THE RHEUMATOLOGICAL EXAMINATION

• Introduction, Wash Hands, Consent,
• General Inspection:
  • Cushingoid Appearance (Steroids➔ Osteoporosis)

• Bird-like Facies (Scleroderma)

• Weight Loss (Autoimmune, Scleroderma)
• Butterfly Rash & Hair Loss (SLE)

• Hands:
  • Rheumatoid Arthritis:
    • Symmetrical PIP Synovitis (Red + Swollen + Tender)
    • Ulnar Deviation
    • Subluxation of MCP Joints
    • Z-Deformity of the Thumbs
    • Swan Neck Deformity of the Fingers
    • Vasculitic Splinters in the Fingers
    • Small Muscle Wasting
    • Palmar Tendon Crepitus
    • Carpal Tunnel (Inverse Prayer Test)

• Reiter’s Syndrome:
  • Syphilitic-like Lesions on Soles & Palms.
  • 
• Osteoarthritis:
  • Heberton’s Nodes (DIP Joints)
  • Bouchard’s Nodes (PIP Joints)
  • 
• Gouty Arthritis:
  • Gouty Tophi in Hands
  • 
• Scleroderma (CREST):
  • Calcinosis (Calcific Nodules in Skin of Fingers)
  • Raynaud’s Phenomenon
  • (+ Esophageal dysmotility)
  • Sclerodactyly
  • Telangiectasias on the Fingers

• Face:
  • Rheumatoid Arthritis:
    • Dry Eyes (Sjogren’s Syndrome)
    • Cataracts (Steroid Side Effect)
    • Conjunctival Pallor (Anaemia from NSAIDs ➔ GI Bleeding)
    • Parotid Gland Enlargement (Sjogren’s Syndrome)
    • Dryness of Mouth (Sjogren’s Syndrome)
    • Mouth Ulcers & Gum Hypertrophy (Methotrexate Side Effects)
    • TMJ Joint Crepitus
  • Ankylosing Spondylitis:
    • Acute Iritis
  • Reiter’s Syndrome:
    • Conjunctivitis
    • Iritis
  • Gout:
    • Gouty Tophi in the Ear
• Neck:
  • Cervical Lymphadenopathy (Rheumatoid, SLE)
• Chest:
  • Rheumatoid Arthritis:
    • Bony Tenderness (Particularly Spine)
    • Pleural Effusions
    • Pericardial Rub
    • Aortic Regurgitation Murmur
  • Ankylosing Spondylitis:
    • Lordosis + Kyphosis
    • Lumbar Tenderness
    • **Markedly ↓ROM of Spine
    • **↓Chest Expansion
    • Aortic Regurgitation Murmur
    • Sacroiliac Joint Tenderness
• Abdomen:
  • Rheumatoid & SLE:
    • **Splenomegaly
    • **Hepatomegaly
• Genitals:
  • Reiter’s Syndrome:
    • Urethral Discharge
    • Balanitis
    • Prostatitis
• Legs:
  • Rheumatoid Arthritis:
    • Quadriceps Wasting
    • Knee Crepitus
    • Valgus (Bowing) Deformity of the Knee
    • Baker’s Cysts (in Popliteal Fossa)
    • Peripheral Neuropathy (***Including Foot Drop***)
  • Ankylosing Spondylitis:
    • Achilles Tendonitis
    • Plantar Fasciitis
  • Gouty Arthritis:
    • Tophi in Big Toe (75% of cases)
    • Tophi in Achilles Tendon
• Feet:
  • Rheumatoid:
    • Foot Drop (Common Fibular Nerve Palsy)
    • MTP Joints Swelling & Subluxation
    • Archilles Tendon Nodules
    • Claw Toes
  • Reiter’s Syndrome:
    • Sausage Toes
    • Plantar Fasciitis
    • Achilles Tendonitis
    • Syphilitic-like Lesions on Soles & Palms.

NB: Limited Cutaneous Scleroderma = CREST Syndrome =

• Calcinosis (Calcific Skin Nodules in the Fingers)
• Raynaud’s Phenomenon
• Esophageal Dysmotility ➔ Dysphagia
• Sclerodactyly of fingers
• Telangiectasia on fingers

Thank You so Much. Happy Learning!!