Rheumatology – Signs and Symptoms

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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