Rheumatology History Taking Flashcards
What are the 4 main rheumatological symptoms?
Pain, stiffness, fatigue and weakness
What questions do you ask regarding pain in rheumatology?
What type of pain?
When did the pain start? Is it worse at night/morning? Worse/better with rest? Worse on particular movements?
How bad is it? (scale of 0-10)
Where is the pain and does it radiate?
What is the patient’s social history, PMH, DH, etc?
What are the causes of acute mono-arthritis?
Infections - staph aureus, strep, etc (septic arthritis)
Crystal induced - gout, pseudogout
Trauma - Haemarthrosis
What are the causes of chronic mono-arthritis?
Infections - TB
Inflammatory - psoriatic arthritis, reactive arthritis, foreign body
Non-inflammatory - OA, meniscal tear (trauma), osteonecrosis, Charcot’s joint (neuropathic)
Tumour - rare
What are the causes of acute poly-arthritis?
Infection (viral) - HIV, Chikungunya, parvovirus
Inflammatory - RA, psoriatic arthritis, reactive arthritis
Autoimmune - SLE, vasculitis
Crystal - uncontrolled gout
What are there causes of chronic (more than 3 months) poly-arthritis?
Inflammatory - RA, psoriatic arthritis, reactive arthritis
Autoimmune - SLE, vasculitis
Crystal - uncontrolled gout
What are the causes of arthritis in the distal interphalangeal joints?
Psoriatic arthritis (plus nail dystrophy on affected digit)
OA - Heberden’s nodes
Regarding stiffness, what do you want to ask?
When they have stiffness?
How long it takes to resolve?
What questions do you want to ask regarding joint swelling and deformity?
How rapidly did the swelling come on?
Any injuries prior to the swelling?
How long does the swelling last?
Is the swelling bony? or soft/tender?
Anything coming out of swelling e.g. chalky material or hard yellowish lumps?
Is the swelling parallel to the joint line?
How do you ask about fatigue and weakness in a rheumatological history?
What causes the fatigue?
Any signs of depression?
Is the weakness muscular, joint related or neurological?
How do you differentiate inflammatory vs mechanical disease in terms of Morning stiffness? Effect of activity? Effect of resting? Fatigue? Systemic involvement?
Morning stiffness - inflammatory more than 1 hour, mechanical less than 30 mins
Effect of activity - inflammatory better, mechanical worse
Effect of rest - inflammatory worse, mechanical better
Fatigue - inflammatory significant, mechanical minimal
Systemic involvement - inflammatory yes, mechanical no
What drug history is important in a rheumatological history?
Pain relief
Penicillin - cutaneous hypersensitivity vasculitis
Minocycline, sulfasalazine - lupus skin rashes
Beta blockers - worsen Raynaud’s
Diuretics - reduce renal uric acid excretion - can lead to gout
What past medical history is important in a rheumatological history?
Previous malignancy
Seronegative spondyloarthropathy may indicate anterior uveitis, psoriasis or IBD
STIs or diarrhoea may indicate reactive arthritis or gonococcal arthritis
What family history is important in a rheumatological history?
Not that important other than how a patient’s family member experiences influence them.
Rheumatic diseases can be genetic e.g. RA, SLE, AS
What social/occupational history is important in a rheumatological history?
Smoking - RA aetiology, Raynaud’s advised to stop smoking
Alcohol - gout, avoid methotrexate in those who have excessive alcohol intake
Back pain is common in manual workers
What constitutional symptoms are important in a rheumatological history?
Fever
Night sweats
Weight loss
Loss of appetite
May indicate underlying inflammatory disease, infection or neoplasia
Could present this way in AS, primary vasculitis, GCA
Uncommon in RA and PsA
SLE patients often present with fever
What are the extra-articular symptoms and signs related to the mouth and eyes?
Dry mouth and/or eyes - Sjogren’s, RA
Mouth ulcers - SLE, reactive arthritis, IBD
Iritis - spondyloarthropathy
Scleritis - RA, granulomatosis with polyangiitis
Visual disturbance - GCA, SLE
What rheumatological conditions present with psoriatic plaques and dystrophic nails?
Psoriatic arthritis
What rheumatological conditions present with Raynaud’s phenomenon?
SLE, Sjogren’s systemic sclerosis
What rheumatological conditions present with subcutaneous nodules?
RA
What rheumatological conditions present with tophi?
Gout
What rheumatological conditions present with digital ulcers?
SLE
vasculitis
systemic sclerosis
What rheumatological conditions present with a malar rash, Livedo reticularis and alopecia?
SLE
What rheumatological conditions present with renal failure, hypertension, microscopic and haematuria +/- proteinuria?
SLE
Vasculitis
What rheumatological conditions present with renal stones?
Gout
What rheumatological conditions present with vaginal/urethral discharge?
Reactive or gonococcal arthritis
What rheumatological conditions present with miscarriages +/- eclampsia?
SLE
What rheumatological conditions present with headache?
SLE
GCA
What rheumatological conditions present with seizures, psychosis or TIA/CVA?
SLE
What rheumatological conditions present with compressive neuropathy e..g carpal tunnel syndrome?
RA
What are some of the cardio-respiratory extra-articular symptoms and signs?
SOB - pleural effusion - SLE and RA SOB - pericardial effusion - SLE SOB - alveolitis - SLE and RA SOB - pulmonary infiltrates - GPA SOB - pulmonary hypertension - SLE pleuritic chest pain - SLE wheeze heamoptysis - CPA sinusitis - GPA
What rheumatological conditions present with recurrent cytopenia?
SLE
What rheumatological conditions present with diarrhoea or bloody stools?
reactive arthritis, AS, enteropathic arthritis
What rheumatological conditions present with weight loss?
any inflammatory condition
neoplasia
