systemic lupus widespread pain, 192 RAPID3 questionnaire, 246f rash. See skin rash rating scale, pain asse ssment erythematosus (SLE), 335 \200\223336 renal manifestations evaluation, 216 intrinsic renal f ailure, erythematosus (SLE), 335, 569, 570t systemic sclerosis, 384, in children, 9f 386t, 387 Wegener \200\231s Raynaud \200\231s phenomenon (RP), 197, 199, 374, 377t 217 \200\223218 granulomatosis (WG), 431 features of, 381 systemic sclerosis, 377t, postrenal azotemia, pulmonary \201 brosis, 214 pulmonary hypertension, scleroderma, 575 pulmonary manifestati ons 216 \200\223217 378 prerenal azotemia, 216 renal tubular acidosis, 218 rheumatic disease, treatment of, 383t reactive arthropathy airways, 215 interstitial lung disease, clinical presentation, 300 diagnosis and treatment 216 \200\223218 scleroderma renal crisis, 214 pleura, 214 pulmonary nodules/ of, 300 \200\223301 re \202 exology, 556 re \202 ex sympathetic 218 renal osteodystrophy, 456, 463t, 463 \200\223464 masses, 214 rheumatic disease, dystrophy, plate 5 renal pain, 84t renal tubular acidosis (RTA), regional musculoskeletal 214 \200\223215 vasculature, 215 systems 218, 457, 457t rheumatic disease, 150. corticosteroid injection therapy, 142 \200\223145 pulmonary nodules/masses, rheumatic disease, 214 pulmonary renal syndromes, See also infection and rheumatic disease cardiac manifestations, foot disorders in children and adolescents, 132 \200\223140 215 210 \200\223212 pustules and blisters, skin disorders, 198 pyoderma gangrenosum, general considerations, 12 knee pain, 104 \200\223117 low back pain and disorders endocrine manifestations, 220 \200\223223 gut and hepatobiliary manifestations, 224 \200\223229 510, 512t in adults, 70 \200\22382 lower leg and foot pyogenic joint infection, management of, 486 \200\223487 disorders, 118 \200\223130 malignancy, 230 \200\223232 pulmonary manifestations, neck pain, 14 \200\22320 pain around the elbow, 214 \200\223215 34 \200\22339 renal manifestations, R radial nerve, upper limb, pelvic, groin, and thigh 216 \200\223218 pain, 92 \200\223103 skin disorders and, 60, 62f radiographs rehabilitation principles, 196 \200\223200 146 \200\223147 skin vasculitis in adults, acute mechanical back shoulder pain, 22 \200\22333 spinal disorders 202 \200\223204 pain, 538 elbow pain, 38 foot, 127 \200\223128 skin vasculitis in children in children and adolescents, 84 \200\22390 and adolescents, 206 \200\223208 INDEX 591 surgery in, 257 rheumatic fever epidemiology and clinical rheumatoid factor negative clinical manifestations and treatment of, 496 \200\223497 presentation, 304 sarcoid, monoarticular/ polyarticular clinical manifestations, diagnosis of, 497 \200\223498 infection with acute polyarthritis, 175t revised Jones criter ia, oligoarticular pain, 163t 322 sarcoidosis juvenile idiopathic bones, 504 \200\223505 clinical manifestations, arthritis (JIA), 322 \200\223323 laboratory tests, 322 proposed 497t 505t diagnosis and treatment treatment, 498 rheumatic symptoms, Wegener \200\231s granulomatosis (WG), 432 subclassi \201 cation, 323t of, 505 \200\223506 treatment, 322 \200\223323 rheumatoid factor positive joints, 504 muscles, 505 musculoskeletal polyarticular childhood, 259 juvenile idiopathic manifestations, 504 \200\223505 rheumatoid arthritis (RA), 6 scalp, skin disorders, 196 Scheuermann \200\231s disease, 73, 84t, 89, 471t, 472 algorithm for arthritis (JIA), 324 rheumatologic emergencies management of adult RA, 258f acute hematologic Scheuermann \200\231s antinuclear antibodies manifestations of SLE (adults), 571 osteochondritis, 66t, 547 (ANA), 184 t anti-TNF-A therapy, acute SLE involving heart and