* heterozygous deletion within the [[PLCG2]] gene at 16q23.3  +#FCAS4 ({{OMIM|616115}})  +#* mutation of [[NLRC4]] gene at 2p22 [[Category:CAPS]] [[Category:CAPS]] [...]



FCU

Tue, 27 Sep 2016 20:58:39 GMT

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#redirect[[Familial cold autoinflammatory syndrome]]
[[Category:Abbreviations]]
[[Category:CAPS]]



FCAS

Tue, 27 Sep 2016 20:58:04 GMT

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#redirect[[Familial cold autoinflammatory syndrome]]
[[Category:Abbreviations]]
[[Category:CAPS]]



NOMID

Tue, 27 Sep 2016 20:55:52 GMT

categorise

← Older revision Revision as of 20:55, 27 September 2016
Line 1: Line 1:
#REDIRECT [[Chronic infantile neurological, cutaneous, articular syndrome]]
#REDIRECT [[Chronic infantile neurological, cutaneous, articular syndrome]]
 +
[[Category:Abbreviations]]
 +
[[Category:CAPS]]
 +
[[Category:Paediatrics]]
 +
[[Category:Clinical genetics]]



CINCA

Tue, 27 Sep 2016 20:55:01 GMT

categorise

← Older revision Revision as of 20:55, 27 September 2016
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#redirect[[NOMID]]
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#redirect[[Chronic infantile neurological, cutaneous, articular syndrome]]
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[[Category:Abbreviations]]
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[[Category:CAPS]]
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[[Category:Paediatrics]]
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[[Category:Clinical genetics]]



NOMID

Tue, 27 Sep 2016 20:52:46 GMT

moved [[NOMID]] to [[Chronic infantile neurological, cutaneous, articular syndrome]] bad having an abbreviation as active page




Ganfyd:Current events

Tue, 27 Sep 2016 19:34:47 GMT

wikify ← Older revision Revision as of 19:34, 27 September 2016 Line 53: Line 53: == [[2016]] == == [[2016]] == === September 2016 === === September 2016 === -* For the first time a baby was born who in a reasonable sense had three parents. The [[sortsofmother|nuclear-and-birth-mother]] carries a mitochondrial genetic disorder, leading to [[Leigh Disease]].  The [[conception procedure]] was carried out in Mexico where the rules are left more to professional discretion than the UK or USA.  The technique was one of several ways which are possible to assemble an individual from three others - not the one approved and licenced in the UK.  The [[cytoplasmic system]] from a [[donor egg]] was used to house the nucleus from one of the mother's eggs and the result was fertilised with the husband's sperm and implanted in the [[sortsofmother|nuclear-mother]].  A possible failure mode is that the nucleus might bring with it a [[mitochondrion]] expressing the mutation for the disease, and that such [[mitochondria]] might reproduce more readily than the ones which do not.  There is no reported indication of the latter happening thus far.  THis week's New Scientist feed       +* For the first time a baby was born who in a reasonable sense had three parents. The [[sortsofmother|nuclear-and-birth-mother]] carries a mitochondrial genetic disorder, leading to [[Leigh syndrome]].  The [[:Category:Conception procedures|conception procedure]] was carried out in Mexico where the rules are left more to professional discretion than the UK or USA.  The technique was one of several ways which are possible to assemble an individual from three others - not the one approved and licenced in the UK.  The [[cytoplasm]] from a [[donor egg]] was used to house the nucleus from one of the mother's eggs and the result was fertilised with the husband's sperm and implanted in the [[sortsofmother|nuclear-mother]].  A possible failure mode is that the nucleus might bring with it a [[mitochondrion]] expressing the mutation for the disease, and that such [[mitochondria]] might reproduce more readily than the ones which do not.  There is no reported indication of the latter happening thus far.  New Scientist feed 27th Sept 2016        * The [[2016 Junior doctors industrial action in England|Juniors doctors industrial action]] in [[England]] resumes with announcement of a 5 day strike and more 5 day strikes to follow. By the end of the month the threatened strike action had been called off on grounds of patient safety. * The [[2016 Junior doctors industrial action in England|Juniors doctors industrial action]] in [[England]] resumes with announcement of a 5 day strike and more 5 day strikes to follow. By the end of the month the threatened strike action had been called off on grounds of patient safety. *[[Aducanumab]] has promising clinical development in [[Alzheimer's disease]] *[[Aducanumab]] has promising clinical development in [[Alzheimer's disease]] [...]



