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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



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.


Associating symptoms:-

  • Swelling

  • Redness.

  • Restriction of movement

  • Stiffness:-

    - Morning.

    - Site.

    - Duration.

    - At which condition.


Muscles:-

- Muscle pain.

- Muscle weakness: -

Site:- proximal or distal

- Duration of symptoms.

- Diurnal variation.

- Associated symptoms

e.g. rash over the knuckles


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.


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.


  • Review of rheumatological features :-

  • Hair loss.

  • Eye: - redness , decreased vision , dryness.

  • Malar rash.

  • Photosensitivity.

  • Mouth ulcers.

  • Mouth dryness.

  • Raynaud’s phenomena.

  • Genital ulcers.


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.


* 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.


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


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 ?


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?


  • 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.


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?


D/D:-

1- SLE.

2- Behcet’s disease.

3- IBD with extra-articular features.

4- Reactive arthritis.


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.



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.


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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