lungs (adults), 569, 570t Schirmer \200\231s test, Sj gren \200\231s syndrome, 368 254 \200\223256 biologic agents, 252, 254 clinical features of, 239 comparison of psoriatic arthritis and, 297t sciatic nerve, 72 scintigraphy. See also bone acute SLE nephritis (adults), 568, 569t giant cell arteritis, 574 gonococcal (GC) septic ar thritis, 564 \200\223565 infections in patients taking anti-TNF-A drugs, 566, 567t methotre xate-induced pneumonitis, 576 pediatric SLE \200\223 acute hematological manifestations, 5 71, 573f scintigraphy Sj gren \200\231s syndrome, 368 disease activity scleredema, 375t assessment, 244 \200\223246 scleroderma-like \201 brosing disease criteria and disorder, 375t, 395 scleroderma, 374. See also systemic sclerosis and related disorders epidemiology, 236, 237t disease-modifying antirheumatic drugs (DMARDs), 249, 251 \200\223252, 253t crises, 575 cutaneous features of, drugs, 247 \200\223254 evaluation and treatment 380 \200\223381 diffuse skin changes, of, 244 \200\223258 380 \200\223381 pediatric SLE \200\223 acute nephritis, 571, 572f scleroderma crises, 575 septic arthritis , 562 \200\223565 severe vasculitis, 574 systemic vasculitis, 574 glucocorticoids, 248 \200\223249 gut and hepatobiliary manifestations, 227 t, 228t gut and hepatobiliary manifestations, 227t localized skin changes, 380 malignancy increase, 232 normal and irregular nailfold capillaries, plate 4 incidence, prevalence, and morbidity, 238 rickets, 84t le \202 unomide, 251 main components in treatment of, 248t management summary, 257 methotr exate, 250 \200\223251 nodules associated with, osteomalacia and, pulmonary hypertension, 454 \200\223457 575 rituximab renal crisis, 575 scleroderma-like \201 brosing disorders, 394 \200\223395 pregnancy, 257 rheumatoid arthritis (RA), 255 systemic lupus plate 16 scleroderma-like nonsteroidal anti- syndromes, 375 \200\223376t skin thickening, 199 \200\223200, erythematosus (SLE), 346 in \202 ammatory drugs (NSAIDs), 247 201t rol \201 ng, 559 rubella, infection with acute polyarthritis, 175t oligoarticular joint pain, scleroderma renal crisis, 218 scleromyxedema, 376t, 394 scoliosis, 68, 71t, 84t, 85, 87 153 t organ disease in, 240 \200\223242, 241t pharmacotherapy, causes, 86t congenital, 546 diagnosing, 89 \200\22390 idiopathic, 546 measurement by Cobb S sacroiliitis, 71t, 73 St. John \200\231s wort, 555 Salmonella, 155 SAPHO (Synovitis, Acne , 256 \200\223257 pregnancy, 256 \200\223257 rheumatoid factor positive polyarthritis in childhood, 259 sulfasalazine and method, 548f neuromuscular, 546 secondary amyloidosis, Pustulosis, Hyperostosis, and Osteitis) diagnosis and treatment, hydroxychloroquine, 249 \200\223250 rheumatoid arthritis (RA), 242 304 \200\223305 INDEX 592 stressing the skin disorders secondary hyperpara- thyroidism, 461 secondary malignant acromioclavicular joint, 28 \200\22329 diagnostic issues in patients with skin thickening, 199 \200\223200, 201t taking a history, 23, tumors, spinal tumors in children and adolescents, 551t secondary metastases, 71t septal pa nniculitis, 508, 509t septic arthritis 25 \200\22326 tests for subacromial face and ears, 196 \200\223197 hands and nails, 197 macular rashes, 197 \200\223198 plaques , 198 pustules and blisters, 198 scalp, 196 textural abnormalities, impingement, 28, 30f treatment, 32 \200\22333 visual inspection, 27 sialography, Sj gren \200\231s antibiotics for, 563t emergency, 562 \200\223565 gonococcal (GC), syndrome, 368 sickle cell crisis, 71t Simpli \201 ed Disease Activity Index (SDAI), 245 Si nding \200\223Larsen \200\223Johansson \200\231s disease, 471t, 472 199 564 \200\223565 types of eruption, immediate