In vitro fertilisation

Tue, 27 Sep 2016 19:32:01 GMT

categorise

← Older revision Revision as of 19:32, 27 September 2016
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{{SubjectBox}}
In vitro fertilisation (IVF) is a technique by which fertilization occurs outside the body outside the body: in vitro ("in glass").  
In vitro fertilisation (IVF) is a technique by which fertilization occurs outside the body outside the body: in vitro ("in glass").  
The woman's ovaries and uterus are stimulated artificially, ova are removed surgically and added to a liquid medium with sperm in a laboratory. The resulting embryos are cultured for 2-6 days at which point they may be transferred to the woman's uterus or frozen, pending delayed embryo transfer.
The woman's ovaries and uterus are stimulated artificially, ova are removed surgically and added to a liquid medium with sperm in a laboratory. The resulting embryos are cultured for 2-6 days at which point they may be transferred to the woman's uterus or frozen, pending delayed embryo transfer.
 +
[[Category:Conception procedures]]



Sortsofmother

Tue, 27 Sep 2016 19:30:48 GMT

categorise

← Older revision Revision as of 19:30, 27 September 2016
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* [[Birth mother]]: the baby came out of this woman;
* [[Birth mother]]: the baby came out of this woman;
 +
* [[Donor mother]]: The ovum was donated by this woman (who can also be the birth mother but had the egg harvested and then re-implanted after fertilisation)
* [[Nuclear mother]]: the nucleus of the ovum which made this baby came from this woman;
* [[Nuclear mother]]: the nucleus of the ovum which made this baby came from this woman;
* [[Host mother]]:  the baby came out of this woman, it is implied she is not the nuclear mother;
* [[Host mother]]:  the baby came out of this woman, it is implied she is not the nuclear mother;
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[[Category: Obstetrics]]
[[Category: Obstetrics]]
[[Category: Gynaecology]]
[[Category: Gynaecology]]
 +
[[Category: Conception procedures]]



Donor egg

Tue, 27 Sep 2016 19:30:02 GMT

categorise

New page

{{SubjectBox}}
An [[egg]] from a [[donor mother]] harvested (in advance of fertilisation in practice).
[[Category:Conception procedures]]



Donor mother

Tue, 27 Sep 2016 19:27:33 GMT

another

New page

#redirect[[Sortsofmother]]
[[Category:Sortsofmothers]]



Category:Sortsofmothers

Tue, 27 Sep 2016 19:22:07 GMT

subclude

New page

{{:Sortsofmother}}



Sortsofmother

Tue, 27 Sep 2016 19:21:35 GMT

subclusion planned ← Older revision Revision as of 19:21, 27 September 2016 Line 1: Line 1: Mother used to be a more simple and certain concept than father, and for the most part remains so, however with various technical improvements or possibilities since the first test-tube baby there are a number of decomposable aspects of biological motherhood.    Mother used to be a more simple and certain concept than father, and for the most part remains so, however with various technical improvements or possibilities since the first test-tube baby there are a number of decomposable aspects of biological motherhood.    -* birth mother: the baby came out of this woman;+* [[Birth mother]]: the baby came out of this woman; -* nuclear mother: the nucleus of the ovum which made this baby came from this woman;+* [[Nuclear mother]]: the nucleus of the ovum which made this baby came from this woman; -* host mother:  the baby came out of this woman, it is implied she is not the nuclear mother;+* [[Host mother]]:  the baby came out of this woman, it is implied she is not the nuclear mother; -* cytoplasmic system mother: the ovum, except for the nucleus, which made this baby came from this woman; (this is probably original work, and may be better-phrased)+* [[Cytoplasmic system mother]] (Cytoplasmic mother): the ovum, except for the nucleus, which made this baby came from this woman; (this is probably original work, and may be better-phrased) - +* and [[adoptive mother]]: Becomes a mother after someone else has been the [[birth mother]] -* and adoptive mother+ One woman might play more than one role. One woman might play more than one role.  +[[Category: Obstetrics]]  +[[Category: Gynaecology]] [...]



