Rheumatology for the AMC exam
Inflammatory and degenerative joint disease, gout, connective tissue disease and vasculitis. Questions test the hot joint, early DMARDs and steroid emergencies like GCA.
High-yield points
Hot swollen joint: aspirate before antibiotics to exclude septic arthritis (send for Gram stain, culture and crystals).
Acute gout: NSAID, low-dose colchicine or prednisolone; start or continue allopurinol at a low dose and titrate to serum urate below 0.36 mmol/L.
Rheumatoid arthritis: refer early; methotrexate (with folic acid) is the first-line DMARD.
Polymyalgia rheumatica: bilateral shoulder/hip girdle pain and stiffness in over-50s with high ESR/CRP; dramatic response to prednisolone.
GCA: urgent high-dose steroids to prevent visual loss, then temporal artery biopsy or ultrasound.
SLE: ANA is sensitive, anti-dsDNA and anti-Smith are specific; hydroxychloroquine for most.
Back pain red flags: age over 50 with new pain, cancer history, fever, weight loss, night pain, saddle anaesthesia or bladder/bowel change.
Methotrexate is taken once weekly; daily dosing errors are fatal.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Diagnosis | Standard classification criteria for RA, SLE and gout. | Largely the same criteria and workup. |
| Biologic DMARDs | Access limited mainly by cost. | PBS authority only after documented failure of conventional DMARDs and disease activity scores; usually rheumatologist-initiated. |
| Gout targets | Urate target under 6 mg/dL. | Urate in mmol/L: target under 0.36 (under 0.30 with tophi). Start allopurinol low and titrate. |
| Osteoarthritis | Analgesics and NSAIDs are often the mainstay. | Exercise, weight loss and education first. Opioids are not recommended; arthroscopy is not for knee OA. |
Diagnosis
India (MBBS)
Standard classification criteria for RA, SLE and gout.
Australia (AMC): what the exam expects
Largely the same criteria and workup.
Biologic DMARDs
India (MBBS)
Access limited mainly by cost.
Australia (AMC): what the exam expects
PBS authority only after documented failure of conventional DMARDs and disease activity scores; usually rheumatologist-initiated.
Gout targets
India (MBBS)
Urate target under 6 mg/dL.
Australia (AMC): what the exam expects
Urate in mmol/L: target under 0.36 (under 0.30 with tophi). Start allopurinol low and titrate.
Osteoarthritis
India (MBBS)
Analgesics and NSAIDs are often the mainstay.
Australia (AMC): what the exam expects
Exercise, weight loss and education first. Opioids are not recommended; arthroscopy is not for knee OA.
The Australian context
Biologic DMARDs are PBS-subsidised only under authority criteria (documented failure of conventional DMARDs and disease activity measures), usually initiated by a rheumatologist. Uric acid is reported in mmol/L in Australia.