management of adult joint sepsis, 562, 563t, 564 197 \200\223199 ulcers and ulcerating rashes, 198 \200\223199 vascular lesions, 198 Sj gren \200\231s syndrome management, 486 \200\223487 monoarticular/ antinuclear antibodies (ANA), 184t skin rash oligoarticular pain, 163t autoimmune diseases, macular, 197 \200\223198 oligoarticular pains, oligoarticular joint pain, 367 153t cardiovascular system 157, 166 postimmediate 1, 366 ulcers and ulcerating rashes, 198 \200\223199 widespread pain, 189 management of, 564 classi \201 cation criteria, pyogenic bacterium 362, 363t causing, 486 clinical manifestations of, skin vasculitis suspecting infection, 572 septic bursitis, management 364 \200\223367 adults, 202 \200\223204 children and adolescents, of, 488 epidemiology, 362 extraglandular (systemic) 206 \200\223208 classi \201 cation of Sever \200\231s disease, foot disorder, 135t disease, 364, 365t gastrointestinal and childhood, 207t epidemiology, 206 examination, 206 hypersensitivity, 203t investigations, 2 07 \200\223208 laboratory tests for suspected, 203t sexual history, widespread pain, 174 sexually transmitted hepatobiliary disease, 365 \200\223366 reactive arthritis (SARA), 300 glandular disease, 364 gut and hepatobiliary manifestations, 227t investigation of, 368 \200\223369 joints, 364 lymphoproliferative disease 1, 366 Shigella, 155 shin splints, 121, 132, 134 shoulder impingement skin biopsy, 204 systemic, 204 syndrome, 8, 530 \200\223531, 532f shoulder pain slump test, low back pain, 75f malignancy increase, 232 neuromuscular disease, small-vessel vasculitis, anatomy, 22 \200\22323 bilateral shoulder movements, 27 common causes, 25t diagnosis and 438 \200\223441 366 allergic vasculitis, 438 cryoglobulinemic vasculitis, 440 erythema elevatum pathology on, 362, 366 \200\223367 pulmonary disease, 365 renal disease, 365 skin, 364 treatment of, 370t, management, 31 \200\22332 diutinum (EED) and granuloma faciale (GF), 441 examination, 27 \200\22331 examination of supine patient, 29 \200\22331 370 \200\223371 Henoch \200\223Sch nlein purpura, 439 isolated muscle testing of girdle muscles, 29t skin Beh et \200\231s disease, 500, hypergammaglobulinemic location of, 26 major shoulder structures, 22f 501t purpura, 440 patients with widespread leukocytoclastic vasculitis, pain, 177 \200\223178 rheumatic fever, 497 rheumatoid arthritis 438, 439t movement of nonleukocytoclastic vasculitis, 439t, 441 glenohumeral joint, 28 movement or position- related pain, 26 \200\22327 muscles of the shoulder, (RA), 240 urticarial vasculitis, Sj gren \200\231s syndrome, 364 systemic lupus 439 \200\223440 social history, oligoarticular 24f erythematosus (SLE), 334 pains, 156 pain and shoulder spinal disorders in children and adolescents lesions, 23 radiographs, 31 Wegener \200\231s granulomatosis (WG), 431 INDEX 593 stability, testing for knee, lumbar disc prolapse, diagnostic procedures, 112, 113f 540, 541t 89 \200\22390 Staphylococcus aureus, rheumatoid arthritis examination, 87 \200\22389 past developmental, 66, 158 (RA), 257 Staphylococcus epidermidis, Sweet \200\231s syndrome, 510, 511t Sydenham \200\231s chorea, 496 \200\223497 medical, family and social history, 85 \200\22387 158 sterile discitis, 543 steroid injections radiographs, 89, 90t scoliosis, 89 \200\22390 taking a history, 84 \200\22387 synovial biopsy, injection of carpal tunnel, oligoarticular pains, 160, 168 plate 15 spinal infections, 66 spinal manipulation, 556 spinal osteomyelitis, 68 spinal stenosis, 71 t, 72, 542 spinal tumors, 549 \200\223550, 551t spiritual healing, 558 \200\223559 spondyli tis, 68 injection of glenohumeral synovial