1. Major manifestations of rheumatologic diseases 1

2. 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. 2

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 3

5. Pain Stiffness Joint swelling and deformity Functional impairments Systemic manifestations Extraarticular features 5

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) 6

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. 7

8. Weakness Consider primary or secondary muscle abnormality Swelling (Fluid, soft tissue, bone) Deformity (Joint, bone) 8

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, 9

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. 10

11. 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 11

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13. 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

14. R.A. Chronic symmetrical small & large joints O.A. Psoriatic Arthritis Gout Distal inter-phalangeal joints O.A. Cervical & lumbar spine Thumb base Knees & hips No systemic or inflammatory features Sero-ve spondarthritis (reactive arthritis) Asymmetrical large joints arthritis + reactive evidence (past diarrhea, urethritic …) 14

15. Ankylosing spondylitis & allied conditions Sacro iliac + lumbar spine + inflammatory / systemic features Traumatic Infective arthritis Crystal arthritis Acute flare of chronic disease Mono-articular onset of a systemic disease Intra-articular bleeding Acute mono-arthritis specially knee or hip 15

16. Typical clinical pattern e.g. carpal tunnel syndrome, plantar fasciitis & tennis elbow Good general health Tenderness outside joint margin Swelling is absent or outside the joint Examples:, plantar fasciitis, subdeltoid bursitis, elbow epicondylitis. 16

17. Acute gout Acute septic arthritis Acute psoriatic arthritis Inflamed overlying skin 17

18. Rheumatic feverTypical (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

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20. Rheumatoid arthritis juvenile rheumatoid arthritis, spondylarthropathies, systemic lupus and. Generlized osteoarthritis. Gout. Pseudogout. Sarcoidosis. 20

21. 21 Early “RA”: First few months of symptoms, frequently a challenging diagnosis

22. 22 Rheumatoid Arthritis: Hands Several months of disease 5 Years of Disease a very clear diagnosis

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