Rash+&+arthritis

Rash and arthritis ผื่นผิวหนังและโรคข้อ ผื่นและอาการปวดข้อถ้าเป็นสาเหตุเดียวกัน อาการต้องสัมพันธ์กัน ความรู้เฉพาะของแต่ละโรคจึงมีความสำคัญอย่างยิ่ง การซักประวัติผื่นที่ผิวหนัง  1. ประวัติผื่น มี 7 คำถาม  1.1  อาการของผื่น เช่น คัน เจ็บ แสบ ฯลฯ  1.2  ระยะเวลา เป็นนานเท่าไหร่  1.3  ตำแหน่งที่ขึ้นครั้งแรก  1.4  การกระจายตัวของผื่น การกระจายจากตำแหน่งแรงไปตำแหน่งอื่น ลักษณะเฉพาะของการกระจายตัว ระยะเวลาการเกิดผื่นเพิ่ม การจายนานเท่าไหร่  1.5  ลักษณะของผื่น เริ่มต้นเป็นแบบใด เปลี่ยนแปลงอย่างไร ในเวลาเท่าใด ผื่นแต่ละผื่นอยู่นานเท่าใด ยุบลงหรือไม่  1.6  สิ่งที่ทำให้ผื่นเป็นมากขึ้นหรือดีขึ้น เช่น เวลามีไข้ อากาศเปลื่ยน เป็นต้น <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.7  <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">การรักษาก่อนมาพบแพทย์ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ประวัติปัจจุบันเกี่ยวกับทางข้อ รวมทั้งความสัมพันธ์ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ประวัติอดีต ส่วนตัว ภูมิแพ้ การแพ้ยา การเดินทาง <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ประวัติครอบครัว <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ประวัติโรคติดต่อทางเพศสัมพันธ์ พฤติกรรมความเสี่ยงต่อการติดโรค การตรวจร่างกาย ดูศีรษะจดเท้าหน้าหลัง เยื่อบุต่างๆ เล็บ ผม และคลำ โดยการลูบดูความนูน คลำขอบเขต ความลึกอยู่ในชั้นใดของผิวหนัง ความนุ่ม - <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">แข็ง เจ็บหรือไม่ ดังนี้ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ลักษณะโดยรวมของผื่นทั่วตัว ( Four cardinal sign) <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ได้แก่ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.1  Type of lesion  <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ชนิดของผื่น เช่น macule, nodule, vesicle, pustule <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.2  Configulation <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">รูปร่างของผื่น เช่น anular, umbilicated, iris <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.3  Arrangement <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">การเรียงตัวที่สัมพันธ์กันของแต่ละผื่น เช่น group, zosteriform, linear, scatter, isolate <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.4  Site <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ตำแหน่งของร่างกายทั้งหมดที่พบผื่น เช่น sun exposure, symmetry, periarticular, acral part, palms and soles <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ลักษณะเฉพาะของแต่ละผื่น (Three major characterisitics) <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ได้แก่ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2.1  <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">สี อะไร สม่ำเสมอหรือไม่ กดแล้วจางหรือไม่ (diascopy test) <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2.2  <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ความนุ่มแข็งของผื่น (consistency); firm, hard, tender <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2.3  <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ผื่นอยู่ในส่วนใดของผิวหนัง (anatomical component) <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">เช่น อยู่เฉพาะหนังกำพร้า หนังแท้ หรือก้อนใต้ผิวหนัง อยู่ตามตำแหน่งของรูขุมขนหรือไม่ Terminology type of skin lesion ( <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">นิยามชนิดผื่นผิวหนัง ) <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. **Macule** – a circumscribed flat area of the skin different in color or texture from its surrounding tissue. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. **Papule** – asmall solid elevation of the skin, less than 0.5 cm in diameter. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. **Plaque** – an elevated area of skin 2 cm or more in diameter. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. **Wheal** – an evanescent area produced by dermal edema. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. **Nodule** – a solid mass of the skin which can be observed as an elevation or can be palpated. Usually 0.5 cm in diameter or more. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 6. **Vesicle** – a circumscribed elevation of skin less than 0.5 cm in diameter containing fluid. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 7. **Bulla** – acircumscribed elevation of skin over 0.5 cm in diameter containing fluid. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 8. **Pustule** – a visible accumulation of pus in skin. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 9. **Cyst** – any closed cavity or sac containing fluid or semisolid material. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 10. **Lichenification** – thickening of the epidermis with exaggeration of its normal marking. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 11. **Scale** – a flat plate or flake of stratum corneum. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 12. **Crust** – an outer layer from the drying of exudates. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 13. **Erosion** – a loss of the epidermais which heal without scarring. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 14. **Ulcer** – a defect or loss of dermis and epidermis.

