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Very important strides were made in realizing the pathophysiologic foundation of many inflammatory stipulations in recent times, yet rheumatology continues to be a self-discipline within which prognosis is rooted within the clinical background skillfully extracted from the sufferer, the cautious actual exam, and the discriminating use of laboratory assessments and imaging. furthermore, collection of the main acceptable remedy for sufferers with rheumatic illnesses additionally is still seriously reliant upon medical event. scientific disciplines equivalent to rheumatology that rely considerably upon scientific knowledge are at risk of the improvement of platforms of Pearls and Myths, relating to the illnesses they name their very own, a Pearl being a nugget of fact in regards to the prognosis or remedy of a selected affliction that has been received via dint of medical event and a fantasy being a regularly held trust that affects the perform of many clinicians yet is fake. This e-book will pool jointly the scientific knowledge of pro, specialist rheumatologists who perform the care of sufferers with autoimmune illnesses, systemic inflammatory problems, and all different rheumatic conditions."
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Additional resources for A Clinician's Pearls and Myths in Rheumatology
Masticatory stimulatory techniques are easy to implement and have few side effects. The combination of chewing and taste, as provided by gums, lozenges, or mints can be very effective in relieving symptoms for patients who have remaining salivary function. They are acceptable to most patients and are generally harmless (assuming that they are all sugar free). 2 Continued • Nystatin cream or ointment (00,000 U/g, 4–5 times/day) • Clotrimazole cream (%, 2 times/day) • Miconazole cream (2%,–2 times/day) Treating underlying disorder Systemic anti-inflammatory • Anti-CD20 resulting in B-cell depletion or immune modulating thera(rituximab) pies to treat the autoimmune • Targeting B-T cell interaction exocrinopathy of Sjögren’s (abatacept) syndrome • Targeting B-cell activating factor (belimumab) Modified from Meiners, PM, Meijer JM, Vissink A, Bootsma H.
21 Chapter 3 Oral features Arjan Vissink, Frederik KL Spijkervet, and Hendrika Bootsma Key points • In general, the principal causative factor underlying the subjective feelings and clinical findings associated with dry mouth is hyposalivation. • The principal oral symptoms associated with hyposalivation are a tender oral mucosa; dry lips, cheeks, tongue, and palate; swollen salivary glands; increase in dental caries; and an increased susceptibility to oral infections. • Patients with oral dryness complain of problems eating, swallowing, and with speech as well as having an urge to frequently moisten their mouth.
9 MRI image of a Sjögren’s patient showing an enlarged left parotid gland with cyst-like lesions. 0 Labial biopsy. After a horizontal incision the labial salivary gland is exposed . 34 Delli K, Vissink A, Spijkervet FKL. Salivary gland biopsy for Sjögren’s syndrome. Oral Maxillofac Surg Clin North Am 204;26:23–33. 0). A lower lip mucosal incision of approximately cm is made and at least seven individual labial glands are excised from the lower lip. ). A cm skin incision is performed around the lower earlobe.
A Clinician's Pearls and Myths in Rheumatology