rheumatology

• Rheumatoid Arthritis


  • Symmetric, erosive joint synovitis
  • Morning stiffness >30-60mins
  • Joint tenderness/swelling/restricted ROM
  • Erythema of joints
  • Fever/fatigue
  • Rheumatoid nodules
  • Joint deformity in late disease
• Rheumatoid Arthritis Systemic Symptoms

  • Osteopenia
  • Muscle weakness
  • Nodules
  • Pleural/parenchymal lung disease
  • Renal disease
  • Pericarditis
  • CAD
  • Scleritis
  • Episcleritis
  • "Felty syndrome" (RA, splenomegaly, neutropenia)
• Rheumatoid Arthritis Diagnosis


  CBC, electrolytes, RF, ESR/CRP, ANA, synovial joint aspiration
• Rheumatoid Arthritis Radiologic Findings

  • Bony erosion
  • Symmetric cartilage loss
  • Juxta-articular osteopenia
  • Soft-tissue swelling
• Rheumatoid Arthritis Non-Pharmacological Treatments

  • Education
  • Hot/cold therapy
  • Alternative therapies (massage, acupuncture, relaxation)
  • PT/OT
  • Psychiatric
  • Nutrition
• Rheumatoid Arthritis Pharmacological Treatments

  • DMARDs
  • NSAIDs
  • Corticosteroids
  • Methotrexate
  • Biologics (etanercept, infliximab, rituximab, abatacept)
• Combination therapy for rheumatoid arthritis is unclear
• Joint diseases to describe classic symptomology for

  • Gout
  • Osteoarthritis
  • Reiter's syndrome
  • Rheumatoid arthritis
  • Psoriatic arthritis
  • Systemic lupus erythematosus
  • Polymyositis
  • Sjogren's syndrome
  • Polymyalgia rheumatica
  • Fibromyalgia
• Joint diseases to describe classic physical exam findings for

  • Gout
  • Osteoarthritis
  • Reiter's syndrome
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
• Osteoarthritis Physical Exam


  • Big joints like hands (Heberden's node or Bouchard node)
• Systemic Lupus Erythematosus Clinical Findings

  • Changeable/moving symptoms
  • Fatigue
  • Fever
  • Weight loss
  • Skin/hair (rash-malar "butterfly", sparing nasolabial folds; oral/nasal ulcers; photosensitivity, alopecia)
  • Arthralgia/myalgia
• Systemic Lupus Erythematosus Physical Exam

  • Vascular disease (Raynaud phenomenon, vasculitis, thromboembolic disease)
  • Glomerulonephritis
  • Pleural effusion
  • Pleuritic chest pain
  • Pericarditis
• Sjogren's Syndrome Physical Exam

  • Salivary/lacrimal gland involvement (enlargement→destruction)
  • Connective tissue absence
  • Xerophthalmia (burning/itch, photosensitivity, conjunctivitis)
  • Xerostomia (dysphagia, dysphonia, dental complaints)
  • Dry mucous membrane
  • "Crocodile tongue"
  • Lots of dental caries
  • Parotid swelling
  • Lymphadenopathy
• Polymyalgia Rheumatica


  • Aching/morning stiffness
  • Giant cell arteritis
  • Discrete onset of symmetric aching and morning stiffness of shoulders/hips >30mins
  • Fever
  • Fatigue
  • Synovitis/bursitis
  • Swelling/edema of hands/feet