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Rheumatology and Diseases of Joints

Rheumatology comprises diseases which primarily affect joints and connective tissue consisting mainly of skin and tendons.

It is a multi system involvement and has diseases which have common properties and one feature common in all of them is that symptoms or findings are referable to the joints or adjacent tissues at some time or the other during the course of illness.

American Rheumatic association has put a classification of rheumatic diseases which is accepted all over the world.

1. Polyarthritis of unknown aetiology

(a) Rheumatoid arthritis

(b) Juvenile rheumatoid arthritis (Stills diseases)

(c) Ankylosing spondylitis

(d) Reiter ‘s syndrome

(e) Miscellaneous

2. Connective tissue disorders

(a) Systemic lupus erythematosis

(b) Polyarteritis nodosa

(c) Scleroderma

(c) Polymyositis and dermatomyositis

3. Rheumatic fever

4. Degenerative joint disease

(a) Osteoarthritis

1. Primary

2. Secondary

5. Non-articular rheumatism

(a) Fibrositis

(b) Intervertebral disc and low back syndrome

(c) Myositis and myalgia

(d) Tendinitis

(e) Fasculitis

(f) Carpal tunnel syndrome

6. Diseases with which arthritis is frequently associated

(a) Sarcoidosis

(b) Relapsing polychondritis

(c) Henoch-Schonlein purpura

(d). Ulcerative colitis

(e) Sjogren’s syndrome

(f) Psoriasis

7. Associated with known infective agents

(a) Bacterial: Brucella, gonococcus, tuberculosis pneumococcus,

salmonella, staphylococcus, syphilis.

(b) Rickettsial, viral, fungal

8. Traumatic and/or neurogenic disorders (a) Traumatic arthritis

(b) Diabetes

(c) Shoulder hand syndrome

(d) Syringomyelia

(e) Mechanical derangement of joints

9. Associated with known biochemical or endocrine abnormalities

(a) Gout

(b) Hemophilia

(c) Hyperparathyroidism (d) Hypothyroidism

(e) Scurvy

(f) Acromegaly

10. Inherited and congenital disorders

(a) Marfan ‘s syndrome

(b) Ehiers-Danlos syndrome

(c) Congenital hip dislocation

(d) Morquio’s disease

11. Miscellaneous

(a) Leukemia

(b) Multiple myeloma

(c) Metastatic

(d) Arthritis due to specific alleigens

(e) Amyloidosis

(f) Erythema nodosum

(g) Hypertrophic osteoarthropathy

(h) Teitz ‘s syndrome

APPROACH TO A PATIENT OF ARTHRITIS

1. History: Start of disease. Precipilating factors (infection, trauma)

2. Pattern of joint involvement: Single or multiple, symmetrical or asymmetrical, severity of disease process.

3. Moming stiffness

4. Remissions/relapses

5. Associated symptoms: Fever, weight loss, malaise

6. Past history: Joint pains, rheumatic fever, recurrent sore throat.

7. Physical examination: Look for anaemia, pallor, skin rash or pigmentation.

Examination of joints: Soft tissue swelling, wasting of muscles, colour of skin overlying joint, movements of joint – range, deformities.

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