Adoptive mother

Tue, 27 Sep 2016 19:20:58 GMT

redirect

New page

#redirect[[Sortsofmother]]
[[Category:Sortsofmothers]]



Cytoplasmic system mother

Tue, 27 Sep 2016 19:20:48 GMT

redirect

New page

#redirect[[Sortsofmother]]
[[Category:Sortsofmothers]]



Host mother

Tue, 27 Sep 2016 19:20:39 GMT

redirect

New page

#redirect[[Sortsofmother]]
[[Category:Sortsofmothers]]



Nuclear mother

Tue, 27 Sep 2016 19:20:28 GMT

redirect

New page

#redirect[[Sortsofmother]]
[[Category:Sortsofmothers]]



Birth mother

Tue, 27 Sep 2016 19:20:19 GMT

redirect

New page

#redirect[[Sortsofmother]]
[[Category:Sortsofmothers]]



Sex

Tue, 27 Sep 2016 19:14:06 GMT

DIY

← Older revision Revision as of 19:14, 27 September 2016
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See also [[drugs]]; [[rock and roll]]; [[sea]]; [[sand]]; [[sun]]
See also [[drugs]]; [[rock and roll]]; [[sea]]; [[sand]]; [[sun]]
 +
[[Category:Conception procedures]]



Conception

Tue, 27 Sep 2016 19:13:28 GMT

categorise

New page

{{SubjectBox}}
Successful fertilisation of an [[ovum]] by a [[sperm]] in man. Can result from [[sex]] or [[assisted conception]].
[[Category:Gynaecology]]
[[Category: Obstetrics]]
[[Category:Conception procedures]]



Category:Conception procedures

Tue, 27 Sep 2016 19:12:06 GMT

categorise

New page

[[Category:Gynaecology]]
[[Category:Gynaecology]]



Assisted conception

Tue, 27 Sep 2016 19:11:35 GMT

categorise

← Older revision Revision as of 19:11, 27 September 2016
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[[Category:Gynaecology]]
[[Category:Gynaecology]]
[[Category:Family planning]]
[[Category:Family planning]]
 +
[[Category:Conception procedures]]
{{Refsec}}
{{Refsec}}
{{draft}}
{{draft}}



Sortsofmother

Tue, 27 Sep 2016 17:01:56 GMT

leaving out "older sister" and aunt...

New page

Mother used to be a more simple and certain concept than father, and for the most part remains so, however with various technical improvements or possibilities since the first test-tube baby there are a number of decomposable aspects of biological motherhood.

* birth mother: the baby came out of this woman;
* nuclear mother: the nucleus of the ovum which made this baby came from this woman;
* host mother: the baby came out of this woman, it is implied she is not the nuclear mother;
* cytoplasmic system mother: the ovum, except for the nucleus, which made this baby came from this woman; (this is probably original work, and may be better-phrased)

* and adoptive mother

One woman might play more than one role.



Ganfyd:Current events

Tue, 27 Sep 2016 16:52:58 GMT

2016: 3 up ← Older revision Revision as of 16:52, 27 September 2016 Line 53: Line 53: == [[2016]] == == [[2016]] == === September 2016 === === September 2016 === -*The [[2016 Junior doctors industrial action in England|Juniors doctors industrial action]] in [[England]] resumes with announcement of a 5 day strike and more 5 day strikes to follow. By the end of the month the threatened strike action had been called off on grounds of patient safety.+* For the first time a baby was born who in a reasonable sense had three parents. The [[sortsofmother|nuclear-and-birth-mother]] carries a mitochondrial genetic disorder, leading to [[Leigh Disease]].  The [[conception procedure]] was carried out in Mexico where the rules are left more to professional discretion than the UK or USA.  The technique was one of several ways which are possible to assemble an individual from three others - not the one approved and licenced in the UK.  The [[cytoplasmic system]] from a [[donor egg]] was used to house the nucleus from one of the mother's eggs and the result was fertilised with the husband's sperm and implanted in the [[sortsofmother|nuclear-mother]].  A possible failure mode is that the nucleus might bring with it a [[mitochondrion]] expressing the mutation for the disease, and that such [[mitochondria]] might reproduce more readily than the ones which do not.  There is no reported indication of the latter happening thus far.  THis week's New Scientist feed       +* The [[2016 Junior doctors industrial action in England|Juniors doctors industrial action]] in [[England]] resumes with announcement of a 5 day strike and more 5 day strikes to follow. By the end of the month the threatened strike action had been called off on grounds of patient safety. *[[Aducanumab]] has promising clinical development in [[Alzheimer's disease]] *[[Aducanumab]] has promising clinical development in [[Alzheimer's disease]] === August 2016 === === August 2016 === Line 60: Line 61: ===July 2016 === ===July 2016 === * The new UK Prime Minister (Ms May) did not find a replacement for the [[Secretary of state for health|Secretary of State for Health]] (Mr Hunt). * The new UK Prime Minister (Ms May) did not find a replacement for the [[Secretary of state for health|Secretary of State for Health]] (Mr Hunt). -*Junior doctors in the UK reject the new contract on offer which is then imposed. Formal industrial action is expected to resume.+* Junior doctors in the UK reject the new contract on offer which is then imposed. Formal industrial action is expected to resume. ===June 2016 === ===June 2016 === -*It is discovered that [[denosumab]] may have potential in prophylaxis for carriers of [[BRCA1]] mutations where the most effective prophylaxis known to date is [[mastectomy]] and/or [[oophorectomy]].+* It is discovered that [[denosumab]] may have potential in prophylaxis for carriers of [[B[...]



