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Dr. Marwa Hany
• To understand what are rheumatic diseases & what 
are the different types 
• To be able to take detailed history from a ...
• What is a rheumatic disease ? 
• What is the classification ? 
• What are the different types ?
A Rheumatic Disease is ….. 
a disease of the Musculoskeletal System
Classification 
Inflammatory Diseases 
Mechanical/ Degenerative Diseases
Rheumatic diseases 
Rheumatoid Arthritis & 
its varients: 
Sjogren’s disease, 
Felty disease, 
Palindromic Rheumatism 
Con...
Joint Nomencalture
• Personal History 
• Complaint 
• Present History 
• Gynacologic & Obstetric 
• Past History 
• Family History
Personal History 
 Name: 
to be familiar with the patient 
 Sex: 
SLE 
RA 
AS 
SLE & RA are more common in females, whil...
 Age: 
SLE is common in childbearing period, 
osteoporosis is common after menopause, 
osteoarthritis is more common abov...
 Occupation: 
Disc prolapse is common in labourers, surgeons & drivers, 
Scleroderma is common in workers in silica indus...
 Marital status & Offspings: for selection of different 
drugs since that some drugs affect ovarian & testicular 
functio...
 Special habits: 
In disc prolapse smoking worsens disc perfusion & also 
coughing associated with smoking increases the ...
Complaint 
Write it in patient’s own words 
 Pain 
 Pain & swelling 
 Limitation of movement 
 Deformity
Present History 
Analysis of the patient’s complaint: 
• Onset, Course, Duration 
• Number of joints affected 
• Distribut...
 Onset: 
Acute onset may occur in traumatic, inflammatory & 
infectious arthropathies. 
Gradual onset may occur in some i...
 Course: 
Progressive/additive course: symptoms occur in some joints 
and persists with subsequent involvement of other j...
 Number of joints affected: 
Monoarticular affection involvement of 
one joint as in traumatic, septic & crystal 
arthrop...
 Distribution of joint affection: 
Small joints of the hands & feet are 
commonly involved in RA 
Large weight bearing jo...
 Symptoms increase or decrease by: 
Inflammatory conditions symptoms are increased by 
rest & relieved by movement, while...
 Erythema & warmth: its site and its relation to joint 
(erythema & warmth are more marked in septic 
arthritis, and in c...
 Morning stiffness : inability to move joints through 
available range of motion marked in the early 
morning improving w...
Comment as follows: 
Condition started….. onset, course, duration, 
site & radiation, character, increases by, decreases b...
 Arthralgia is defined as pain without 
other signs of inflammation 
 Arthritis is defined as inflammation 
of the joint...
Extra-articular features: 
 Fever, weight loss, myalgias, 
arthralgias: may occur with 
inflammatory arthropathies like 
...
 Photosensitivity, falling of hair, oral ulcers, skin 
rash: as in SLE 
 Subcutaneous nodules, dryness of eye & mouth, 
...
Systemic review: 
 Symptoms suggestive of cardiac affection; chest pain, 
exertional dysnea, palpitation( valvular diseas...
 Symptoms suggestive of urologic affection; dysuria, 
heamaturia, loin pain ( Glomerulonephritis in SLE & 
vasculitis) 
...
 Symptoms suggestive of GIT affection; nausea, 
vomiting, diarhea, abdominal pain, melena, 
constipation ( inflammatory b...
Gynecological &Obstetric History 
 RA tends to go into remission in pregnancy, while SLE 
flares in pregnancy 
 Fetal lo...
Past History 
 Trauma: may precede disc prolapse, traumatic arthritis, 
ligament sprains 
 Diabetes mellitus: increased ...
 Endocrinal disorders; hyper/hypothyroidism, 
hypo/hyperparathyroidism, acromegally and cushing all 
are associated with ...
Family History 
 Similar conditions: increased risk of development 
of RA & SLE & JIA in first degree relatives 
 Relate...
• General Examination 
• Local Examination
General Examination 
 Patient appears mildly/moderately or severely ill, lying 
comfortable in bed, cooperative/un, of av...
Regions: 
 Head: hair ( alopecia), face ( cushiongoid, malar rash), 
eyebrows ( lost outer third), mouth ( oral ulcers, l...
 Neck: lymphadenopathy, thyroid swelling 
 Upper limb: pallor, cyanosis, erythema, tremors, rash 
 Lower limb: oedema, ...
Local Examination 
 Inspection : swelling, muscle wasting, deformity, skin 
changes (rash, scars) 
 Palpation: tendernes...
Rheumatology Sheet
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Rheumatology Sheet

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Rheumatology Sheet from Rheumatology Department, Faculty of Medicine, Zagazig University, Egypt.

