All residents will participate in rheumatology outpatient activities appropriately supervised by dedicated attending faculty members. The goals of this experience will be for the residents to gain expertise in the outpatient evaluation and management of digestive problems. The experience provides an opportunity to develop an understanding for the natural history of these conditions over an extended period of time.

In this 14th edition, the MKSAP delivers another comprehensive review of internal medicine and its subspecialties. Eleven separate booklets cover the topics of internal medicine foundations, cardiovascular medicine, gastroenterology and hepatology, rheumatology, neurology, hematology and oncology, infectious disease, pulmonary and critical care medicine, general internal medicine, endocrinology and metabolism, and nephrology.


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For physicians outside of the subspecialties of hematology, oncology, and rheumatology, those sections are the most laborious. The generalist is not likely to see many of the uncommon conditions that are detailed, and discussions of treatment options go beyond the interest of anyone outside of those fields.

There are many different models of rheumatology practice. Rheumatologists may have their own practice, seeing patients in consultation for other physicians and longitudinally for management of their rheumatic disease. Rheumatologists also frequently serve as hospital consultants for patients admitted with rheumatological disorders. Some rheumatologists maintain practices seeing a mix of patients with rheumatological issues and those with general medical problems. In academic settings, rheumatologists provide consultative and ongoing care in ambulatory and inpatient settings, perform basic science and clinical research in rheumatological diseases, and teach medical students and residents.

Fellowship training in rheumatology is two years following completion of a three year basic internal medicine residency. Following completion of a rheumatology fellowship, board certification is available through the American Board of Internal Medicine.

Dual certification in both rheumatology and allergy and immunology is also available and requires a minimum of three years of training beyond the three year basic internal medicine residency. Completion of this combined fellowship allows for board certification in both rheumatology and allergy and immunology.

In these pages, you will flnd updated information on approaches to the patient with rheumatologic disease, principles oftherapeutics, rheumatoid arthritis, osteoarthritis, spondyloarthritis, systemic lupus erythematosus, systemic sclerosis,infectious arthritis, and other clinical challenges. A11 ofthese topics are uniquely focused on the needs ofgeneralists andsubspecialists outside of rheumatologz.MKSAP 19 strives to provide the clinical knowledge its learners need to navigate their longitudinal learning paths. MKSAP 19'score content contains essential, newly researched information in 11 subspecialty areas of internal medicine-created bydozens of expert generalists and subspecialists. Development of MKSAP 19's syllabus and its 1200 all new peer-reviewed,psychometrically validated multiple-choice questions (MCQs) has been informed by ABIM Certification and Maintenanceof Certification (MOC) requirements, emerging internal medicine knowledge, and our learners' feedback. MKSAP 19 contin-ues to include HighValue Core (HVC) recommendations and MCQs, based on the concept of balancing clinical benefit with costs and harms. Hospital-based internists can continue to trust that MKSAP's comprehensive hospitalist content, integratedthroughout the syllabus, and hospitalist focused MCQs, specially designated with the blue hospitalist icon (El), continue to align with the ABIM's Focused Practice in Hospital Medicine MOC exam blueprint and enhance learning for hospital-based practitioners. More than ever before, MKSAP 19 Digital focuses on individualized learning and convenience. In addition to custom quizzes and interlinked questions and sy'labus sections, MKSAP 19 Digital's new learning dashboard enables users to create a self directed learning plan, with topic-specific links to resources within MKSAP and ACP Online. Multimedia formats, including whiteboard animations and clinical videos, will benefit our audiovisual learners, while MKSAP's Earn as You Go CME/MOC feature now allows subscribers to earn CME/MOC as they answer individual questions. In addition to Extension Questions and New Info Updates, MKSAP 19 Complete and Complete Green continue to offer Virtual Dx and Flashcards and now offer brand new enhancements: MKSAP Quick Qs, a set of concise questions mapped to high-frequency/high-importance areas of the ABIM blueprint mirroring boards-style MCQs, and an embedded digital version of Board Basics for easy access exam prep. Language can be imprecise and imperfect, but MKSAP 19's Editors and contributors commit to using language and images that support ACP's commitment to being an anti-racist organization that supports diversity, equity, and inclusion through- out health care and health education. ACP also continues to ensure diversity among MKSAP's physician-contributors. When appropriate, the MKSAP Editors also rely on MKSAP 19 Digital's expanded use of multimedia enhancements, including video and audio, to explore and more fully explain issues surrounding the presentation of MKSAP 19 clinical content as it relates to race and ethnicity. MKSAP 19 users are encouraged to contact the Editors at mksap_editors6acponline to help us identifiz opportunities for improvement in this area. On behalf of the many internists and editorial staff who have helped us create our new edition, we are honored that you have chosen to use MKSAP 19 to meet your lifelong learning needs. Sincerely, Davoren Chick, MD, FACP Editor-in-Chief Senior Vice President Medical Educat ion DivisionAmerican College of Physicians

