Joint Pain
Complaint of joint pain
- Duration
- Number of jt
- Which jt
- Pattern (sym/ asym)
- Severity
- Morning stiffness
- Deformity
If deformed, functional limitation
Associated features
- Rheumatoid nodules
- SLE: Skin rash, if (+), photosensitivity
- Psoriasis : Nail pitting
If RA
Extra-articular features of RA
1. Neuro
Spinal cord compression
Peripheral neuropathy
2. Eyes
scleritis/ episcleritis
3. CVS
IHD, if present,……..hospitalization,ECG, Rx
HT
Echo: for AR
4. Res
Pneumonitis
TB ( after treatment of RA, reactivation of TB) If (+), investigations and tx
5. Renal
odmea, puffiness of face, history of any renal disease
6. Vasculitis
Ischemic ulcerations
7. Bone
Osteoporosis and #
8. Blood
Anemia, blood transfusion, intercurrent fever
Investigations at hospital
- Blood : ENA profile result?
- CXR : cardiomegaly due to hypertension, pneumonitis?
- ECG : IHD
- USG ( abd) : splenomegaly
- HBV, HCV : tested? Results? Any vaccination
Treatment at hospital
- NSAIDs
- Medison( prednisolone)
- Only oral drugs for RA ? any injections? ( methotrexate)
- Biological agents ( expensive drugs)
SE of drugs
- NSAIDs induced PU
- Steroid induced gastritis ( abd pain)
PMH - any history of hospitalization
Family History - HT, Ht d/s, DM, TB, RA
Personal and social - smoking, alcohol, occupation
History format + ICE
Physical examination of RA
General
- Age, sex, body weight, conscious level, dysponeic
- Fever
- Face: puffy face
- Eyes: anemia, jaundice
- Neck : LN
- Extremities: odema, pyoderma gangrenosum
Systemic
- Hand examination
- CVS : pulse, BP, pericardial rub, AR ( EDM)
- Res: pneumonits and pleural effusion ( m/m, Trachea, percussion, auscultation),
- Neuro : pronator drip, peripheral neuropathy
- Abdomen: splenomegaly
Bedside tests
- RBS, fundoscope ( steroid SE)
- Schimmer test ( normal 5-15min)
DAS 28 in clinical practice ( 28 joints) for disease activity
- MCP jt
- PIP jt
- Knee
- Elbows
Dx: symmetrical , chronic polyarthritis of hands probably RA , complicated by deformity and
extra-articular menifestion ( eg anemia,,,,,,,)
