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74 Brochures Health Education



74 Brochures Health Education

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Tabled Paper 2134


Tabled Papers for 6th Assembly 1990 - 1994; Tabled Papers; ParliamentNT




Tabled by Mike Reed


Made available by the Legislative Assembly of the Northern Territory under Standing Order 240. Where copyright subsists with a third party it remains with the original owner and permission may be required to reuse the material.




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4. C o u rse Systematic follow-up of patients w ho consult doctors spontaneously in the acute phase shows that only a minority recovers fully within 3 months. Although many of the rest do not require active treatment in the late stages of the illness som e will seek continuing or intermittent medical help. Nearly one-quarter will have rheumatic symptoms for a year or more. If they have been seen in the acute stage, detailed notes and early confirmatory serology w ill be invaluable in discriminating other unrelated rheumatic complaints (see section 9 iii). Patients presenting for the first time at these later stages pose special problems in diagnosis. 5. C h ro n ic phase (i) Pain, tenderness and slight swelling round affected parts often persist, with quite severe morning stiffness of an hour or more, which can continue for months. Later the stiffness is quickly relieved by movement but typically recurs with immobility such as sitting in a car. (ii) The patients may report these symptoms but present no signs on the day. If seen often, their observations will be confirmed, the main signs being pain on movement and tenderness. (iii) Small effusions can persist or recur for many months (and have been confirmed by aspiration), in the knee, ankle and tendon sheaths. The joints are not usually hot at this stage. (iv) Signs are often conspicuous in the small joints of the fingers, the tendon attachments, the Achilles tendon and the plantar fascia. (v) The usual course is one of gradual subsidence, typically waxing and waning, with each episode less severe and less extensive. Exacerbations of symptoms can occur at intervals of some months after apparent recovery, and usually last about one week. (vi) Fatigue reappears concurrently with exacerbations of rheumatic symptoms. The chronic phase of RRV disease is thus a more distinct entity than the postviral syndromes now widely reported. 6. La b o ra to ry f in d in g s (i) Peripheral blood examination is often quite normal. Common findings are a depression of total leucocyte count, or of neutrophils, which can also show a slight shift to the left without distinct elevation. A few 'atypical', or reactive, lymphocytes are often found in the acute stage and are sometimes numerous enough to suggest other causes. 7

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