Major manifestations of
rheumatologic diseases
1
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.
3
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
4
Pain
Stiffness
Joint swelling and deformity
Functional impairments
Systemic manifestations
Extraarticular features
6
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)
7
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 .
8
Weakness
Consider primary or secondary muscle
abnormality
Swelling
(Fluid, soft tissue, bone)
Deformity (Joint, bone)
9
Non-specific symptoms of systemic illness
(Reflecting acute phase reaction)
Weight loss,
± reduction in appetite
Fatigability,
poor concentration
Sweats and chills, particularly at night
Feeling ill,
10
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
12
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
13
Acute gout
Acute septic arthritis
Acute psoriatic arthritis
Inflamed overlying skin
14
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
16
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
19
Rheumatoid Arthritis: Hands
Several months
of disease
5 Years of Disease
a very clear diagnosis