Anakinra

Tue, 27 Sep 2016 09:58:20 GMT

update ← Older revision Revision as of 09:58, 27 September 2016 Line 1: Line 1: -{{SubjectBox}}+{{PharmacologyBox||Kineret®}} Anakinra is a recombinant non-glycosylated form of the human [[interleukin-1 receptor antagonist]] (IL-1Ra).  It works by binding the type 1 [[IL-1 receptor]], causing competitive inhibition, and preventing the actions of the pro-inflammatory [[cytokine]]s [[IL-1]]α and [[IL-1]]β. Anakinra is a recombinant non-glycosylated form of the human [[interleukin-1 receptor antagonist]] (IL-1Ra).  It works by binding the type 1 [[IL-1 receptor]], causing competitive inhibition, and preventing the actions of the pro-inflammatory [[cytokine]]s [[IL-1]]α and [[IL-1]]β. It is excreted by the kidney, and is given as a subcutaneous injection. It is excreted by the kidney, and is given as a subcutaneous injection. ==Indications== ==Indications== -*[[Rheumatoid arthritis]]+*[[Rheumatoid arthritis]] in combination with [[methotrexate]] **Reduces disease symptoms in [[rheumatoid arthritis]] (RA) patients on [[methotrexate]] further than those on methotrexate alone, and also to help prevent radiological disease progression.  A long term study showed it helped increase function. **Reduces disease symptoms in [[rheumatoid arthritis]] (RA) patients on [[methotrexate]] further than those on methotrexate alone, and also to help prevent radiological disease progression.  A long term study showed it helped increase function. **Suggested dosing regime for moderate to severe RA is 100mg per day, given by sub-cut injection at approximately the same time each day.  In severe renal insufficiency it should be given every 48 hours. **Suggested dosing regime for moderate to severe RA is 100mg per day, given by sub-cut injection at approximately the same time each day.  In severe renal insufficiency it should be given every 48 hours. *[[Neonatal-onset multisystem inflammatory disease]].[[Pubmed:16899778|Goldbach-Mansky R, Dailey NJ, Canna SW, Gelabert A, Jones J, Rubin BI, et al. Neonatal-onset multisystem inflammatory disease responsive to interleukin-1beta *[[Neonatal-onset multisystem inflammatory disease]].[[Pubmed:16899778|Goldbach-Mansky R, Dailey NJ, Canna SW, Gelabert A, Jones J, Rubin BI, et al. Neonatal-onset multisystem inflammatory disease responsive to interleukin-1beta   inhibition. The New England journal of medicine 2006;355:581-92.]] ([http://dx.doi.org/10.1056/NEJMoa055137 Direct link] – subscription may be required.)   inhibition. The New England journal of medicine 2006;355:581-92.]] ([http://dx.doi.org/10.1056/NEJMoa055137 Direct link] – subscription may be required.)  +Neonatal-Onset Multisystem Inflammatory Disease (NOMID) / Chronic Infantile Neuro[...]