i Developer/Architect), and John McKnight (Senior WebDeveloper).The College also wishes to acknowledge that many otherpersons, too numerous to mention, have contributed tothe production of this program. Without their dedicatedefforts, this program would not have been possible.MKSAP Resource PageThe MKSAP Resource Page (wwwacponline/mksap19-resources) provides access to MKSAP 19 online answersheets for transcribing answers from the print eclition;access to MKSAP 19 Digital; Board Basics '; informationon Continuing Medical Education (CME), Maintenanceof Certification (MOC), and international ContinuingProfessional Development (CPD) and MOC; errata; andother new information.lnternational MOC/CPDInformation and instructions on submission ol international MOC/CPD is available by accessing the CME/MOC/CPD tab on the left navigation menu of MKSAP 19Digital.Continuing Medical EducationThe American College of Physicians is accredited by theAccreditation Council for Continuing Medical Education(ACCME) to provide continuing medical education forphysicians.The American College of Physicians designates this enduringmaterial, MKSAP 19, for a maximum of 300 AMA PRACategory 1 CreditsrM. Physicians should claim only thecredit commensurate with the extent of their participationin the activity.Up to 24 AMA PRA Category 1 Creditdtu are available fromJanuary 31,2022, to January 31, 2025, for the MKSAP lRheumatology section.Learning ObjectivesThe learning objectives of MKSAP 19 are to:. Close gaps between actual care in your practice andpreferred standards of care, based on best evidence. Diagnose disease states that are less common and sometimesoverlooked or confusing. Improve clinical management decisions that affect patientsafety and quality of careo Determine when to ref'er patients for care by medicalsubspecialists, surgeons, and other members olthe healthcare teamr Pass the ABIM Certification Examinationr Pass the ABIM Maintenance of Certification ExaminationTarget Audienceo General internal medicine specialists, including primarycare physicians and hospitalistso Internal medicine subspecialists who desire to remain upto date in internal medicine. Residents preparing for the ABIM Internal MedicineCertifi cat ion Examination. Physicians engaged in the ABIM Maintenance ofCertification Longitudinal Assessment Option, pre-paring for the ABIM Internal Medicine Maintenance olCertitlcation Examination, or engaged with the ABIMFocused Practice in Hospital Medicine programEarn CME Credits or MOC Points OnlineTo earn CME credits or to apply for MOC points, MKSAPusers need to answer at least one of two questions cor-rectly (earning a score of at least 50%) and click the SubmitCME button. Each single MKSAP 19 self-assessment ques-tion qualifies for one quarter of a CME credit hour or ABIMMOC point.MKSAP 19 Subscribers can enter their self assessmentquestion answers and submit for CME/MOC in twoways:

The primary purpose of MKSAP 19 is educational. Information presented, as well as publications, technol-ogies, products, and/or services discussed, is intended to inform subscribers about the knowledge, techniques, andexperiences of the contributors. A diversity of professionalopinion exists, and the views of the contributors are theirown and not those of the ACP. Inclusion of any material in the program does not constitute endorsement or recommendation by the ACP. The ACP does not warrant the safety, reliability, accuracy, completeness, or usefulness of and disclaims any and all liability for damages and claims that may result from the use of information, publications, technologies, products, and/or services discussed in this program. Publisher's Information Copyright ,: 2022 American College of Physicians. A rights reserved. This publication is protected by copyright. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, elec- tronic or mechanical, including photocopy, without the express consent of the ACP. MKSAP 19 is for individual use only. Only one account per subscription will be per- mitted for the purpose of earning CME credits and MOC points and for other authorized uses of MKSAP 19. Disclaimer Regarding Direct Purchases from Online Retailers CME and/or MOC for MKSAP 19 is available only to cus- tomers who purchase the program directly from ACP. ACP will not set up MKSAP CME/MOC accounts for purchasers of MKSAP sold by unauthorized sellers (e., Amazon, eBay), with whom ACP has no relationship. We do not honor third party sales. CME credits and MOC points can not be awarded to those purchasers who have purchased the program from non authorized sellers. Unauthorized Use of This Book ls Against the Law Unauthorized reproduction of this publication is unlaw ful. ACP prohibits reproduction of this publication or any of its parts in any form either for individual use or for distribution. ACP will consider granting an individual permission to reproduce only limited portions of this publication for his or her own exclusive use. Send requests in writing to MKSAP" Permissions, American College of Physicians, 190 N Independence Mall West, Philadelphia, PA 19106-1572, or email your request to mksap editorspacponline. MKSAP 19ISBN: 978 1-938245-7s 6 Rheumatology ISBN: 978 I-938245 87 9 Printed in the United States of America. For order information in the U. or Canada, call 800-ACP-1915. In all other countries, call 215-351- (Monday to Friday, 9-5 plr ET). Fax inquiries to 215-351 2799 or email to custserv@acponline. Errata and Revisions Errata and Revisions for MKSAP 19 will be available through MKSAP 19 Digital at mksaplg.acponline as new information becomes known to the editors. vll e24fc04721

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