<span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">แนวทางการวินิจฉัยในที่นี้แยกเป็นสองส่วน ส่วนแรกแบ่งตามลักษณะของผื่นที่สอดคล้องกับอาการของโรค ส่วนที่สองแบ่งตามสาเหตุ สาเหตุ ของผื่นร่วมกับอาการปวดข้อ / <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ข้ออักเสบ แบ่งตามสาเหตุการเกิดโรคดังนี้ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. Systemic connective tissue disease <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. Vasculitides <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. Infectious disease <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. Metabolic, endocrine, and hematologic disease <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. Heroidtary, congenital and inborn errors of metabolism <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 6. Inflammatory skin disorders and seronegative spondyloarthropathy <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 7. Miscellaneous Type of skin lesion and arthritis <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">แบ่งตามลักษณะของผื่นและตำแหน่งที่สอดคล้องกับอาการของโรค <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ร่วมกับลักษณะพิเศษ __** T1. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">โรคปวดข้อที่พบร่วมกับผื่นชนิด macule/papule **__ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. Viral infection(rubella,HIV, HBV,HCV,EBV,CMV) Skin : disseminated maculapapule/central distributed; face, trunk spread to extremities Joint : acute non-erosive symmetry polyarthralgia arthritis Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. Rheumatic fever Skin : erythema marginatum/trunk, subcutaneous nodule/elbow Joint : acute, migratory poly arthritis Special : Large joints, non-destructive; carditis <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. Secondary syphilis Skin : Erythematous macules or scaling macules,papules/trunk, palm, sole Joint : Polyarthralgia/arthritis Special : Confirmed by serology <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. Bacteria septicemia(non-GC) Skin : Petichae, purpura, pustule, hemorrhagic vesicles, nodules/trunk and extremities Joint : Septic arthritis ; acute mono or oligo-arthritis Special :Host impaired immune; young children, elderly <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. Dissiminated gonococcal infection (DGI) Skin : Few papules, hemorrhagic vesicles/over peripheral joint Joint : Migratory polyarthritis Special : Young healthy adult <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 6. Lyme disease Skin : Erythema chronicum migrans; site of tick bite early phase; satellite lesions/trunk in 2nd or 3rd stage. Joint : Transient arthralgia, bursitis in 2nd stage; chronic persistent in 3rd stage Special : Cardiac and nervous system involvement; serologic diagnosis <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 7. Adult onset Still’s disease Skin : Transient salmon-color maculopapule/trunk, proximal extremities Joint : Similar to rheumatoid arthritis Special : Rash elicite with fever, quotidian or diquotidian fever <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 8. Lupus erythematosus (systemic) Skin : Malar erythematous papules, scaling papule, plaque/ sun expose area; Discoid rash/ face, pinna Joint : Non-erosive arthritis involve 2 or more peripheral joint. Additive pattern Special : - <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 9. Dermatomyositis Skin : Gottrons’s papules, Gottrons’ signs, heliotrope, periungual telangiectasia, violaceous macule/ hands, arms neck, shoulder Joint : Chronic polyarthritis, symmetry Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 10. Symmetric sclerosis(scleroderma) Skin : Thick. Tight, hyper-pigmented skin/trunk, arms, legs, mask face, sclerodactyly Joint : Chronic polyarthritis, symmetry Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 11. Serum sickness Skin : urticaria, urticarial casculitis, angioedema, palpable purpura/ trunk, extremities Joint : Intermittent polyarthralgia Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 12. Kawasaki disease Skin : Dissiminated morbiliform rash/trunk, extremities, edema of hands and feet; desquamation later Joint : Acute, short-lived polyarthritis of small joint of hands and feet Special : Strawnery tongue. Children under 8 yr.