chondromatosis, joint, plate 12 519 synovitis, 53 injection of subacromial space, plate 13 examine for knee joint, injection of tennis elbow, 111 \200\223112 plate 14 knee, 116 \200\223117 lower leg and foot knee, 109 oligoarticular pains, radiograph of psoriatic, 152, 166 plate 7 disorders, 129 \200\223130 wrist pain, 42 \200\22343 synovium, disorders of, spondyloarthridities, 284 ankylosing spondylitis osteoarthritis, 269 Still \200\231s disease, juvenile 518, 519 systemic arthritis (AS), 290 \200\223295 idiopathic arthritis (JIA), 328 storage disorders, 479 Streptococcal species, ASAS (Assessment of Spondyloarthritis International Society) criteria for axial spondyloart hritis, 286, 287t clinical features, 316 \200\223318, 317t diagnostic evaluation of, nongonococcal septic arthritis, 158 318 \200\223319 differential diagnosis, 318 radiological abnormalities, stress fracture, foot disorder, 135t stress management, 558 strontium ranelate, osteoporosi s treatment, 452 subacromial articulation, corticosteroid injection, 143 subacromial imping ement ASAS criteria for peripheral spondyloarthritis, 286, 288t 319t treatment, 320 systemic lupus erythematosus in childhood, 306 \200\223307 comparison of (SLE), 330 acute hematologic seronegative, 289t diagnostic criteria and clinical subsets, 286 enteric arthropathy, 302 p soriatic arthritis, manifestations of SLE (adults), 571 acute SLE, 568 \200\223573 acute SLE involving heart syndrome diagnosis of, 530 disorders presenting, 531t pragmatic algorithm for and lung (adults), 569, 570t 296 \200\223298 reactive arthropathy, acute SLE nephritis (adults), 568, 569t American College of 300 \200\223301 SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis), 304 \200\223305 managing, 532f Rheumatology (ACR) criteria, 330, 331t radiographic abnormality in chronic, plate 2 antiphospholipid undifferentiated test for, 28, 30f (antibody) syndrome and, 338 spondyloarthritis, 303 subacromial space, injection spondyloarthritis in, plate 13 anti-TNF-A therapy, 346 autoantibodies of, in gut and hepatobiliary manifestations, 227t oligoarticular joint pain, sulfasalazine ankylosing spondylitis clinical practice, 341t (AS), 295 autologous 153t gut and hepatobiliary side hemopoietic stem cell transplantation (HSCT), 346 azathioprine, 345 belimumab, 345 cardiova scular disease, undifferentiated, 303 spondyloarthropathies, 67, effects, 229 pregnancy, 256 rheumatoid arthritis (RA), 84t, 94, 284 juvenile, 307 thoracic spine and chest 249 \200\223250 suprascapular nerve, upper limb, 58 \200\22359, 62f wall, 66t 334 spondylolysis, defect in pars interarticularis, plate 8 surgery childhood, 349 clinical features of, ankylosing spondylitis spondylolysis/ (AS), 295 back pain, 540 knee pain, 117 lower leg and foot disorders, 130 334 \200\223337 spondylolisthesis, 84t, 89, 548, 549f cutaneous manifestations of, 335t sports, foot pain during, 134 Sprengel \200\231s deformity, 88 cyclophosphamide, 345 INDEX 594 cutaneous features of examination, 67 \200\22368 magnetic resonance diagnosis and scleroderma, 380 \200\223381, 382t investigation of, 340 \200\223341 (MR), 69 diagnostic criteria, 374, painful conditions of thoracic spine and chest wall, 66t palpation, 67 \200\22368 quality o f pain, 67 radiographs, 68 \200\22369 symptoms and risk drug-induced lupus 377t, 378 erythematosus (DILE), 342 drug use diffuse cutaneous systemic sclerosis, 392 epidemiology, 374, 378 gastrointestinal tract, recommendations, 347t gastrointestinal features, 384, 385t 337t limited cutaneous factors, 67 gut and hepatobiliary systemic sclerosis, 392 taking a history, 64 \200\22367 treatment, 69, 81 \200\22382 visual inspection, 