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Main clinical symptoms in rheumatic diseases

            The successful way to establishing the right diagnosis begins with detailed history for the clinical symptoms of the patients.

            Main clinical symptoms in patients with rheumatic diseases          

            Articular syndrome   


            The joint involvement is a key feature of rheumatic diseases. Joint pain due to the involvement of the joint itself is characterized with pain in all movements, similar intensity of pain during active and passive motion. Two types of joint pain is distinguished – “mechanical” and “inflammatory”. “Mechanical” pain is those, that increases with repeated use of the joint. It is worst at the end of the day and relieves during rest. In addition, it may increase after resting, usually without night pain. “Mechanical” pain is accompanied by short stiffness after period of rest and short (<10minutes) early morning stiffness. “Mechanical” pain is a characteristic feature of degenerative joint disease – osteoarthritis. Contrary, “inflammatory” pain is worst in the morning and improves by continued use of the joint during the day. Pain often appears during the night and is accompanied by longer (>30 minutes) morning stiffness.  “Inflammatory” joint pain is a feature of inflammatory arthritis. Joint inflammation (arthritis) is accompanied by “inflammatory” joint pain, swelling, warmth, compromised function (limited motion), while erythema of the skin occurs only in several type of arthritis – gout flare and septic arthritis being the most common in rheumatologic practice. The type of arthritis has to be characterized according to several other features in order to facilitate the differential diagnosis e. g. type of onset, number of involved joint etc.


            Specific extraarticular signs may be a clue for connective tissue diseases and have to be sought in the history of a patient with suspected rheumatic pathology. Main extraarticular symptoms are listed below

- Skin rashes    - systemic lupus erythematosus, dermatomyositis, different types of vasculitis, psoriatic arthritis

- Photosensitive rash - systemic lupus erythematosus, dermatomyositis

- Abnormal bleeding (may be a clue to thrombocytopenia) - systemic lupus erythematosus, antiphospholipid syndrome

- Oral ulcers - systemic lupus erythematosus, reactive arthritis - Reiter syndrome, Behçet syndrome, Sjögren syndrome

- Hypertension (may be due to renal involvement) - systemic lupus erythematosus, vasculitis (microscopic polyangiitis, Wegener’s granulomatosis)

- Raynaud’s phenomenon - systemic sclerosis, systemic lupus erythematosus, Sjögren syndrome, polyarthritis nodosa etc.

- Dactylitis (diffuse oedema of fingers or toes which extend the joints) - psoriatic arthritis, reactive arthritis

- Skin thickening - systemic sclerosis

- Headache (may be due to neurologic involvement) - systemic lupus erythematosus

- Sicca syndrome – xerostomia, xerophtalmia - Sjögren syndrome

- Dental caries - may be a sequel to the lack of saliva in Sjögren syndrome

- Myalgia (secondary to myositis) - systemic lupus erythematosus, rheumatoid arthritis, vasculitis


                                                                       Dr Sevdalina Lambova, MD, PhD