__** T2. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">โรคปวดข้อที่พบร่วมกับผื่นชนิด papule/nodule **__ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. Rheumatic fever, SLE, Scleroderma <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดูหน้าที่ผ่านมา <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. Rheumatoid arthritis Skin : Subcutaneous nodule/extensor of forarm, olecranon, bursa, over joint, pressure area Joint : Additive/intermittent symmetric polyarthritis; small joints of hands and wrists. Special : Plamar erythema, vasculitis <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. Gout Skin : Chalky content tophi/ subcutaneous, synovial or subchrondral bone Joint : First metatarsophalangeal joint of the great toe. Special : Trigger by alcohol, diet excess in purine, exercise, trauma <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. Erythema nodosum Skin : Erythematous tender nodule/pretibial area Joint : Depend on associated disease Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. Bechçet’disease Skin : Recurrent apthous, erythema nodosum, aceiform lesion, palpable purpura, pyoderma gangreosum Joint : Seronegative non-erosive loigoarthritis Special : Dx by International study group criteria <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 6. Amyloidosis Skin : Waxy papule, nodule, plaque, petichae, purpura, ecchymosis/eyelids, post auricular, neck, trunk, extremities Joint : Non-inflammatory arthropathy mimic rheumatoid arthritis Special : Secondary amyloidosis common in late RA, JRA, Ankylosing spondylitis <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 7. Weber-Christian disease Skin : Cluster of subcutaneous nodule 1-2 cm with erythema, tenderness/trunk,extremities Joint : Polyarthralgia/arthritis Special : Exacerbation of rash not paralal to arthritis <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 8. Multicentric reticulohistiocytosis Skin : Reddish-brown nontender hemispherical papule, nodule/ face, paranasal, ear, neck, arm, periungium Joint : Symmetric polyarthritis; severe destructive arthropathy Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 9. Dyslipidemia Skin : Xanthoma/tendon, around joint Joint : Intermittent mono/oligoarthritis Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 10. Disseminated fungal and mycobacterial infection Skin : Papule, nodule, abscess, ulcer/truck, extremities Joint : Reactive of septic arthritis Special : Microorganism demonstrated from skin lesion of blood <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 11. Sarcoidosis Skin : Small asymptopmatic subcutaneous nodule/ trunk, extremities; erythema nodosum Joint : Acute/chronic polyarthritis rheumatoid like Special :-

<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. Sarcoidosis <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">หน้าที่ผ่านมา <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. Sweet’s syndrome Skin : Pronounced edematous red papules, plaques/face, neck, arms, back Joint : Paraneoplastic arthritis; polyarthrits Special : Diagnosis by skin biopsy, fever and neutrophilia <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. Endocrinopathy; Diabetes mellitus Skin : Scleroderma adultorum, shin spot, necrobiosis lipodica diabeticulum, acanthosis nigricans Joint : Neuropathic joint, joint stiffness Special : - <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. Hyperthyroidism Skin : Pretibia myxedema, onycholysis, plummer’s nails, hyperhidrosis Joint : Neuropathic joint, joint stiffiness Special : - <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. Hypothyroidism Skin : Myxedema, onycholysis Joint : Neuropathic joint, joint stiffiness Special :- <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 6. Relapsing polychrondritis Skin : Tender edematous erythematous papule, plaque/pinna, nose Joint : Non erosive inflammatory polyarthritis Special : Destruction of pinna and saddle nose <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 7. Psoriasis Skin : Sharp, well circumscribe erhthematous plaque with silvery acaly/acalp, elbows, knees, trunk Joint : 5 subtype: asymmetric oligo arthritis, predominant DIP, arthritis multilan, polyarthritis rheumatoid like, axial involvement Special : Auspitz sign positive, Koebner phenomenon, nails: pitted, yellow macule, subungual hyperkeratosis <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 8. Reiter’s syndrome Skin : Keratodermia blennorrhagicum/hands, feet, circinate balanitis Joint : Acute oligoarthritis, enthesopathy Special : Triad : urethritis, conjunctivitis, arthritis <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 9. Syphysis <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดู T1
 * __ T3. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">โรคปวดข้อที่พบร่วมกับผื่นชนิด plaque/papulosquamous lesion __**

