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Rheumatological sheet

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  1. Rheumatological sheet

  2. By • Dr . MarwaAbo-elhawa • Dr. RadwaElkhouly • Dr. ShymaaHablas Ass.lects. Of Rheumatology

  3. Personal History: 1- age 2- sex 3- residence 4- habits 5-occupation 6- mareital status 7 – number of children

  4. Age • Young: 1. JIA (5-15) 2. ARF (5-15) 3. HSP (4) 4. Kawasaki (5) • Middle. age: • 1.RA(40-60) 2.SLE,ss Reiter(20-40yrs.), • 3. Takayasu , PAN, Wegner (20-60) • Old: • 1.GCA >50 2. Gout (50yrs) 3. Pseudo gout 4. OA 5. OP

  5. Sex incidence in middle age

  6. Occupation: • Vibrating tools, typist • Health providers, blood bank staff • Manual worckers • Silica • Farmers

  7. Complaint: • Chief symptom & its duration

  8. Analysis of the complain:(present history) • Pain (site-pattern-type-releiving& exagerating factors) • Stiffness(site-duration-relation to activity) • Swelling (hard-soft-firm) • Constitutional manifestation(fever-fatigue-malaise-weight loss) • Muscle weakness(distribution-painful or not)

  9. Pattern of articular involvement DIP: OA, Psoriatic PIP: OA, RA, SLE, Psoriatic MCP: RA, Pseudogout, Hemochromatosis 1st CMC OA DeQuervain’s tenosynovitis Wrist: RA, Pseudogout, ganglion cyst, carpal tunnel syndrome

  10. Monoarticular Inflammatory • Crystalline • Infection • Monoarthritis associated with systemic disease Noninflammatory • Post traumatic • OA • Neuropathic arthropathy • Malignancy

  11. Polyarticular • Inflammatory • Endocrinal • Metabolic

  12. +ve & -vesymtoms: • Face & scalp: Alopecia Photosensitivity 5(mechanism) ?uv Photophobia Blurring of vision Eye inflammation Dryness of eye &mouth Oral ulcers Ear ,hearing

  13. Skin • Colour changes • Ecchymosis • Skin eruptions • Swellings

  14. Hand & nails • Colour changes • Swelling of the fingers • Nail changes Neck swellings

  15. GIT • Difficulty of swallowing • Reflux • Nausia ,vomiting • Recurrent abdominal pain • Changes in bowel habits Genitourinary • Urithritis • Genital Ulcers • Vaginitis

  16. Renal • Puffiness of the face, • Change of the odour and colour of the urine • Blood pressure • LL edema • Renal colic

  17. Blood Tachycardia – recurrent infection – bleeding tendency CNS • Behavioral changes TIA, strokes • Headaches neuropathy

  18. Cardiopulmonary • epistaxis • Change of voice • Dyspnea • chest pain • cough • haemoptysis

  19. Menstrual history • Age of menarche • Menstrual cycle • menopause

  20. Past history • Drugs • Infections • Previous fractures • Previous surgery

  21. Family history: • Of similar conditions Examination

  22. Face & scalp: Skin Eye Oral cavity Ear Nose • Palpation of the temporal artery and fascial artery

  23. Malar rash

  24. Maculopapular eruption

  25. Photosensitivity

  26. Discoid lupus

  27. Lupus pernio (sarcoidosis)

  28. Scleroderma facies

  29. Oral ulcer

  30. Saddle nose

  31. Proptosis

  32. Severe Xerostomia with dry tongue

  33. Sjogren’s Syndrome- Cervical Dental Caries

  34. Sjogren’s Syndrome - Diffuse Submandibular Salivary Gland Enlargement

  35. Sjogren’s Syndrome - Ascending Salivary Gland Infection

  36. Shirmer test

  37. Heliotrope rash

  38. Hand & nails

  39. Vasculitis

  40. Dupytren’s Contracture

  41. Generalized OA

  42. RA

  43. RA

  44. Raynaud’s

  45. Scleroderma

  46. Edematous phase

  47. Gottron’s papule

  48. Interarticular dermatitis