Rheumatology system

Clinical examination
 History taking
Major Sx
-Joints : pain, swelling, morning
stiffness,Loss of f(x), Deformity,
weakness, instability, changes in
sensation
-Eyes: Dry eyes, mouth,red eyes
-Systemic: Raynaud’s phenomenon,
rash, fever, fatigue, weight loss,
diarrhea,mucosal ulcers
 Peripheral joints
Pain & swelling:
Arthralgia =joint pain w/o swelling
Arthritis = joint pain w swelling
One or more joints involve?
Painful area & place?
Acute or chronic?
Getting better or worse?
Effect of exercise and rest?
Morning stiffness?(inflammatory type- RA
>1hr,>6weeks)
Deformity?progressive change in shape of the area?
Joint instability?true dislocation or muscle weakness?
Changes in sensation?numbness or para
aesthesia?distinguish nerve entrapment.
 Back Pain
Began suddenly or gradually?
Localised or diffused?
Radiates?
Aggrevated by
movement?cough?straining?
 Basically….
General inspection:
As the pts walk into the room 
walking(painful &difficult?) , require
assistant (stick), obvious deformity?
LOOK:
-compare rt and lt
-from front to back and the sides
-skin erythema (underlying infection,active
arthritis), atrophy, scars, rashes (psoriasis)
-vasculitic skin rash palpable purpura, lived
reticularis, skin necrosis.
-swelling over the joint (effusion,
hyperthrophy, inflammation)
- Deformity (chronic) destructive arthritis
-subluxation
-dislocation
-muscle wasting
 Feel….
Skin warmth( use back of finger)
Swollen & warmth(active
synovitis,infection, gout)
Tenderness
Grade Pts complain tenderness
1
Grade 2 Grade 1 + winces
Grade 3 Grade 2 + withdraw the joints
Grade 4 Does not allow palpation

-synovitis(soft & spongy),

effusion(fluctuant, shifted w/in joint),
bony swelling (hard, immobile
osteophyte, subchondral bone
thickening)
 Move..
Passive movement:
Determine –tense effusion, fixed
deformity, limited extension, limited
flexion

Active movement: joint f(x)

Stability
Joint crepitus
LASTLY: measure range of movement