This document discusses the physical examination of rheumatoid arthritis. It notes that rheumatoid arthritis causes persistent symmetric polyarthritis of the hands and feet as well as extra-articular involvement and difficulty performing daily activities. The physical examination should assess the upper and lower extremities for stiffness, tenderness, pain on motion, swelling, deformity, and limited range of motion. Laboratory tests like rheumatoid factor, antinuclear antibody, HLA tissue typing, and erythrocyte sedimentation rate can help confirm a diagnosis of rheumatoid arthritis or related conditions.

1. 1
Physical Examination of
Rheumatoid ArthritisPROBLEM BASED LEARNING (PBL)
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

2. Signs & Symptoms
• In most patients with RA, onset is insidious,
often beginning with
– fever,
– malaise
– arthralgias
– Weakness
• before progressing to
– joint inflammation and swelling

3. • Signs and symptoms of rheumatoid arthritis may
include the following:
– Persistent symmetric polyarthritis (synovitis) of hands
and feet (hallmark feature)
– Progressive articular deterioration
– Extra-articular involvement
– Difficulty performing activities of daily living (ADLs)
– Constitutional symptoms

4. • Physical examination should address the
following:
– Upper extremities (metacarpophalangeal joints,
wrists, elbows, shoulders)
– Lower extremities (ankles, feet, knees, hips)
– Cervical spine

5. • During the physical examination, it is important
to assess the following:
– Stiffness
– Tenderness
– Pain on motion
– Swelling
– Deformity
– Limitation of motion
– Extra-articular manifestations
– Rheumatoid nodules

6. LAB INVESTIGATIONS

7. Antinuclear antibody (ANA)
• Commonly found in the blood of people who
are having auto immune disease. This test can
be used to confirm the diagnosis of arthritis.

8. Rheumatoid factor (RF)
• detect and measure the level of an antibody,
positive in people with rheumatoid arthritis.

9. HLA tissue typing
• detects the presence of certain genetic
markers in the blood, can confirm a diagnosis
of ankylosing spondylitis (a disease involving
inflammation of the spine and sacroiliac joint)
or Reiter’s syndrome (a disease involving
inflammation of the urethra, eyes and joints).
The genetic marker HLA-B27 is almost always
present in people with either of these
diseases.

10. Erythrocyte sedimentation rate
• this test measures how fast red blood cells
cling together, fall and settle (like sediment) in
the bottom of a glass tube over an hour. The
higher the rate, the greater the amount of
inflammation.