Canakinumab

Tue, 27 Sep 2016 09:47:37 GMT

seems to work in most of the periodic fevers ← Older revision Revision as of 09:47, 27 September 2016 Line 1: Line 1: {{PharmacologyBox||Ilaris®}} {{PharmacologyBox||Ilaris®}} -A  anti-human [[IL-1]]β recombinant antibody that can be used to treat [[:category:CAPS|CAPS]][http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=19494217  Lachmann HJ, Kone-Paut I, Kuemmerle-Deschner JB, Leslie KS, Hachulla E, Quartier P, Gitton X, Widmer A, Patel N, Hawkins PN. Use of canakinumab in the cryopyrin-associated periodic syndrome. The New England journal of medicine. 2009 Jun 4; 360(23):2416-25.]([http://dx.doi.org/10.1056/NEJMoa0810787 Link to article] – subscription may be required.). It causes marked and rapid improvement in acute symptoms. [[C-reactive protein]] and serum [[amyloid]] A levels are reduced.+A  anti-human [[IL-1]]β recombinant antibody that can be used to treat:  +* [[:category:CAPS|CAPS]][https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=19494217  Lachmann HJ, Kone-Paut I, Kuemmerle-Deschner JB, Leslie KS, Hachulla E, Quartier P, Gitton X, Widmer A, Patel N, Hawkins PN. Use of canakinumab in the cryopyrin-associated periodic syndrome. The New England journal of medicine. 2009 Jun 4; 360(23):2416-25.]([http://dx.doi.org/10.1056/NEJMoa0810787 Link to article] – subscription may be required.). [https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=27635935  Kone-Paut I, Quartier P, Fain O, Grateau G, Pillet P, Le Blay P, Bonnet F, Despert V, Stojanovic KS, Willemin L, Quéré S, Reigneau O, Hachulla E. Real-world experience and impact of canakinumab in cryopyrin-associated periodic syndrome: Results from the French observational study ENVOL. Arthritis care & research. 2016 Sep 16.](Epub ahead of print) ([http://dx.doi.org/10.1002/acr.23083 Link to article] – subscription may be required.)  +** [[Muckle-Wells syndrome]] (MWS)  +** [[Neonatal-onset multisystem inflammatory disease]] (NOMID) / [[Chronic infantile neurological, cutaneous, articular syndrome]] (CINCA)  +** [[Familial cold autoinflammatory syndrome]] (FCAS) / [[Familial cold urticaria]] (FCU)  +*  [[Still's disease]]  +**[[Adult-onset Still's disease]] (AOSD)  +**[[Systemic juvenile idiopathic arthritis]] (SJIA)[https://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractp[...]



Internet resources

Mon, 26 Sep 2016 22:09:36 GMT

categorise

← Older revision Revision as of 22:09, 26 September 2016
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==Other resources that may be of interest to doctors==
==Other resources that may be of interest to doctors==
*[http://www.donotlink.com/dnl/faq DoNotLink] this website provides a way to link to sites that you may want to bring to people's attention, but which you do not wish to promote in the process.
*[http://www.donotlink.com/dnl/faq DoNotLink] this website provides a way to link to sites that you may want to bring to people's attention, but which you do not wish to promote in the process.
 +
[[Category:Education]]



Sources of advice and support for patients

Mon, 26 Sep 2016 22:08:50 GMT

categorise

← Older revision Revision as of 22:08, 26 September 2016
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http://www.nacc.org.uk/content/home.asp
http://www.nacc.org.uk/content/home.asp
[[Category:Communication]]
[[Category:Communication]]
 +
[[Category:Education]]



Category:Education

Mon, 26 Sep 2016 22:07:56 GMT

categorise

New page

[[Category:Society]]



On becoming a doctor

Mon, 26 Sep 2016 22:05:41 GMT

categorise

← Older revision Revision as of 22:05, 26 September 2016
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{{Refsec}}
{{Refsec}}
 +
[[Category:Education]]



Pre-employment screening for school and nursery staff

Mon, 26 Sep 2016 22:04:52 GMT

categorise

← Older revision Revision as of 22:04, 26 September 2016
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There is little point in excluding pregnant women from work, even if there is an outbreak of Parvovirus, as they are as likely to contract the disease in the community as in the workplace.
There is little point in excluding pregnant women from work, even if there is an outbreak of Parvovirus, as they are as likely to contract the disease in the community as in the workplace.
 +
[[Category:Education]]
 +
[[Category:School medicine]]