Medicine
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Lecture.11 Major manifestations of rheumatologic diseases
JOINTS
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.
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
Cartilage cushions joints and helps them work smoothly
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Medicine
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Major Symptoms In Joint Disorders
❖ Pain
❖ Stiffness
❖ Joint swelling and deformity
❖ Functional impairments
❖ Systemic manifestations
❖ Extra-articular features
IMPORTANT MSK SYMPTOMS
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)
Medicine
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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 .
Weakness
• Consider primary or secondary muscle abnormality
• Swelling
• (Fluid, soft tissue, bone)
• Deformity (Joint, bone)
Joint redness
• Acute gout
• Acute septic arthritis
• Acute psoriatic arthritis
• Inflamed overlying skin
Medicine
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Non-specific symptoms of systemic illness (Reflecting acute phase reaction)
1. Weight loss,
2. ± reduction in appetite
3. Fatigability,
4. poor concentration
5. Sweats and chills, particularly at night
6. Feeling ill,
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
Arthralgia
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.
Medicine
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Acute Mono-arthritis History
• Septic arthritis
• Crystal synovitis
• Trauma
• Haemarthrosis
• Foreign body reaction
polyarthritis: selected causes
• Rheumatoid arthritis
• juvenile rheumatoid arthritis ,
• spondylarthropathies ,
• systemic lupus .
Rheumatoid Arthritis: Hands
Medicine
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Extra-articular manifestation