Disclaimer : not my slide. Just uploading for my personal use..

Published in: Health & Medicine

Rheumatology Sheet

  1. 1. Dr. Marwa Hany
  2. 2. • To understand what are rheumatic diseases & what are the different types • To be able to take detailed history from a patient with rheumatological disease • To be able to interpret collected information in the sheet • To understand the importance of early and appropriate care of patients with rheumatic diseases
  3. 3. • What is a rheumatic disease ? • What is the classification ? • What are the different types ?
  4. 4. A Rheumatic Disease is ….. a disease of the Musculoskeletal System
  5. 5. Classification Inflammatory Diseases Mechanical/ Degenerative Diseases
  6. 6. Rheumatic diseases Rheumatoid Arthritis & its varients: Sjogren’s disease, Felty disease, Palindromic Rheumatism Connective tissue diseases SLE Scleroderma Polymyositis Dermatomyositis Mechanical /Degenerative Osteoarthritis Disc prolapse Spondylolisthesis Others: Crystal induced (Gout) Endocrine associated Blood disorders associated Malignancy associated Seronegative Arthropathies Ankylosing Spondylitis Psoriatic arthropathy Reactive arthritis (Reiter) IBD associated arthropathies
  7. 7. Joint Nomencalture
  8. 8. • Personal History • Complaint • Present History • Gynacologic & Obstetric • Past History • Family History
  9. 9. Personal History  Name: to be familiar with the patient  Sex: SLE RA AS SLE & RA are more common in females, while Ankylosing spondylitis is more common in males
  10. 10.  Age: SLE is common in childbearing period, osteoporosis is common after menopause, osteoarthritis is more common above 50 yrs, RA is common between 40-60 yrs
  11. 11.  Occupation: Disc prolapse is common in labourers, surgeons & drivers, Scleroderma is common in workers in silica industries, Raynaud’ s phenomena is common with use of vibrating tools
  12. 12.  Marital status & Offspings: for selection of different drugs since that some drugs affect ovarian & testicular function like cyclophosphamide
  13. 13.  Special habits: In disc prolapse smoking worsens disc perfusion & also coughing associated with smoking increases the symptoms, In RA smoking induces the production of rheumatoid factor & anti-CCP
  14. 14. Complaint Write it in patient’s own words  Pain  Pain & swelling  Limitation of movement  Deformity
  15. 15. Present History Analysis of the patient’s complaint: • Onset, Course, Duration • Number of joints affected • Distribution of joint involvement • Symptoms increase by & decrease by • Associated symptoms
  16. 16.  Onset: Acute onset may occur in traumatic, inflammatory & infectious arthropathies. Gradual onset may occur in some inflammatory & degenerative conditions like RA and OA
  17. 17.  Course: Progressive/additive course: symptoms occur in some joints and persists with subsequent involvement of other joints as in RA & SLE. Regressive course: symptoms are self limited as is viral arthritis . Intermittent course: repetitive attacks of arthritis with complete remission inbetween attacks as in gout Migratory course: symptoms occur in some joints for a few days then disappear to appear in other joints as in rheumatic fever
  18. 18.  Number of joints affected: Monoarticular affection involvement of one joint as in traumatic, septic & crystal arthropathies Oligoarticular affection involvement of 4 joints or less as in seronegative arthropathies Polyarticular affection involvement of more than 4 joints as in RA
  19. 19.  Distribution of joint affection: Small joints of the hands & feet are commonly involved in RA Large weight bearing joints like knees & hips are affected in OA Axial and large girdle joints like shoulders & hips are affected in AS
  20. 20.  Symptoms increase or decrease by: Inflammatory conditions symptoms are increased by rest & relieved by movement, while in Degenerative/ Mechanical conditions symptoms are increased by movement & relieved by rest
  21. 21.  Erythema & warmth: its site and its relation to joint (erythema & warmth are more marked in septic arthritis, and in crystal arthropathies but may occur with others)
  22. 22.  Morning stiffness : inability to move joints through available range of motion marked in the early morning improving with moving the joint ( morning stiffness > 1 hr occurs in RA, morning stiffness less than 30 min occurs in OA )  Inactivity stiffness : gelling of the joint after a small period of inactivity ( as in OA )
