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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Dr : BASMA EL-HABBASH
Tripoli Medical Center
Approach to painful joints
- Site:- symmetrical or not.
- Duration of symptoms
- Onset of symptoms:-- Sudden.
Pattern:- ( course ) e.g. fleeting, additive, progressive,
- Aggravating & relieving factors.
- At which condition.
- 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
Symptoms related to back pain :-
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.
- 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.
1-middle aged female
3-small hand joints involvement.
4-long duration means chronic disease.
5-morning stiffness > 1 hours.
6- no other rheumatological features.
Diagnosis Rheumatoid arthritis
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?
1- Rheumatoid arthritis.
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?
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.
SLE is the probable clinical diagnosis
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 :-
2- recurrent oral ulcers.
3- hematological manifestations:- leukopenia and lymphopenia.
4- Positive VDRL.
5- Positive ANA.
6- other features:- hepatosplenomegaly.