67 thoracic vertebral disease, thoracic spine and chest wall, 66t thrombocytopenia, manifestations, 227t, 228t malignancy, 388 organ involvement, 388, hematopoietic involvement, 336 \200\223337 hydroxychloroquine, 345 immunologic features, 337t monoarticul ar/ 389t prognosis, 392 pulmonary disease, 384, 386t, 387 oligoarticular pain, 163t renal disease, 387 \200\223388 scleroderma-like \201 brosing disorders, 394 \200\223395 antiphospholipid syndrome (APS), 354, 355t, 357t musculoskeletal, 334 mycophenolate mofetil (MMF), 345 myocarditis, 210 neonatal, 350 nervous system disorders, 337 pediatric SLE \200 \223 acute hematological manifestations, 571, 573f scleroderma-like thrombosis, syndromes, 375 \200\223376t skin thickening, 199, 201t systemic vasculitis, 202, 204 classi \201 cation of, 420t giant cell (temporal) antiphospholipid syndrome (APS), 354, 355t, 357t thyroid gland, systemic sclerosis, 389t thyrotoxicosis, 223 tocilizumab arteritis, 574 severe, 574 pediatric SLE \200\223 acute nephritis, 571, 572f pericardial effusions, 210 pregnancy and , 339 prognosis and survival pregnancy, 256 rheumatoid arthritis T Tai Chi, 556 Takayasu \200\231s arteritis (TA) (RA), 255 systemic arthritis, 320 tofacitinib, rheumatoid in, 348 childhood, 207t treatment of, 423 vasculitis, 422 arthritis (RA), 255 \200\223256 tomography, knee pain, 114 torticollis, 86 toxic oil syndro me, 376t Toxoplasma gondii, pulmonary disease, 335 reduction of cardiovascular disease risk factors, 344 renal involvement, talipes equinovarus, 132, 133t tendons and ligaments, rheumatoid arthritis (RA), 242 tendon sheaths, wrist, infection with acute polyarthritis, 175t 335 \200\223336 rituximab, 346 skin, 334 standard therapies for, 344 \200\223345, 344 \200 \223346 trauma 40, 41f childhood, 188t monoarticular/ tennis elbow, 37, 534, 535f injection in, plate 14 oligoarticular pain, 163t Systemic Lupus International Collaborating Clinics (SLICC) criteria, 330, 332t, 341 tenosynovitis, 53 teriparatide, osteoporosis treatment, 452 oligoarticular pain, 164 osteoarthritis, 265t triamcinolone acetonide, tertiary hyperparathyroidism, injection therapy, 142 461 trigger \201 nger, 51, 220 trigger points, 8 tuberculosis, mycobacterium, treatment of, 344 \200\223346 vascular features, 337t thalassemia, monoarticular/ oligoarticular pain, 163t Systemic Lupus thermotherapy, 559 thigh. See pelvic, groin, and 490 \200\223491 Erythematosus Disease Activity Index (SLEDAI), 340 systemic sclerosis and related disorders tumor necrosis factor- thigh pain associated periodic syndrome (TRAPs), 523 thoracic back and chest pain background, 64 bone scan, 69 characteristics of chest anti \201 brotic and U ulcerative colitis, rheumatic immunosuppressive therapies for, 390, 391t pain, 65t checking thoracic spinal features, 225t antinuclear antibodies movement, 68 ulcers and ulcerating (ANA), 184t cardiac disease, 387 classi \201 cation of, 374, 377t diagnostic procedures, rashes, skin disorders, 198 \200\223199 68 \200\22369 INDEX 595 dysphagia, abdominal pain ulnar nerve panniculitis with, and diarrhea, 177 electrophysiology and slight \202 exion of fourth and \201 fth \201 ngers, plate 6 509 \200\223510 vasculitis and autoimmune connective tissue disease, childhood, 207t imaging, 183 examination, 177 \200\223181 family history, 175 \201 bromyalgia tenderness upper limb, 59, 62f ultrasonography, Takayasu \200\231s arteritis (TA), 422 Vasculitis Damage Index sites, 180f ischemia, 174 joint examination, 178 joint pain, 172 joint symptoms over time, 172 \200\223173 major causes of ultrasound (VDI), 419 Vilanova disease, 508 viral arthritis, monoarticular/ oligoarticular