  23. 23. Comment as follows: Condition started….. onset, course, duration, site & radiation, character, increases by, decreases by, association with other symptoms ( swelling, limitation, warmth, erythema, morning/ inactivity stiffness)
  24. 24.  Arthralgia is defined as pain without other signs of inflammation  Arthritis is defined as inflammation of the joint where pain is also associated with other signs of inflammation like swelling, limitation of movement, warmth & erythema
  25. 25. Extra-articular features:  Fever, weight loss, myalgias, arthralgias: may occur with inflammatory arthropathies like SLE, infectious arthropathies, and in vasculitis
  26. 26.  Photosensitivity, falling of hair, oral ulcers, skin rash: as in SLE  Subcutaneous nodules, dryness of eye & mouth, lymphadenopathy: in RA patients and variants like Sjogren’s and Felty’s  Genital ulcers, heel pain, preceding dysuria or diarhea, scaly skin lesions, bowel complaint as in seronegative arthropathies
  27. 27. Systemic review:  Symptoms suggestive of cardiac affection; chest pain, exertional dysnea, palpitation( valvular disease may occur in rheumatic fever, RA, Ankylosing spondylitis, while pericardial effusions & pericarditis may occur in SLE )  Symptoms suggestive of pulmonary affection; dysnea, cough, sputum, chest pain, heamoptysis ( interstitial lung fibrosis occurs in scleroderma & methotrexate use in RA, apical lung fibrosis in AS, pleurisy& pleural effusion in SLE)
  28. 28.  Symptoms suggestive of urologic affection; dysuria, heamaturia, loin pain ( Glomerulonephritis in SLE & vasculitis)  Symptoms suggestive of neurologic affection; motor weakness, parasthesia, sensory loss, sphincteric disturbance ( as in disc prolapse), coma, convulsions, persisting headache not responding to analgesics, hemiparesis ( as in SLE)
  29. 29.  Symptoms suggestive of GIT affection; nausea, vomiting, diarhea, abdominal pain, melena, constipation ( inflammatory bowel associated arthropathies, pancreatitis in SLE, mesenteric vascular occlusion in vasculitis)
  30. 30. Gynecological &Obstetric History  RA tends to go into remission in pregnancy, while SLE flares in pregnancy  Fetal losses may occur in SLE pts with APA syndrome  Menstrual irregularities may be associated with drug intake like corticosteroids & cyclophosphamide  Some drugs used for rheumatic diseases are contraindicated in pregnant & lactating females
  31. 31. Past History  Trauma: may precede disc prolapse, traumatic arthritis, ligament sprains  Diabetes mellitus: increased incidence of carpal tunnel syndrome, shoulder periarthritis, limited mobility of hand joints  Hypertension: either primary or secondary due to steroid use, renal disease due to SLE 0r vasculitis  Drug intake: Drug- induced lupus, drug-drug interactions
  32. 32.  Endocrinal disorders; hyper/hypothyroidism, hypo/hyperparathyroidism, acromegally and cushing all are associated with many musculoskeletal conditions  Hematologic diseases; hemophilia may be associated with hemophilic arthropathy & muscle hematoma  Malignancies: metastasis to joints, paraneoplastic conditions
  33. 33. Family History  Similar conditions: increased risk of development of RA & SLE & JIA in first degree relatives  Related conditions: history of psoriases, inflammatory bowel disease, ankylosing spondylitis in relatives ( seronegative arthropathies)
  34. 34. • General Examination • Local Examination
  35. 35. General Examination  Patient appears mildly/moderately or severely ill, lying comfortable in bed, cooperative/un, of average body built/ overweight/ underweight  Vital signs: Blp, pulse, temp, resp rate
  36. 36. Regions:  Head: hair ( alopecia), face ( cushiongoid, malar rash), eyebrows ( lost outer third), mouth ( oral ulcers, limited mouth aperture), nose ( nasal ulcers), eye (red)
  37. 37.  Neck: lymphadenopathy, thyroid swelling  Upper limb: pallor, cyanosis, erythema, tremors, rash  Lower limb: oedema, cyanosis/gangrene, leg ulcers
  38. 38. Local Examination  Inspection : swelling, muscle wasting, deformity, skin changes (rash, scars)  Palpation: tenderness, temperature, crepitus, synovial thickening, confirm nature of swelling  ROM: Active, Passive  Special Tests: specific for each region

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