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HLA-B27 is frequent in this population with all of its associations (reiters syndrome, Rheumatoid arthritis, and spondylarthopathies are much more common here. We have a rheumatologist who comes 2x a year and he is always available by phone. We manage much Methotrexate out here with the common rheumatic arthritis. Remember the labs that need to be done Q 1-2 months – kidney, liver, and blood count – CBC and Comp Chem.