Clinical medicine (London, England)
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We present the case of a 26-year-old Indian male who developed pleural effusion while undergoing treatment for tuberculous lymphadenitis. We describe the work-up for his condition and how he was managed. The possibility of development of a paradoxical reaction in the form of pleural effusion after initiation of anti-tuberculous therapy has to be kept in mind while treating such patients.
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Psoriatic arthritis (PsA) accounts for around 20% of referrals to the early arthritis clinic and presents a significant diagnostic and management challenge. Early diagnosis is important to prevent long term functional disability and to ensure optimal management of arthritis and key comorbidities. From the rheumatologist's perspective, the differential diagnosis includes rheumatoid arthritis, gout and other inflammatory arthritides. ⋯ Using this information, appropriate treatment can be planned using therapies that are effective at treating the relevant domains of disease. Despite poor data, traditional disease-modifying anti-rheumatic drugs are commonly used and have been effective in observational studies. Following tumour necrosis factor inhibitors, which have proven excellent efficacy in multiple domains of PsA, new biologics are available or in development and will improve treatment options for people with refractory PsA.