pain, 163t hand and wrist disorders, 54 \200\22355 knee pain, 115 oligoarticular pains, 167 pelvic, groin and thigh viral enteritis, rheumatic features, 225t Von Gierke \200\231s disease, pain, 101 muscle pain/weakness, 192t myopathies, 176t shoulder pain, 31 widespread pain, 193 malignancy investigations, 184 \200\223185 undifferentiated muscle biopsy, 183 muscle pain, 173 myalgias and weakness, spondyloarthritis, 303 upper limb musculoskeletal W Waldenstrom \200\231s lesions macroglobulinemia, antinuclear antibodies (ANA), 184t 173 adhesive capsulitis (AC), past medical history, 174 patients with myalgias, 533 lateral epicondylitis, watermelon stomach, 224 weakness, 173 Wegener \200\231s granulomatosis 179 \200\223181 534, 535f prevalence of antinuclear antibodies (ANA), 184t shoulder (subacromial) impingement syndrome, 530 \200\223531, 532f (WG) psychosocial and sexual cardiac lesions, 211 clinical features of, history, 174 screening examination for proximal myopathy, 182f tennis elbow, 534, 535f upper limb peripheral nerve 430 \200\223432 ear, nose and throat, 430 eye disease, 432 investigation of, 432 nervous system, 432 pulmon ary disease, 431 pulmonary \201 brosis, 214 pulmonary nodules, 214 renal disease, 431 rhe umatic symptoms, 432 skin disease, 431 Whipple \200\231s disease, lesions anatomy, 62f background, 58 long thoracic nerve, 58 median nerve, 60 \200\22361 rad ial nerve, 60 suprascapular nerve, skin and nails, 177 \200\223178 taking a history, 170 \200\223177 tests for polyarthropathy , 181, 182 travel, 175 widespread pain in children and adolescents, 186 \200\223194 58 \200\22359 ulnar nerve, 59 background, 186 bone pain, 187 bone scan, 193 classi \201 cation of childhood urticarial vasculitis, 439 \200\223440 U.S. Preventative Services Task Force (USPSTF), back pain, 538 uveitis, oligoarthritis, 314t, rheumatic features, 225t widespread pain in adults, disorders, 188t disease classi \201 cation, 170 \200\223185 315 abnormality patterns, 186, 187t 178 \200\223179 examination, 190 \200\223194 full medical examination, V valvular disease, cardiac involvement in rheumatic disease, 211 age, sex, and racial background, 170 190 benign joint juvenile idiopathic hypermobility syndrome (BJHS), 180t arthritis (JIA), 186 laboratory tests, 191 magnetic resonance (MR), 193 \200\223194 muscle pain, 194 musculoskeletal vascular features bone biopsy, 185 bone pathology, 171, 174 categories of skin disorders, 198 systemic lupus erythematosus (SLE), 337t musculoskeletal pain, 171t vasculature, pulmonary manifestations, 215 vasculitides. See primary examination, 190 \200\223191 ophthalmic symptoms, chest pain, dyspnea, palpitation, cough, and hemoptysis, 177 189 \200\223190 vasculitides radiographs, 192 rare inherited causes of common infections, 175t diagnostic procedures, vasculitis. See also systemic vasculitis monoarticular/ muscle pain/weakness, 192t rash, 189 181 \200\223185 drug history, 176 \200\223177 oligoarticular pain, 163t INDEX 596 quality of pain, 43 synovitis, 42 \200\22343 taking a history, 40 \200\22343 trauma history , 40, 42 corticosteroid injection, 144 diagnoses and treatment, widespread pain in children and adolescents (Cont.) 44, 53 \200\22355, 55 \200\22356 diagnoses from simple radiographs, 54t examination, 43 \200\22344 \202 exion/extension range systemic-onset JIA and fever, 188, 189f taking a history, 186 \200\223190 tests for suspected systemic JIA, 193t X X-linked hypophosphatemic tests, 44 ultrasound, 193 functional anatomy, 40, 41f joint/musculoskeletal Wilson \200\231s disease, rheumatic rickets, 456 features, 226t symptoms, 43 major diagnoses, 42t occupational and leisure