Locomotor system dr basma el habbash rheumatology unit tripoli medical center
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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

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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 dr basma el habbash rheumatology unit tripoli medical center

Approach to painful joints


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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

Associating symptoms:-

  • Swelling

  • Redness.

  • Restriction of movement

  • Stiffness:-

    - Morning.

    - Site.

    - Duration.

    - At which condition.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

Muscles:-

- Muscle pain.

- Muscle weakness: -

Site:- proximal or distal

- Duration of symptoms.

- Diurnal variation.

- Associated symptoms

e.g. rash over the knuckles


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

  • Review of rheumatological features :-

  • Hair loss.

  • Eye: - redness , decreased vision , dryness.

  • Malar rash.

  • Photosensitivity.

  • Mouth ulcers.

  • Mouth dryness.

  • Raynaud’s phenomena.

  • Genital ulcers.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

* 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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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 ?


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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?


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

  • 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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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?


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

D/D:-

1- SLE.

2- Behcet’s disease.

3- IBD with extra-articular features.

4- Reactive arthritis.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

►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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

SLE is the probable clinical diagnosis


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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.


Locomotor system dr basma el habbash rheumatology unit tripoli medical center

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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