The document provides an in-depth overview of rheumatic diseases, including classifications, types, and important clinical history-taking aspects. It details various conditions such as rheumatoid arthritis, osteoarthritis, and lupus, along with the significance of personal history, symptoms, and examinations in diagnosing these diseases. The comprehensive approach emphasizes the necessity for early intervention and tailored care for patients with rheumatological conditions.

1. Dr. Marwa Hany

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. • What is a rheumatic disease ?
• What is the classification ?
• What are the different types ?

4. A Rheumatic Disease is …..
a disease of the Musculoskeletal System

5. Classification
Inflammatory Diseases
Mechanical/ Degenerative Diseases

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. Joint Nomencalture

8. • Personal History
• Complaint
• Present History
• Gynacologic & Obstetric
• Past History
• Family History

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.  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.  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.  Marital status & Offspings: for selection of different
drugs since that some drugs affect ovarian & testicular
function like cyclophosphamide

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. Complaint
Write it in patient’s own words
 Pain
 Pain & swelling
 Limitation of movement
 Deformity

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.  Onset:
Acute onset may occur in traumatic, inflammatory &
infectious arthropathies.
Gradual onset may occur in some inflammatory &
degenerative conditions like RA and OA

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.  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.  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.  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.  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.  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. 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.  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. Extra-articular features:
 Fever, weight loss, myalgias,
arthralgias: may occur with
inflammatory arthropathies like
SLE, infectious arthropathies,
and in vasculitis

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. 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.  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.  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. 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. 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.  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. 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. • General Examination
• Local Examination

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. Regions:
 Head: hair ( alopecia), face ( cushiongoid, malar rash),
eyebrows ( lost outer third), mouth ( oral ulcers, limited
mouth aperture), nose ( nasal ulcers), eye (red)

37.  Neck: lymphadenopathy, thyroid swelling
 Upper limb: pallor, cyanosis, erythema, tremors, rash
 Lower limb: oedema, cyanosis/gangrene, leg ulcers

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