<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. Dermatitis herpetiformia Skin : Group of vesicles on erythematous skin/ face, trunk Joint : Symmetric polyarthritis involve large joint Special : Associate with gluten sensitive enteropathy <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. Bacteria septicemia, gonococcal, non-gonococcal <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดู T1 <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. Vasculitides(common in small vessel vasculitides) Skin : Begin as erythematous papules, palpable purpura turn to vasicles/lower extremities, hands, arms, few at trunk Joint : Arthralgia more common than arthritis Special : Must be confirmed by histopathology; search for underlying disease and systemic involvement <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. Pustular psoriasis Skin : Disseminated, small superficial sterile pustule on erythematous plaques Joint : <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดู T2 Special : Before remission skin rash turn to plaque type <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. Sweet’s syndrome Skin : Small pustule on top plaque Joint &Special : <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดู T2 <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 6. Secondary syphilis Skin : Hyperkeratotic papule or plaque with pustule on top/trunk, palms, soles. Joint &Special : <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดู T2 <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 7. Reiter’s syndrome Skin : Early lesion of keratodermia blennorrhagicum/palms, soles Joint &Special : <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดู T2 <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 8. Behçet’s disease Skin : Follicular lesions as acneiform lesion/ face, back;traumatic site as pathergy Joint &Special : <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดู T1 <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">**__สรุป__ การวินิจฉัยที่สำคัญในแต่ละโรค** สาเหตุ ของผื่นร่วมกับอาการปวดข้อ / <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ข้ออักเสบ แบ่งตามสาเหตุการเกิดโรคดังนี้ <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1. **Systemic connective tissue disease** <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.2  Rheumatoid arthritis <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ดูตาม criteria <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.3  Adult-onset Still’s disease <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.4  Antiphospholipid syndrome <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.5  SLE <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">มี skin lesion <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ชัด <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.6  Scleroderma <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">มี skin lesion <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ชัด <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.7  Dermatomyositis <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">มี skin lesion <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ชัด <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 1.8  Relapsing polyarthritis <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">มี skin lesion <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ชัด <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 2. **Vasculitides** <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 3. **Infectious disease** 3.1 bacterial infection 3.1.1 Leprosy 3.1.2 Lyme disease 3.1.3 Rheumatic fever : John criteria 3.2 Virus infection 3.3 Fungal infection <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 4. ** Metabolic, endocrine, and hematologic disease: gout, hypo-,hyperthyroidism etc ** <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 5. **Heroidtary, congenital and inborn errors of metabolism** <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 6. **Inflammatory skin disorders and seronegative spondyloarthropathy** 6.1 Psorisis <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">มี skin lesion <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ชัด 6.2 Reiter’s syndrome <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ตาอักเสบ UTI <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ปวดข้อ 6.3 Behçet’s disease <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">แผลร้อนในที่ปากและอวัยวะเพศ ร่วมกับอาการทางตา 6.4 Plamoplantar pustulosis, hydradinitis suppurativa etc. <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; msobidifontfamily: Calibri; msobidithemefont: minor-latin; msolist: Ignore;"> 7. **Miscellaneous** 7.1 Erythema nodosum <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">ผื่นนูนแดงหน้าแข้งชัดเจน 7.2 Weber-Christian disease 7.3 Sweet’s syndrome(acute febrile neutrophilia dermatosis) 7.4 Serum sickness 7.5 Amyloidosis 7.6 Sarcoidosis 7.7 Multicentric reticulohistiocytosis 7.8 Pyoderma gangrenosum <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">
 * __ T4. <span style="font-family: 'Cordia New','sans-serif'; font-size: 14pt; line-height: 115%; mso-ansi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: 'Cordia New'; mso-bidi-theme-font: minor-bidi; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin;">โรคปวดข้อที่พบร่วมกับผื่นชนิด vesicle/bullae; pustule __**