Monoarthritis with morning stiffness: Difference between revisions

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{{CMG}}; {{AE}}{{EG}}
{{CMG}}; {{AE}}{{EG}}


<small>
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
{| align="center" style="border: 0px; font-size: 90%; margin: 3px;"
! colspan="3" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Diseases
! colspan="3" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |Diseases
Line 32: Line 33:
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" |Other
|-
|-
! rowspan="16" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Monoarthritis
! rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Monoarthritis
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Osteoarthritis]]<ref name="pmid28149655">{{cite journal| author=Chen D, Shen J, Zhao W, Wang T, Han L, Hamilton JL et al.| title=Osteoarthritis: toward a comprehensive understanding of pathological mechanism. | journal=Bone Res | year= 2017 | volume= 5 | issue=  | pages= 16044 | pmid=28149655 | doi=10.1038/boneres.2016.44 | pmc=5240031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28149655  }}</ref>
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infection]]
!+
!-
!-
!-
!-
!-
![[Heberden's node|Heberden nodes]]
![[Anemia]]
!-
!Noninflammatory joint fluid
!Urinary [[pyridinium]] cross-links
!Joint-space loss, Subchondral bony [[sclerosis]], Cyst formation
!Malalignment of the patellofemoral [[joint]]
!Early diagnosis of [[osteoarthritis]] of the hand with [[bone scan]]
!-
!Clinical findings
!Microfracture, [[Bone pain]]
|-
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Trauma]]<ref name="pmid27651925">{{cite journal| author=Punzi L, Galozzi P, Luisetto R, Favero M, Ramonda R, Oliviero F et al.| title=Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation. | journal=RMD Open | year= 2016 | volume= 2 | issue= 2 | pages= e000279 | pmid=27651925 | doi=10.1136/rmdopen-2016-000279 | pmc=5013366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27651925  }}</ref>
!+
!-
!-
!-
!-
!+
![[Wound]] or [[laceration]]
!-
!-
![[Hemarthrosis]]
!-
!Severe joint effusion, [[Bone fracture|Fracture]]
!Fracture, Synovial tear
!-
!-
![[X-ray]]
![[Deformity]], Severe [[pain]]
|-
! colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Neoplasms]]<ref name="pmid17915099">{{cite journal |vauthors=Askling J |title=Malignancy and rheumatoid arthritis |journal=Curr Rheumatol Rep |volume=9 |issue=5 |pages=421–6 |date=October 2007 |pmid=17915099 |doi= |url=}}</ref>
!+
!-
!+
!+/-
!-
!-
![[Rash]]
![[Normocytic normochromic anemia]]
!↑
! High [[WBC]] count (10,000-40,000/µL)
![[Hypercalcemia]], [[Hyperphosphatemia]]
!Peri-[[articular]] [[Osteoblastic sarcoma|osteoblastic]] or [[Osteoclast|osteoclastic]] lesion
!Elevation of the [[periosteum]]
!Intense [[radionuclide]] uptake in [[bone scan]]
!Spindle-shaped and atypical [[Stromal cell|stromal cells]], with irregular [[nuclei]]
!Clinical findings and imaging
![[Pain|Nocturnal pain]], [[Pathological|Pathologic fractures]]
|-
! rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Infection]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gonococcal infection]]<ref name="pmid12787521">{{cite journal |vauthors=Bardin T |title=Gonococcal arthritis |journal=Best Pract Res Clin Rheumatol |volume=17 |issue=2 |pages=201–8 |date=April 2003 |pmid=12787521 |doi= |url=}}</ref>
!+
!+
!-
!-
!-
!+
![[Maculopapular]], [[Pustular rash|Pustular]], [[Vesicular]] lesions on an [[Erythematous|erythematous base]]
