RA

• Swollen, red, warm joints esp MCP, PIP, wrist, elbow, knee, ankle, MTP joints
• Sparing of DIPs
• Tenosynovitis
• Bursitis – elbow, trochantric
• Fatigue
• Morning stiffness > 1hr lasting > 6 weeks
• Affects joints symmetrically
• Feeling unwell
• Weight loss
• Myalgia
• Joint pain
• ESR
• CRP
• Hb
• Rh factor can be negative; anti CCP antibody more specific for RA
• Rheumatoid nodules (rare these days – sign of poor control)
• Radiographic changes – erosions especially wrists, hands, feet

SLE

• Aches and pains in joints
• Fever
• Fatigue
• Skin rashes (malar, discoid)
• Think of SLE if ESR ? but CRP normal
• Low WCC
• Can cause inflammation of linings of heart and lungs
• Oral ulcers
• Photosensitivity
• Renal disorders
• CNS disorders (seizures or psychosis)
• Haematological disorders (anaemia, leucopenia, lymphopenia)

Osteoporosis

• Often present with rheumatology disorders
• Low bone density scan
• Reduced standing height

Polymyalgia rheumatica

• Stiff muscles especially in morning
• If joints involved, it is usually shoulder, hip or wrist
• Symmetrical aching and stiffness in shoulders and proximal limb muscles > 1 month
• Mild polyarthritis
• ESR > 30 or CRP > 6
• Prompt and dramatic response to steroids
• Common in people over 70
• Tenosynovitis eg CTS
• Depression
• Fatigue
• Fever
• Weight loss
• Anorexia
• Possible headaches + loss of vision if temporal arteritis present

Sarcoidosis

• Rapid onset fever initially
• Joint pain – often ankles
• Erythema nodosum
• Tender swollen lymph glands especially in chest

Scleroderma

• Fatigue and weight loss
• Raynauds Syndrome
• Swelling of hands or feet – skin becomes shiny, usual skin creases disappear
• Stiffness of joints
• Ulceration of fingers can appear at late stages
• Inflamed joints leading to contractures
• Can affect connective tissue of internal organs causing heart burn, dysphagia and disturbance of bowel function
• HT if kidneys affected

Psoriatic arthritis

• Psoriasis
• Stiff and painful joints involving spine and DIP joints
• Asymmetrical oligoarthritis
• Symmetrical polyarthritis indistinguishable from RA
• Absence of juxta articular osteoporosis as in RA
• Ankylosis
• Stiff and painful back or neck
• Pitting and discolouration of nails
• Iritis
• RF present in 10%

Ankylosing spondylitis

• Pain and stiffness in lower back and other areas of spine
• Tightness in chest + limitation of expansion
• Enthesitis (TA, plantar fascia)
• Fibrosis and ossificationof ligament, tendon and capsular insertion into bone
• Synovitis especially in the hips and knees
• Fatigue
• Iritis
• Anaemia
• HLA B27 possibly positive
• MRI showing sacroiliitis
• Bamboo spine
• Asymmetrical joint pain
• Alternating buttock pain
• Limitation of lumbar spine movement
• Bilateral pulmonary fibrosis (upper lobe)

Sjogrens Syndrome

• Dry eyes
• Dry mouth
• Tired and achy
• Abnormal lower lip biopsy
• Raynauds Syndrome
• Positive shirmers test

Osteoarthritis

• Pain on movement
• Worse at end of day
• Constant background pain
• Joint instability
• Heberdens Nodes (DIP joints and first MCP joint)
• X-ray – loss of joint space, marginal osteophytes, subchondral sclerosis + cysts

Gout

• Swollen, red, extremely painful joints esp big toe but also ankles, knees, hands, wrists or elbows
• Attack lasts a few days
• Urate crystals in tissues and synovial fluid
• X-rays later show punched out lesions in juxta-articular bone

Pseudogout

• Similar to gout but affects different joints – mainly wrist, shoulder or knee

Reactive arthritis

• Often one or more large joints affected
• Enthesitis
• Iritis
• Keratoderms blenhorragica (brown aseptic abcesses on soles and palms)
• Mouth ulcers
• May follow dysentery, chlamidia urethritis, salmonella, helicobacter jejuni
• ESR and CRP
• Stool culture

Fibromyalgia

• Widespread pain in tendons, ligaments and muscles
• Fatigue
• Stiffness
• Sleep disturbance
• Extreme tenderness to pressure in specific areas
• Occasionally poor circulation, headache, irritability, loss of concentration, abdo pain, diarrhoea

Vasculitis

• Giant cell arteritis (temporal arteritis)
• Tender temporal artery
• Visual disturbance
• Headache
• Jaw pain
• Cerebrovascular insufficiency
• ESR > 30 mm/h or CRP > 6mg/ml
• Good response to steroids
• Abnormal artery biopsy

Juvenile idiopathic arthritis

• Always clinical diagnosis of exclusion
• Joint swelling rather than pain
• Some stiffness
• 2/3 present with single joint disease 1/3 with 2 joints
• Most common joints are knee, elbow, ankle
• A period of 2 – 5 years of active arthritis is common
• Uveitis is common
• Fatigue
• Can be systemic, polyarthritis, psoriatic arthritis or enthesitis related arthritis

This summary has been compiled by Barbara Hill, physiotherapist.

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