Major manifestations of rheumatologic diseases

Bones are linked by joints. There are three main subtypes.

1- Fibrous joints characterized by limited .movement like skull sutures
2- fibrocartilage joints These joints comprise a simple bridge of fibrous or fibrocartilage tissue joining two bones together where there is little requirement for movement. The intervertebral disc is a special type of fibrocartilage joint in which an amorphous area termed the nucleus pulpous lies in the centre of bridge.
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3-Synovial joints

Synovial joints are more complex structures containing several cell types and are found where a wide range of movement is required. Articular cartilage In synovial joints the bone ends are covered by articular cartilage. This is an avascular tissue consisting of chondrocytes embedded in a meshwork of type II collagen fibrils that extend through a hydrated 'gel' of proteoglycan molecules example the knee .joint
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Pain
Stiffness
Joint swelling and deformity
Functional impairments
Systemic manifestations
Extraarticular features
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Pain
Usage pain-worse on use, relieved by rest (mechanical strain, damage) example disc prolapse .
Rest pain-worse after rest, improved by movement (inflammation).example rheumatoid arthritis.
Night or 'bone' pain-mostly at movement (bone origin)
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Stiffness

Subjective feeling of inability to move freely after rest.
Duration and severity or early morning and inactivity stiffness that can be 'worn off' suggest degree of inflammation .
Example rheumatoid arthritis stiffness more than hour .
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Weakness

Consider primary or secondary muscle abnormality
Swelling
(Fluid, soft tissue, bone)
Deformity (Joint, bone)
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Arthralgia is pain in one or more of your joints. The pain may be described as sharp, dull, stabbing, burning or throbbing, and may range in intensity from mild to severe.
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Arthritis Symptoms

Arthritis causes joint pain, swelling, stiffness, and limited movement. Symptoms can include:
Joint pain
Joint swelling
Reduced ability to move the joint
Redness of the skin around a joint
Stiffness, especially in the morning
Warmth around a joint
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R.A. / sero-ve spondarthritis / SLE / … etc Inflammatory / autoimmune disorders

Disc prolapse / meniscus tear …etc Mechanical disorders
Septic / T.B. / Brucella / gonococcal … etc Infective
Gout & pseudogout
Crystal induced
Traumatic joint disorders
Tendinitis / bursitis / capsulitis / epicondylitis / carpal tunnel … etc Periarthritis
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R.A.
Chronic symmetrical small & large joints
O.A.
Psoriatic Arthritis
Gout
Distal inter-phalangeal joints
O.A.
Cervical & lumbar spine
Thumb base
Knees & hips
No systemic or inflammatory features
Sero-ve spondarthritis (reactive arthritis)
Asymmetrical large joints arthritis + reactive evidence (past diarrhea, urethritic …) *

Ankylosing spondylitis & allied conditions

Sacro iliac + lumbar spine + inflammatory / systemic features
Traumatic
Infective arthritis
Crystal arthritis
Acute flare of chronic disease
Mono-articular onset of a systemic disease
Intra-articular bleeding
Acute mono-arthritis specially knee or hip
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Typical clinical pattern e.g. carpal tunnel syndrome, plantar fasciitis & tennis elbow

Good general health
Tenderness outside joint margin
Swelling is absent or outside the joint
Examples:, plantar fasciitis, subdeltoid bursitis, elbow epicondylitis.
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Acute gout

Acute septic arthritis
Acute psoriatic arthritis
Inflamed overlying skin
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Rheumatic fever

Typical (classical)  pattern ; arthritis does not remain in a single joint more than 7 days . Gonococcal arthritis
Viral arthritis
SLE
Idiopathic juvenile arthritis
Poly articular gout
Lyme disease
Acute reactive arthritis
others
Migratory element  29


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Rheumatoid arthritis juvenile rheumatoid arthritis ,

spondylarthropathies ,
systemic lupus and .
Generlized osteoarthritis .
Gout .
Pseudogout .
Sarcoidosis .
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* Early “RA”: First few months of symptoms , frequently a challenging diagnosis

* Rheumatoid Arthritis: Hands
Several months
of disease
5 Years of Disease
a very clear diagnosis