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Rheumatology in the Elderly

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Sjogren's syndrome

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Emphasize eye and oral care, monitor for lymphoma, adjust therapies for systemic involvement.

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Psoriatic arthritis

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Careful with systemic treatments due to comorbidities, monitor for dermatologic and joint manifestations, tailor exercise programs.

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Osteomalacia

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Look for causes of vitamin D deficiency, correct with appropriate supplementation, and monitor for bone pain and muscle weakness.

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Gout

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Use lower starting doses of medications, assess for comorbid conditions, encourage hydration.

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Adult-onset Still's disease

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Be aware of atypical presentation, manage systemic symptoms, monitor for complications like macrophage activation syndrome.

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Osteoporosis

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Focus on fall prevention, ensure adequate calcium and vitamin D, monitor bone density.

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Sarcopenia

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Implement resistance and balance exercises, ensure adequate protein intake, assess for vitamin D deficiency.

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Systemic lupus erythematosus (SLE)

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Assess organ system involvement, adapt medications to reduce side effects, close monitoring for comorbidities.

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Giant cell arteritis

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High-dose steroids are the first line of treatment, monitor for visual symptoms, consider temporal artery biopsy for diagnosis.

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Tendinitis and bursitis

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Use conservative management first, consider local corticosteroid injections with caution, emphasize gradual return to activity.

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Paget's disease of bone

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Diagnose with alkaline phosphatase levels and imaging, treat with bisphosphonates if symptomatic, monitor for hearing loss and osteoarthritis.

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Polymyalgia rheumatica

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High-dose corticosteroids are the mainstay treatment, monitor for giant cell arteritis, consider long-term side effects of steroids.

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Septic arthritis

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Early diagnosis and treatment are critical, consider atypical organisms in the elderly, ensure appropriate antibiotic therapy.

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Calcium pyrophosphate deposition disease (CPPD)

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Identify crystal deposition via imaging, use NSAIDs cautiously, consider underlying metabolic disorders.

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Relapsing polychondritis

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Steroid-sparing agents may be required, watch for airway involvement, manage pain and inflammation.

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Rheumatoid arthritis

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Consider age-related changes in drug metabolism, monitor for infections due to immunosuppression, emphasize low-impact exercises.

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Ankylosing spondylitis

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Physical therapy and exercise are key, use TNF inhibitors cautiously, focus on maintaining spinal mobility.

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Fibromyalgia

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Pain management should be tailored, consider sleep disturbances, engage in gentle aerobic exercises.

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Osteoarthritis

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Prioritize non-pharmacological therapy, adjust drugs for renal function, monitor for side effects.

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Vasculitis

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Be vigilant for systemic symptoms, use corticosteroids and immunosuppressants cautiously, screen for infections.

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