This month's Round Up includes a variety of topics but a highlight is a first in a series about knee joint injections by Dr Elspeth Wise and Dr Alan Walker on behalf of the Primary Care Rheumatology and Musculoskeletal Medicine Society – Annual Conference November 14th to 16th 2019. Other topics highlighted include "cyclist syndrome" – a keen cyclist presenting with perineal pain; sundowning – the sudden appearance of neuropsychiatric symptoms such as agitation, confusion and anxiety in a chronologic fashion, usually during late afternoon or early evening; and the ELF test