![[Leukocytosis]]
!↑
!Purulent with cell count > 50,000 [[WBC]]/µL (with PMNs > 90%)
![[Blood culture|Blood]] and [[Synovial fluid|synovial fluid culture]]
!Minor [[articular]] damage
!-
!-
!Dermal [[vasculitis]] with perivascular [[neutrophils]]
![[Nucleic acid amplification technique|Nucleic acid amplification tests (NAATs)]]
![[Dermatitis]], [[Tenosynovitis]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Nongonococcal urethritis|Nongonococcal bacterial infections]]<ref name="pmid194809972">{{cite journal |vauthors=García-De La Torre I, Nava-Zavala A |title=Gonococcal and nongonococcal arthritis |journal=Rheum. Dis. Clin. North Am. |volume=35 |issue=1 |pages=63–73 |date=February 2009 |pmid=19480997 |doi=10.1016/j.rdc.2009.03.001 |url=}}</ref>
!+
!+
!-
!-
!-
!+
!Local [[erythema]]
![[Leukocytosis]]
!↑
!Purulent with cell count > 50,000 [[WBC]]/µL (with PMNs > 90%)
![[Blood culture|Blood]] and [[Synovial fluid|synovial fluid culture]]
![[Joint]] effusion, [[Cartilage injuries|Cartilage destruction]], Joint space narrowing
![[Sternoclavicular joint|Sternoclavicular]] or [[sacroiliac joint]] infections
!Periarticular [[osteomyelitis]] in [[MRI]]
!-
![[Synovial fluid]] culture
![[Limp|Limping]], [[Malaise]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mycobacterial infection]]<ref name="pmid16297734">{{cite journal |vauthors=Gardam M, Lim S |title=Mycobacterial osteomyelitis and arthritis |journal=Infect. Dis. Clin. North Am. |volume=19 |issue=4 |pages=819–30 |date=December 2005 |pmid=16297734 |doi=10.1016/j.idc.2005.07.008 |url=}}</ref>
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Mycobacterial infection]]<ref name="pmid16297734">{{cite journal |vauthors=Gardam M, Lim S |title=Mycobacterial osteomyelitis and arthritis |journal=Infect. Dis. Clin. North Am. |volume=19 |issue=4 |pages=819–30 |date=December 2005 |pmid=16297734 |doi=10.1016/j.idc.2005.07.008 |url=}}</ref>
!-
!-
Line 148: Line 54:
![[Limp|Limping]], [[Malaise]], [[Chronic cough]]
![[Limp|Limping]], [[Malaise]], [[Chronic cough]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Fungal infection]]<ref name="pmid1616344">{{cite journal| author=Cuéllar ML, Silveira LH, Espinoza LR| title=Fungal arthritis. | journal=Ann Rheum Dis | year= 1992 | volume= 51 | issue= 5 | pages= 690-7 | pmid=1616344 | doi= | pmc=1005712 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1616344  }}</ref>
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic|Systemic disorders]]
!-
!+/-
!-
!-
!-
!+/-
!Local [[eczema]], Local [[erythema]]
![[Eosinophilia]], [[Leukocytosis]]
!↑
![[WBC]] counts range from 9,000-43,000/µL ([[PMNs]] predominance)
!Direct [[microscopy]]
![[Joint]] effusion, [[Joint dislocation|Dislocation of the joint]], [[Metaphyseal]] irregularities and punched out lesions
![[Articular]] erosion
!-
!Villonodular [[synovitis]], Typical [[pannus]], Non-[[Caseous necrosis|caseating granulomas]], Spherules containing [[Coccidioides spp|coccidioidal endospores]]
![[Synovial]] [[histopathology]]
![[Malaise]], [[Tenderness]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Lyme disease]]<ref name="pmid25999223">{{cite journal| author=Arvikar SL, Steere AC| title=Diagnosis and treatment of Lyme arthritis. | journal=Infect Dis Clin North Am | year= 2015 | volume= 29 | issue= 2 | pages= 269-80 | pmid=25999223 | doi=10.1016/j.idc.2015.02.004 | pmc=4443866 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25999223  }}</ref>
!+
!+
!+/-
!+/-
!-
!-
![[Erythema migrans]]