World Health Organization (WHO), osteoporosis, 444 Y Yersinia, 155 activities, 43 wrist pain. See also hand Plate 1 MR scan of the neck showing loss of height and signal affecting several disks with multisegmental spondylotic bars, compression of the cord from protrusion of the C5/6 disc a nd myeloppathic changes (high signal) in the cord. Plate 2 Patterns of radiographic abnormality in chronic SAI: sclerosis and cystic changes i n greater tuberosity. Plate 3 Dactylitis, nail changes, and DIP joint arthritis in psoriatic arthritis. (a) (b) Plate 4 (a) Normal nailfold capillaries. (b) Nailfold capillaries in scleroderma showing av ascular areas and dilated capillaries in an irregular orientation (original magni \201 cat ion 65x). Plate 5 Diffuse arm and hand swelling in chronic regional pain syndrome (re \202 ex sympat hetic dystrophy). Plate 6 Slight \202 exion of fourth and \201 fth \201 ngers as a result of an ulnar n erve lesion at the elbow. The area of sensory loss is indicated by the dotted line. Plate 8 Spondylolysis. The defect in the pars interarticularis (black arrows) may only be n oted on an oblique view. The patient has had a spinal fusion (open arrows). Plate 7 Psoriatic spondylitis: Non-marginal and \200\234 \202 oating \200\235 (non-attach ed) syndesmophytes. (a) (b) Plate 9 Testing passive hip \202 exion and rotational movements (a) and hip abduction (b) .The pelvis should be \201 xed when testing abduction and adduction. Plate 10 Bone scintigraphy showing osteonecrosis of the left femoral head (on the right-han d side as this is an anterior view). Photopenia (an early sign) corresponds to ischemia. Plate 11 The \200\234patellar tap \200\235 test. Any \202 uid in the suprapatellar pouch is squeezed distally by the left hand. The patella is depressed by the right hand. It will normally tap the underlying femur immediately. Any delay in eliciting the tap or a feeling of damping as the patella is depressed suggests a joint effusion. Plate 12 Injection of the glenohumeral joint via the anterior route Plate 13 Injection of the subacromial space. Plate 14 Injection of tennis elbow (lateral humeral epicondylitis/enthesitis). Plate 15 Injection of the carpal tunnel to the ulnar side of Palmaris longus tendon. (a) (b) (d) (c) Plate 16 Nodules associated with joint diseases. (a) RA: typically over extensor surfaces a nd pressure areas. (b) Chronic tophaceous gout: tophi can be indistinguishable clinically f rom RA nodules though may appear as eccentric swellings around joints (image provided court esy of Dr. R. A. Watts). (c) Multicentric reticulohistiocytosis: nodules are in the skin, a re small, yellowish-brown, and are often around nails. (d) Nodal OA: swelling is bony, typi cally at PIPs and DIPs. Plate 17 Bone scintigraphy (99m Tc MDP) of a 65-year-old man with widespread bone pain and weakness suspected to have metastatic malignancy. Undecalci \201 ed transiliac bone biopsy con \201 rmed severe osteomalacia. There was coincidental Paget \200\231s disease (arrowe d lesions). Plate 18 Increased growth of the left lower limb due to chronic knee in \202 ammation in ( RF-) JIA. Plate 19 Lupus pernio presenting as a bluish-red or violaceous swelling of the nose extendi ng onto the cheek. Plate 20 Nailfold capillaries, demonstrating normal capillary loops. Magni \201 ed 300x. P hotograph used with the kind permission of Graham Dinsdale, Tonia Moore, and Ariane Herrick . Plate 21 Nailfold capillaries, demonstrating abnormal capillary loops, including capillary loop dilatation and dropout. Magni \201 ed 300x. Photograph used with the kind permission of Graham Dinsdale, Tonia Moore, and Ariane Herrick.