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The systemically ill patient 

The systemically ill patient
The systemically ill patient
Oxford Textbook of Rheumatology (4 ed.)

Joanna Robson

, Anna Mistry

, Kuljeet Bhamra

, Stefan Kluzek

, and Raashid Luqmani


The rheumatologist is commonly tasked with the difficult problem of making a diagnosis of a patient who appears to have a multisystem condition. The problem can be compounded by the use of partial treatment, especially the use of high doses of glucocorticoids, which can mask important clues to the diagnosis, and may even prevent the possibility of confirming a diagnosis; worst of all, they may exacerbate any underlying infection that may be the true cause of the problem. The rheumatologist should not discount the value of repeating initial investigations, if the condition changes, and of reviewing the diagnosis accordingly. Wherever possible, evidence should be used for management decisions, but there is still a degree of art, fashioned from experience, that needs to be practised in managing these cases effectively.

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