Pathogenesis of Rheumatic and Other Musculoskeletal Diseases

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As with most disease, research into the causes of rheumato-logic and musculoskeletal diseases shows that the cause for each disease is actually multifactorial. Further identification

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Figure 32-2 Evaluation of polyarticular symptoms. ANA, Antinuclear antibodies; CBC, complete blood cell count; ESR, erythrocyte sedimentation rate; RF, rheumatoid factor. (From American College of Rheumatology Ad Hoc Committee on Clinical Guidelines: Guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. Arthritis Rheum i996;39:i.)

Figure 32-2 Evaluation of polyarticular symptoms. ANA, Antinuclear antibodies; CBC, complete blood cell count; ESR, erythrocyte sedimentation rate; RF, rheumatoid factor. (From American College of Rheumatology Ad Hoc Committee on Clinical Guidelines: Guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. Arthritis Rheum i996;39:i.)

functional ability, occupational history, and activities requiring repetitive joint movement, as well as the ergonomics of such activities, should also be considered routinely in initial and serial evaluations. How are the symptoms affecting the patient's ability to perform self-care activities of daily living (ADLs) such as bathing, dressing, and eating? Is the patient able to do instrumental activities of daily living (IADLs) such as buying groceries, cooking, using the telephone, and opening jars? Rheumatic disease can have a devastating effect on quality of life for both the patient and the family, with serious psychosocial and economic consequences. Therefore the physician should address effects on occupational, recreational, and sexual activities in the context of family and other support systems.

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