![[Leukopenia]], [[Thrombocytopenia]]
!-
!Cell counts 500-98,000/µL
![[Microscopic hematuria]], [[Proteinuria]], ↑[[ALT]] or [[AST]]
![[Knee joint]] effusion. Intra-[[articular]] [[edema]] 
!-
!Unspecific effusion, [[Synovial]] thickening or enhancement in [[MRI]]
![[Fibrosis]] of the deeper [[dermis]] and hyalinization of collagen bundles
![[Serological testing|Serologic '''tests''']]
![[Erythema migrans]]
|-
! rowspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Crystal arthritis|Crystal-induced arthritis]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gout]]<ref name="pmid62879632">{{cite journal |vauthors=Reginato A, Paul H, Schumacher HR |title=Crystal-induced arthritis |journal=Arch Phys Med Rehabil |volume=63 |issue=9 |pages=401–8 |date=September 1982 |pmid=6287963 |doi= |url=}}</ref>
!+
!+/-
!-
!-
!-
!+
!Local [[swelling]] and [[erythema]]
![[Leukocytosis]]
!↑
!Needle shaped [[urate]] crystals, [[WBC]] count > 2000/µL
!Urinary [[uric acid]] (>1100 mg in 24h)
!Punched-out erosions or [[lytic]]<nowiki/>areas with overhanging edges 
!Complementary for recognizing [[Erosion (dental)|erosions]]
![[Tophus|Tophi]] or [[edema]] in [[MRI]]
!Large pale pink acellular areas ([[Uric acid|urate crystals]]), surrounded by [[histiocytes]] and [[multinucleated giant cells]]
![[Synovial fluid]] microscopy
![[Conjunctival|Conjunctival nodules]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pseudogout|Pseudo-gout]]<ref name="pmid22870500">{{cite journal| author=Macmullan P, McCarthy G| title=Treatment and management of pseudogout: insights for the clinician. | journal=Ther Adv Musculoskelet Dis | year= 2012 | volume= 4 | issue= 2 | pages= 121-31 | pmid=22870500 | doi=10.1177/1759720X11432559 | pmc=3383522 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22870500  }}</ref>
!+
!-
!-
!-
!-
!+/-
!Local [[swelling]] and [[erythema]]
![[Leukocytosis]]
!↑
!Rod shaped [[Calcium pyrophosphate deposition disease|CPPD crystals]], [[WBC]] count > 2000/µL
![[Hypercalcemia]], [[Hypercalciuria]]
!Radiodense lines paralleling the [[articular]] surface and [[calcification]] ([[chondrocalcinosis]])
!Calcific mass with a lobulated configuration in the [[ligamentum flavum]] or the [[joint capsule]]
![[Synovitis]] and [[Calcification|calcific]] deposits in [[ultrasonography]]
!Synovial [[Calcium pyrophosphate|calcium pyrophosphate crystals]]
![[Synovial fluid]] microscopy
![[Tenderness]]
|-
! rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Systemic|Systemic disorders]]
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Reactive arthritis]]<ref name="pmid15084505">{{cite journal| author=Colmegna I, Cuchacovich R, Espinoza LR| title=HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations. | journal=Clin Microbiol Rev | year= 2004 | volume= 17 | issue= 2 | pages= 348-69 | pmid=15084505 | doi= | pmc=387405 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15084505  }}</ref>
!+/-
!+/-
!-
!-
!-
!-
![[Genital]] [[ulceration]]
![[Normocytic normochromic anemia]]
!↑
! High [[WBC]] count (10,000-40,000/µL)
! [[HLA-B27|HLA-B27 test]] 
![[Periosteal reaction]] and proliferation of [[Enthesitis|tendon insertion site]]
![[Sacroiliitis]]
![[Enthesitis]] in [[ultrasonography]]
![[Keratoderma blennorrhagica|Keratoderma blennorrhagicum]],[[Balanitis circinata]] 
! [[Spondyloarthritis]] and unequivocal demonstration of preceding infection
