Rheumatology - signs and symptoms Flashcards
OA symptoms and signs
Asymmetrical Hands, spine, weight-bearing joints DIP, PIP, wrist, 1st CMC Joint crepitus Restricted activity Morning stiffness <1h Pain worse at the end of the day Pain exacerbated by exercise and relieved by rest
- Osteophytes
- Bouchard’s Nodes (PIP)
- Heberden’s Nodes (DIP)
No systemic features e.g. fever, rash
DIP affected in OA not affected in RA
RA symptoms and signs
Symmetrical synovitis
Symmetrical bilateral polyarthritis (>4 joints)
PIP , MCP, wrists, elbow (squeezing small joints will cause pain)
Neck
Hips, knees, ankles, MTP
Early morning stiffness (>1 h)
Pain worse at the start of the day
- Restricted activity
- Extra-articular diseases
- Rheumatoid/SC nodules (pathognomic)
- Radial deviation of wrist - prominent ulnar styloid process
- Ulnar deviation of fingers
- Subluxation at MCP joints
- Boutonnieres deformity (hyperextension at DIP, flexion at PIP)
- Swan neck deformity (flexion of DIP, hyperextension of PIP)
- Z shaped thumbs
- Trigger finger
• Presence of systemic features e.g. Fever, weight loss, lethargy
DIP NOT involved
Extra-articular presentations
- tenosynovitis, bursitis
- lymphadenopathy, episcleritis, pleuriitis, pericarditis, amyloidosis, ACD, felty syndrome (splenomegaly, neutropenia, ACD)
- Systemic sx
- Anaemia
- pulmonary fibrosis
Common in young women
Difference bn OA + RA
OA Assymetrical DIP involved Early morning stiffness <1h Pain worse at the end of the day Absence of systemic features
RA Symetrical DIP NOT involved Early morning stiffness >1h Pain worse at the stARt of the day Presence of systemic features (e.g. fever, weight loss, lethargy)
Amyloidosis symptoms + signs
- Fatigue
- Unexplained weight loss
- Oedema resistant to diuretic therapy
• Renal disease
o Amyloid deposits damage the glomerulus- proteinuria, hypoalbuminemia
o Oedema
• Heart disease
o Restrictive cardiomyopathy
o Arrhythmias, palpitations
• GIT disease
o Motility abnormalities of oesophagus, small + large intestine
o Malabsorption –> Weight loss
• Nervous system o Injury to peripheral nerves --> Autonomic disturbance --> postural hypotension o Peripheral neuropathy o Alternating bowel habits o Carpal tunnel syndrome
Other
- Hepatosplenomegaly
- Macroglossia
- T2DM (deposits to pancreas)
- Periorbital purpura
In summary
- Nephortic syndrome
- Hepatsplenomegaly
- Carpal tunnel syndrome + peripheral neuropathy
- Periorbital purpura
- Restrictive caridiomyopathy
- Macroglossia
Ankylosing spondylitis symptoms + signs
• Inflammatory back pain – hallmark clinical feature
Worse in the morning
Gets better with exercise
Starts at sacroiliac joint - may be felt as diffuse nonspecific buttock pain
Pain can cause wake the up at night
Question mark posture
- Systemic inflammatory disease – therefore systemic symptoms - Fatigue, Fever, Weight loss
- Morning stiffness
6As
• Apical lung fibrosis + limited chest expansion –> restrictive lung disease –> dyspnoea
• Anterior uveitis
• Aortic regurgitation, atrioventricular block
• Amyloidosis
• Achilles tendonitis/plantar fasciitis (enthesitis)
• Arthritis – may affect large joints asymmetrically (asymmetrical oligoarthritis) but affects lumbar joints symmetrically
Order with which the signs appear
1 sacroilitis, 2 syndesmophytes, 3 bamboo spine
Reactive arthritis symptoms + signs
Can't see, can't pee, can't climb a tree • Reiter’s syndrome - Conjuctivits - Urethritis - Oligoarthritis
- Systemic symptoms - malaise, fatigue, fever
- Arthritis - asymmetrical oligoarthritis, lower limbs, large joints, Spondylitis
• Enthesitis, dactylitis, achilles tendonitis, plantar fasciatis metatarsalgia
• Skin inflammation - circinate balantits, keratoderma blennorhagicum
• Nails (dystrophic changes)
• Mucous membranes (mouth ulcers)
Difference bn RA + reactive arthritis
RA - no enthesopathy or eye inflammation, symmetrical polyarhtirits
Reactive arthritis - enthesopathy, eye inflammation (conjunctivitis), assymetricaal oligoartritis
Septic arthritis symptoms + signs
• Triad of
- Fever (+Hot swollen tender joint)
- Pain (on active/passive movement)
- Impaired range of motion
- Acute Monoarthropathy
- Knee most common joint involved then hip, shoulder, ankle, wrist
