Arthritis & Musculoskeletal Disorders

DIAGNOSIS & EVALUATION

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Examination of the Patient

The diagnosis of a rheumatic disease can often be made by history and physical examination.

In general, the two clinical clues most helpful for diagnosis are
the joint pattern and the presence or absence of extra-articular manifestations.
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 The joint pattern is defined by answering three questions:

(1) Is inflammation present? (2) How many joints are involved? and (3) What specific joint sites are affected?

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 Joint inflammation is manifested by

redness, warmth, swelling, and morning stiffness of at least 30 minutes' duration.

Both the number of affected joints and the specific sites of involvement help determine the differential diagnosis
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 Inflammation
Present
Rheumatoid arthritis, systemic lupus erythematosus, gout

Absent
Osteoarthritis

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 Number joints of involved

Monarticular
Gout, trauma, septic arthritis, Lyme disease

Oligoarticular (24 joints)

Reiters disease, psoriatic arthritis, inflammatory bowel disease

Polyarticular( 3-5 joints)

Rheumatoid arthritis, systemic lupus erythematosus
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 Site of joint involvement

Distal interphalangeal
Osteoarthritis, psoriatic arthritis (not rheumatoid arthritis)

Metacarpophalangeal, wrists
Rheumatoid arthritis, systemic lupus erythematosus (not osteoarthritis)

First metatarsal phalangeal

Gout, Osteoarthritis
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 Laboratory procedures complete the evaluation,

sedimentation rate, tests for rheumatoid factor and antinuclear or other antibodies, synovial fluid analysis, and x-rays of affected joints.

These studies are important for diagnosis and as a baseline for judging the results of therapy.

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