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Right and the recording will start as well once we're live? Ok, perfect. Can you guys see the main slide now? The slide. Yeah. Yeah, I don't know where that is going. Hi guys, this is session two for rheumatology. We're just going to give it a couple of minutes to see if anyone else joins and then we'll start. Should we say we start at five past for everyone? Just filter. Yeah, that sounds good. Um Don't worry guys, we'll keep it nice and concise this evening. We won't keep you er keep you past eight. Yeah and if you wanna put anything in the chart, I'll monitor it for you guys. Ok? Are we recording Lucy or we haven't stopped? Yeah, I'll be recording from now from now. Ok. Thank you. Mm. Alright guys, we'll start in a minute or so, isn't it like anyone else is joining? Um let me just get everything up and we'll give it 30 more seconds I think. Yes. No. Right guys. I think we'll get started then. So thank you everyone for coming. Um this is teaching session four. We'll get into what we're gonna talk about in just a minute. But a quick disclaimer before we start. Um So I'm Joe, nice to meet you all. I'm a current F one working in rheumatology. Um Obviously, everything in this teaching session is geared towards your learning and exams. Um It's not necessarily to be directly used in place of guidelines or uh clinical knowledge in um practice. Please guys um feel free to reach out of any questions throughout, just send messages in the chat and Lucy um who's helping out and has kindly arranged all of these teaching sessions and delivered the first session I believe um will, will help me out and read, read them out and help answer them. Um So all X rays and clinical photographs have been taken from open source um websites and radio pia, the type the likes of um they've all got patient consent. None of them are from my own clinical practice and the like. Um but please guys um want to make it as interactive as possible. So please just send anything in the chat if you want to ask at any point. So starting with the structure of today, we're gonna break it down into um two core components of rheumatology that are pretty, pretty different. Um So we'll start with gout and the broader spectrum of disease referred to as crystal arthropathies. So that includes pseudo gout um which are common topics for exam questions. Um could crop up Insys as well as um multiple choice and then we'll move on to a much more complex and more interesting, possibly topic in vasculitis. But we'll just cover it in a brief introduction to vasculitis. And then we'll go over the, the classical conditions that you see in exams and which associations to look out for in those single best answer questions. So, um, hopefully we'll have you guys prepared if any of this crops up in your upcoming finals or wherever you are in medical school. So we'll just start with a bit of a recap. So how to assess a red and swollen, red or swollen joint? Um So back to our principles of any M SK or joint exam. So, does anyone uh does anyone wanna shout out a few questions? Um You might ask if you were asked to come and examine someone or what, what, what, how would you start? Does anyone have any particular, any points in the chart? Not that I can see right now. Um But yeah, so on the slides as I've got there, um we start all histories of Socrates, don't we? We wanna know which joints were affected? Um And we wanna know um when that came on, was it a gradual onset, was it a rapid onset? We wanna know the character of the pain? And we wanna know where it localizes to or where, where it radiates to so often that can give us a really good clue. Um We know that pain radiation um can tell us a lot in terms of, um, for example, shoulder tip pain, um, or pain in the, um, a CJ joint, the chromic joint can radiate to the neck. Um, we want to know any associated symptoms. So, d does a person have any fevers? Do they have any other constitutional symptoms? Um, and we want to know um, about which joints are affected. So, does anyone know how we classify different types of arthritis in terms of, um, if, if three joints are affected, what would we call that? I don't know if anyone in the chat can send the, uh, the definition. So, if we call a single, an arthritis affecting one single joint, a monoarthritis, what would we call, uh, an arthritis affecting three joints? I don't know if anyone's there in the chat. Nothing in the chat. Is it polyarthropathy? So, yeah, exactly. We've got polyarthropathy and we've got an oligo arthropathy, um, in between a mono arthropathy and a poly, er, and a polyarthropathy usually in which 2 to 3 joints are affected. So, um, our basic principles of any joint examination, um, and they're more seen in your orthopedic, um, assessments are, look, feel, move and function. So we're gonna observe a joint and we're gonna see, are there any skin changes overlying it? Um, are there any, is there any clear swelling of the joint? Um, and the like, and then we're going to palpate the joints. So we're gonna start with the uh joint itself and any surrounding soft tissue structures, tendons, um the related muscles to the joint, um and so forth. And then of course, we're gonna think about in any oy or any clinic examination. What are a must not miss diagnoses relating to that um, joint and there's some particularly important ones in regard to gout, which we'll get onto in a minute. So, moving on, um, when we think about gout, um it's caused by chronically elevated blood urea, oh uric acid level, sorry, not urea. So hyperuricemia and uh what occurs in, in the disease process of gout is you get uric crystals depositing within the joint. Now it's more common in men. Um It actually accounts for around a quarter of a million GP consultations each year. Um And we know it's more common with increasing age. So you can see there. Um It's most common in the middle and middle aged and elderly. Um with gout. Um, there's some specific clinical features we think of and that's acute onset um of severe joint pain and it typically affects certain joints. So I don't know if anyone knows which joints are affected most commonly in gout if anyone can send in the chat. Um, if anyone's available, um just, just send in to the chat guys if you know which joint is most commonly affected in gout. Um or if not, we know it's actually the first methar. So