Gout symptoms + signs (acute gout attack + chronic gout)
- Symmetrical
- 1st metatarsal joint of the foot (podagra)
• Acute gout attack
Swollen, warm, red joint
Fever, leucocytosis, raised ESR + CRP
Precipitated by trauma, infection
• Chronic gout
Asymptomatic between gout attacks
Tophi (1st metatarsal, external ear, olecranon bursa, achilles tendon)
Polyarticular arthritis
Kidney stones (loin to groin pain, dysuria, haematuria)
Renal glomerular, tubular, interstitial disease
Pseudogout symptoms + signs
- Tends to affect more than 1 joint
- Usually affects larger joints (e.g. knee, elbow, shoulder, wrist joints) - can lead to chronic degeneration with joint destruction + limited joint mobility
- Acute gout attack - painful, swollen, warm, red
• Chronic CPPD - Polyarticular arthritis (chronic Calcium pyrophosphate deposition disease)
Dermatomyositis symptoms + signs
• Bilateral Proximal myopathy (difficulty rising from a cahir, lifitng arms, climbing stairs)
• Muscle weakness can lead to atrophy
• Rash
Heliotrope or lilac rash - pruritic purplish rash on/around the eyelids
Rash that appears on sun-exposed areas (similar to malar rash in SLE but this one expands beyond the nasolabial folds)
Gottron’s papules - flat, red, scaly papules typically located on bony prominences
Gottron’s sign - when papules erupt on the MCP/ IP joints
o Shawl sign - macular rash over the shoulders and back
o Mechanic’s hands - painful crackling over the tips of the fingers
o Prominent nail fold capillary loops
Inclusion body myositis symptoms + signs
- Slow progressive weakness + wasting of both distal + proximal muscles (esp. involving quadriceps, wrists, fingers, muscles that lift the front of the foot)
- Involvement may not be bilateral
- Initial complain - weakness of grip strength (e.g. can’t open jars)
- Difficulty getting up out of a chair, frequent falls
- Mild muscle pain
Sarcoidosis symptoms + signs
• LUNGS (90%), skin, eyes most commonly affected
• Bihilar Lymphadenopathy
• Uveitis (commonset), keroconjuctivitis - cause blurry vision
90% of patients present with blurry vision
• Erythema nodosum on the legs, lupus pernio on the face, SC nodules
• Hypercalcaemia + Hypercalciuria (bones, groans, abdominal moans)
• Non-productive cough, dyspnoea, wheezing, restrictive pattern, airway obstruction
• Nonspecific constitutional symptom - Fever, night sweats, weight loss, fatigue
• Arthralgia – Inflammatory arthritis
• Abdomen – hepatomegaly, splenomegaly
• Arrhythmias
• Bilateral parotitis + swelling
• Hepatic granuloma infiltration
SLE symptoms + signs
4 or more needed to dx SLE - SOAP BRAIN MD
• Serositis (pleuritis>pericarditis) [pleuritis > pericarditis, pleura effusion)
• Oral ulcers
• Arthritis – NON EROSIVE, 2+ joints (Symmetrical small joint polyarthritis)
• Photosensitivity rash
- Blood – all low (anaemia, leukopenia, thrombopenia)
- Renal – proteinuria >0.5mg/24h, 3+ positive dipstick, cellular casts, diffuse proliferative glomerulonephritis common in lupus patient- nephritic syndrome
- ANA
- Immunologic (anti-DNA antibody, anti-Smith antibody, anti-phospholipid antibody (anti-cardiolipin, anti β2 glycoprotein I, lupus anticoagulant))
- Neurologic (psychosis, seizures, anxiety, depression)
- Malar rash (often ppt by light, spares naso-labial fold)
- Discoid rash
Other
• Constitutional symptoms – fatigue, fever, weight loss
• Alopecia, Raynaud’s phenomenon, signs of nephrosis e.g. oedema, lymphadenopathy
Raised ESR, normal CRP
SLE can cause pericarditis, myocarditis endocarditis but endocarditis is not usually symptomatic (doesnt cause murmurs)
Limited cutaneous scleroderma symptoms + signs
systemic sclerosis
- All the common signs and
CREST syndrome - Calcinosis cutis
- Raynaud’s disease
- Oesophageal dysmotility
- Sclerodactyly
- Telangiectasia
- No signs of internal organ involvement
- Pulmonary HTN is common
Common signs • Swelling (non-pitting oedema) of fingers + toes • Hard + thickened + tight + shiny + smooth skin, no wrinkles • Raynaud’s phenomenon • Digital ulcerations • Calcinosis cutis • Telangiectasia • Microstomia, beak like nose • Oesophageal dysmotility • Salt + pepper skin
- Fatigue
- Weight loss