![[Conjunctivitis]], [[Uveitis]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Psoriatic arthritis]]<ref name="pmid23493653">{{cite journal| author=Sankowski AJ, Lebkowska UM, Cwikła J, Walecka I, Walecki J| title=Psoriatic arthritis. | journal=Pol J Radiol | year= 2013 | volume= 78 | issue= 1 | pages= 7-17 | pmid=23493653 | doi=10.12659/PJR.883763 | pmc=3596149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23493653  }}</ref>
!+
!-
!-
!-
!-
!+
!Scaly [[Erythematous rash|erythematous plaques]],
[[Guttate psoriasis|Guttate lesions]], Lakes of [[pus]],
 
[[Erythroderma]]
!Normal
!↑
!High [[WBC]] count (5000-15,000/µL) with >50% of [[PMN|PMN leukocytes]]
!↑[[RF]], [[ANA]], [[IgA]]
![[Joint]]-space narrowing, [[Periostitis|Fluffy periostitis]]
!Pencil-in-cup deformity, Early signs of [[synovitis]]
![[Synovitis|Sacroiliitic synovitis]], [[Enthesitis]] in [[MRI]]
!Lack of intrasynovial [[Immunoglobulin A|Ig]] and [[RF]], Greater propensity for [[Ankylosis|fibrous ankylosis]], [[Osseous|osseous resorption]], and [[Heterotopic ossification|heterotopic bone formation]]
!Clinical findings
![[Onycholysis]], [[Splinter hemorrhage|Splinter hemorrhages]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease]]-associated [[arthritis]]<ref name="pmid22933865">{{cite journal| author=Orchard TR| title=Management of arthritis in patients with inflammatory bowel disease. | journal=Gastroenterol Hepatol (N Y) | year= 2012 | volume= 8 | issue= 5 | pages= 327-9 | pmid=22933865 | doi= | pmc=3424429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22933865  }}</ref>
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory bowel disease]]-associated [[arthritis]]<ref name="pmid22933865">{{cite journal| author=Orchard TR| title=Management of arthritis in patients with inflammatory bowel disease. | journal=Gastroenterol Hepatol (N Y) | year= 2012 | volume= 8 | issue= 5 | pages= 327-9 | pmid=22933865 | doi= | pmc=3424429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22933865  }}</ref>
!+
!+
Line 285: Line 73:
!Clinical findings and history
!Clinical findings and history
![[Anterior uveitis|Acute anterior uveitis]]
![[Anterior uveitis|Acute anterior uveitis]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Sarcoidosis|Sarcoid]] periarthritis<ref name="pmid18032765">{{cite journal |vauthors=Iannuzzi MC, Rybicki BA, Teirstein AS |title=Sarcoidosis |journal=N. Engl. J. Med. |volume=357 |issue=21 |pages=2153–65 |date=November 2007 |pmid=18032765 |doi=10.1056/NEJMra071714 |url=}}</ref>
!+
!-
!-
!-
!-
!-
!Mild [[papules]] and [[nodules]]
!Mild [[anemia]]
!↑
!Cell count < 25% [[PMNs]] (non-[[inflammatory]])
! [[IL-2]] and [[Interferon gamma|IFN-γ]], ↑[[Angiotensin-converting enzyme|ACE]], ↑[[Vitamin D|1, 25-dihydroxyvitamin D]]
!Bilateral [[Adenopathy|hilar adenopathy]]
!Active [[alveolitis]] or [[fibrosis]]
![[Hepatosplenomegaly]] in [[ultrasonography]]
![[Granuloma|Noncaseating granulomas (NCGs)]]
![[Histopathology|Histological confirmation]]
![[Heart block]], [[Ocular disease|Ocular lesion]]
|-
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rheumatoid arthritis]]<ref name="pmid24024009">{{cite journal| author=Heidari B| title=Rheumatoid Arthritis: Early diagnosis and treatment outcomes. | journal=Caspian J Intern Med | year= 2011 | volume= 2 | issue= 1 | pages= 161-70 | pmid=24024009 | doi= | pmc=3766928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24024009  }}</ref>
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rheumatoid arthritis]]<ref name="pmid24024009">{{cite journal| author=Heidari B| title=Rheumatoid Arthritis: Early diagnosis and treatment outcomes. | journal=Caspian J Intern Med | year= 2011 | volume= 2 | issue= 1 | pages= 161-70 | pmid=24024009 | doi= | pmc=3766928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24024009  }}</ref>
