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let me say one more so in regard to diagnosis which is I think what we're speaking about one important thing for our internal medicine colleagues is the exclusion of other diagnoses that are important so what what are the confusing or confounder confounding diagnoses around austerity so we need to rule out rheumatoid arthritis and the inflammatory are through these and that can be done with lab tests right which lab tests um a simple sed rate will help diagnose these do those those rheumatoid factor there are a number of other markers for inflation they're still doing sed rate they are and gout I think is another thing needs to be ruled out if they have recurrent of fusions and sepsis needs to be ruled out if there are any an infected joint yeah I think that's a better emergency so you know that can't wait six weeks right so okay so so I think Peter it's important to put this in context you know it's it's quite unusual for multi j

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