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Rasburicase: acts on soluable urate and monosodium urate crystals and cause rapid reduction in tophi.
Allopurinol block xanthine oxidase and prvent production.

Jaccoud's arthritis: non-erosive but can be deforming and corrected. common in SLE.
Hydroxychloroquine is the mainstay Rx for mild SLE; specially with mainly skin involvement.

Proliferative lupus nephritis:
Cycolophosphamide and high dose steroids are the standart treatment. Switch to azathioprine for maintenance. Low dose cyclo induction as effective and safer than high dose cyclo.

ACE/ARB: any one with proteinuria, BP >130/80
hydroxychloroquine asboulute baseline Rx.
bone protection; steroids.
In pregnancy- not active not Rx. mild disease activity- hydrochloroquine.
active lupus: prednisolone, AZA if necessary

Recurrent miscarriage, levida reticualris; lupus syndrome- anticardiolipin antibodies the most helpful to diagnose the problem.
If previous DVT and/or PE, prior pregnancy loss: ASA 100mg daily and SC heparin throughout the pregnancy.

Diffuse scleroderma: lung 30%(Scl-70), poor prognosis.
Limited Scleroderma: pulmonary hypertension 10%, good prognosis, CREST: clacinosis, Raynaud;s, Esophogeal dysmotility, sclerodactyly, telangiectasia.Anti-centromere ab positive.

Pulmonary HT in diffuse and limited Systemic sclerosis: 12%, suspect if DLCO <50%(normal lung volumes), poor prognosis 2yrs without Rx <50%.

High dose steroids is not recommended in renal crisis in SSc.
Bosentan/ambrisentan-Endothelin-1 receptor antagonist- vasodilatation in PHT.alternative; sildenafil, iloprost

Sjogren's syndrome: anti Ro(SSA) and/or La(SSB).
44 x high RR of developing lymphoma c/w general population-primary b ell origin.

The most common cause of SJS is Allopurinol, antigout meidcations, antibioitcs Sulfonamide(sulfamathazazole,dapsone)>penicillin> cephalosporin.
Antipsychotic and antiepileptics.

NSAIDs especially Piroxicam