Line 323: Line 92:
!Clinical findings coupled [[Anti-citrullinated protein antibody|anti-CCP antibody]]
!Clinical findings coupled [[Anti-citrullinated protein antibody|anti-CCP antibody]]
![[Rheumatoid nodules]]
![[Rheumatoid nodules]]
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Myelodysplastic syndrome|Myelodysplastic]] and [[leukemic]] disorders<ref name="pmid24378738">{{cite journal| author=Mekinian A, Braun T, Decaux O, Falgarone G, Toussirot E, Raffray L et al.| title=Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 1 | pages= 1-10 | pmid=24378738 | doi=10.1097/MD.0000000000000011 | pmc=4616329 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24378738  }}</ref>
!+
!+
!+
!+/-
!-
!-
![[Petechia]] and [[purpura]]
![[Anemia]],
[[Leukocytosis]],
[[Thrombocytopenia]]
!↑
![[WBC]] count >2000/µL ([[inflammatory]]), with [[neutrophil]]<nowiki/>predominance
![[LDH]], [[Uric acid]]
![[Articular]] surface erosion, [[Synovial]] effusion
!Thickened [[synovium]]
![[Synovitis]] in [[MRI]]
![[Inflammatory cells]] [[Infiltration (medical)|infiltration]] in synovial tissue
![[Bone marrow biopsy]]
![[Fatigue]], [[Nausea]], Recurrent [[infections]]
|-
|-
|}
|}

Revision as of 18:38, 3 May 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Joint Swelling Fever Weight loss Claudication Morning stiffness Local erythema Skin manifestation CBC ESR Synovial fluid Other X-ray CT scan Other
Monoarthritis Infection Mycobacterial infection[1] - + + + +/- - Local erythema Leukocytosis, Normocytic normochromic anemia ↑ Moderately elevated WBC counts (neutrophilic predominance), low glucose, and increased protein PPD  Tissue swelling, Bone destruction with normal joint space, Osteopenia Vertebral anterior portion collapse Complicated effusion with partial joint destruction and erosion in MRI Granulomatous inflammation Synovial fluid culture Limping, Malaise, Chronic cough
Systemic disorders Inflammatory bowel disease-associated arthritis[2] + + - - + +/- Pyoderma gangrenosum(ulcerative colitis),Erythema nodosum(Crohn disease) Iron deficiency anemia, Leukocytosis, Thrombocytosis ↑ Mild to moderate inflammatory fluid, PMNpredominance ↑RF, Antiendomysial Ab,Antitransglutaminase Ab Bilateral sacroiliitis, Syndesmophytes and apophyseal joint involvement in spine - Early detection of spinal and sacroiliac lesions in MRI - Clinical findings and history Acute anterior uveitis
Rheumatoid arthritis[3] + - + + + - Rheumatoid nodules Anemia, Thrombocytosis ↑ WBC count >2000/µL (generally 5000-50,000/µL), with neutrophilpredominance (60-80%) Anti-CCP Ab, Hyperuricemia Joint-space narrowing Microfractures Synovitis in MRI Influx of inflammatory cells into the synovial membrane, withangiogenesis Clinical findings coupled anti-CCP antibody Rheumatoid nodules

References

  1. ↑ Gardam M, Lim S (December 2005). "Mycobacterial osteomyelitis and arthritis". Infect. Dis. Clin. North Am. 19 (4): 819–30. doi:10.1016/j.idc.2005.07.008. PMID 16297734.
  2. ↑ Orchard TR (2012). "Management of arthritis in patients with inflammatory bowel disease". Gastroenterol Hepatol (N Y). 8 (5): 327–9. PMC 3424429. PMID 22933865.
  3. ↑ Heidari B (2011). "Rheumatoid Arthritis: Early diagnosis and treatment outcomes". Caspian J Intern Med. 2 (1): 161–70. PMC 3766928. PMID 24024009.
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