Rheumatology Sheet from Rheumatology Department, Faculty of Medicine, Zagazig University, Egypt.
Disclaimer : not my slide. Just uploading for my personal use..
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 ?
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)
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)