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Locomotor system Dr : BASMA EL-HABBASH Rheumatology unit Tripoli Medical Center. Approach to painful joints. Locomotor system History Joints:- Pain:- - Site:- symmetrical or not. - Duration of symptoms - Onset of symptoms:-- Sudden. - Gradual

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locomotor system dr basma el habbash rheumatology unit tripoli medical center
Locomotor system

Dr : BASMA EL-HABBASH

Rheumatology unit

Tripoli Medical Center

slide3

Locomotor system

History

Joints:-

Pain:-

- Site:- symmetrical or not.

- Duration of symptoms

- Onset of symptoms:-- Sudden.

- Gradual

Pattern:- ( course ) e.g. fleeting, additive, progressive,

stationary, intermittent.

- Severity.

- Character.

- Aggravating & relieving factors.

slide4
Associating symptoms:-
  • Swelling
  • Redness.
  • Restriction of movement
  • Stiffness:-

- Morning.

- Site.

- Duration.

- At which condition.

slide5
Muscles:-

- Muscle pain.

- Muscle weakness: -

Site:- proximal or distal

- Duration of symptoms.

- Diurnal variation.

- Associated symptoms

e.g. rash over the knuckles

slide6
Symptoms of proximal myopathy :-

-Difficulty in arising from setting position.

-Difficulty in climbing stair.

-Difficulty in combing hair.

-Difficulty in lifting objects above the level of

head.

slide7
Symptoms related to back pain :-

1- Site.

2- severity.

3- Associated symptoms:- stiffness after a period of rest, numbness.

4- Aggravating factor:- eg movement.

5- Associated pain in sacroiliac joints.

6- Previous H/O of trauma or fall down.

slide8
Review of rheumatological features :-
  • Hair loss.
  • Eye: - redness , decreased vision , dryness.
  • Malar rash.
  • Photosensitivity.
  • Mouth ulcers.
  • Mouth dryness.
  • Raynaud’s phenomena.
  • Genital ulcers.
slide9
Case history

- 41 years old female, presented to rheumatology OPD complaining of symmetrical small hand joints pain of 2 months duration.

* Gradual fixed severe joint pain involving MCP&PIP joints of both hands of 2 months duration interfering with her sleep and daily activities associated with swelling & morning stiffness of 2 hours duration of the above mentioned joints.

slide10
* She has no muscle pain or weakness.

She has no hair loss, eye symptoms, malar rash, photosensitivity, mouth ulcers, Raynaund’s phenomena or genital ulcers.

slide11
Important point:-

1-middle aged female

2-symmetrical involvement.

3-small hand joints involvement.

4-long duration means chronic disease.

5-morning stiffness > 1 hours.

6- no other rheumatological features.

Diagnosis Rheumatoid arthritis

slide12
Case report

28 years old female patient, was referred to Rheumatology OPD, complaining of pain and swelling affecting both wrists and both knees of 2 months duration. The pain started gradually and become more sever in the last 2 weeks interfering with her sleep and daily activities, increased by movement and relieved by rest

What do you want to ask more ?

slide13
Morning stiffness: No.

Other joint involvement: No.

Associated redness: No.

Associated restriction of movement: yes, she can

not walk or move her hands normally because of

pain and swelling.

What is the diagnosis?

slide14
D/D:-

1- Rheumatoid arthritis.

2- SLE.

3- Behcet’s disease.

4- IBD with exra-articular manifestations.

5- Reactive arthritis.

6- Psoriatic arthritis.

7- Ankylosing spondilitis.

slide15
Review of locomotor system:-

►Negative apart from recurrent oral ulcers (4 times in the last 6 months).

►It was painless occurred on the tongue and inner aspect of the cheeks.

What is the diagnosis?

slide16
D/D:-

1- SLE.

2- Behcet’s disease.

3- IBD with extra-articular features.

4- Reactive arthritis.

slide17
►No genital ulcers, No eye symptoms of previous attacks of anterior or posterior uvietis.

►No H/O diarrhea, blood or mucous in the stool or wt loss in the previous period.

►No H/O conjunctivitis, urethritis or previous attack of gastroentritis or G.U.T infection in the period before joint pain.

slide19
Investigations

1- CBC:- leukopenia and lymphopenia.

2- CXR:- normal.

3- ECG:- normal.

4- U/E/C:- normal.

5- Urine R/E:- normal.

6- 24 hrs collection of urine for protein: normal.

7- VDRL:- was positive.

8- U/S abdomen:- mild hepatosplenomegaly.

9- ANA was positive.

10- Anti-DNA antibodies were negative.

slide20
So the patient has :-

1- Arthritis.

2- recurrent oral ulcers.

3- hematological manifestations:- leukopenia and lymphopenia.

4- Positive VDRL.

5- Positive ANA.

6- other features:- hepatosplenomegaly.

SLE

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