Differentiating rheumatoid arthritis from other diseases: Difference between revisions

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__NOTOC__
__NOTOC__
{{Rheumatoid arthritis}}
{{Rheumatoid arthritis}}
{{CMG}}; {{AE}} {{AN}}
{{CMG}}; {{AE}} {{MKK}}


==Overview==
==Overview==
Line 31: Line 31:
**[[Sarcoidosis]]
**[[Sarcoidosis]]
**[[Sjogren syndrome]]
**[[Sjogren syndrome]]
==Differential diagnosis==
<small>
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
|-
|
|'''History of Psoriasis'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|[[Enthesopathy|'''Enthesopathy''']]
|'''[[Dactylitis]]'''
|'''[[Nail (anatomy)|Nail]] [[Dystrophy]]'''
|'''[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] association'''
|'''[[Upper extremity]]-hands'''
|'''[[Lower extremity]]'''
|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Spine]]'''
|'''[[Osteopenia]]'''
|'''[[Joint]] Space'''
|'''[[Ankylosis]]'''
|'''[[Periostitis]]'''
|'''[[Soft tissue]] swelling'''
|'''[[ESR]]'''
|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[HLA-B27]]'''
|-
|'''[[Psoriatic arthritis]]'''
| +
| +
| ++
| +
| +
| +
| +
| +++ ([[Distal interphalangeal joints|DIP]]/[[Proximal interphalangeal joints|PIP]])
| +++
| ++ (Unilateral)
| ++
| -
| ++ (Widening)
| ++
| +++ (Fluffy)
| ++
| +
| -
|30-75%
|-
|'''[[Rheumatoid arthritis]]'''
| -
| ++
| +
| -
| -
| -
| -
| +++
([[MCP joints|MCP]]/[[wrist]])
| +++
| + (Unilateral)
| ++([[Cervical spine|Cervical]])
| +++
| +++ (Narrowing)
| +
| + (Linear)
| +++
| +++
| +++
|6-8%
|-
|'''[[Ankylosing spondylitis]]'''
| -
| +++
| -
| +
| -
| -
| -
| +
| +
| +++ (Bilateral)
| +++
| +++
| ++ (Narrowing)
| +++
| +++ (Fluffy)
| +
| +++
| -
|90%
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
| -
| +++
| -
| +
| +
| -
| -
| ++
| +++
| ++ (Unilateral)
| +
| +
| + (Narrowing)
| -
| +++ (Fluffy)
| ++
| ++
| -
|75%
|}
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
{| class="wikitable"
!Disease
!Differentiating signs and symptoms
!Diagnostic findings
|-
|[[Fibromyalgia]]
|
* Symptoms have been present at a similar level for at least 3 months.
* Chronic [[musculoskeletal pain]] with multiple tender points
* [[Stiffness]], [[numbness]], and [[fatigue]]
* [[Headaches]]
* [[Sleep disorder]]
|
*All lab tests are normal
|-
|[[Rheumatoid arthritis]]
|
* Multiple [[joint swelling]]
* Morning [[stiffness]]
* [[Rheumatoid nodules]]
|
* [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]] is positive.
* Markers of systemic inflammation ([[ESR]], [[CRP]]) are typically elevated.
|-
|[[SLE]]
|
* [[Maculopapular rash]]
* Multi-system involvement
|
*Positive anti-Smith [[antibodies]]
|-
|[[Chronic fatigue syndrome]]
|Fatigue plus 4 of the following symptoms:
*Short-term [[memory loss]]
*[[Sore throat]]
*Tender [[lymph nodes]] in the neck or armpit
*[[Muscle pain]]
*[[Joint pain]] without [[swelling]] or [[Redness of the skin|redness]]
*[[Headaches]]
*[[Insomnia]]
*[[Malaise]]
|
*Diagnosis of exclusions
*Symptoms must present for more than 6 months
|-
|[[Spondyloarthritis]]
|
* [[Axial skeleton|Axial skeletal]] pain and [[stiffness]]
* Restricted spinal motion
|
* Elevated [[ESR]] or [[CRP]]
* Negative [[RF]]
* [[Bamboo spine]] on [[x-ray]]
|-
|[[Polymyalgia rheumatica]]
|
* Older at onset
* Generalized [[stiffness]]
|
* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP)
* Response to [[corticosteroids]]
|-
|[[Osteoarthritis]]
|
* Localized [[joint pain]]
* Restricted to affect joints
* Older at onset
|
* [[X-ray]] of the involved joints demonstrate degenerative changes
|-
|[[Hypothyroidism]]
|
*Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]]
*[[Myalgia|Muscular aching]] and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]].
|
*[[TSH]] is elevated and free [[T4]] is low.
|-
|Myopathaies ([[polymyositis]] and [[dermatomyositis]])
|
*Pelvic and shoulder girdle [[muscle weakness]]
*[[Rash]]
|
*[[Muscle biopsy]] confirms the diagnosis
*Elevated [[CPK|CPK enzyme]]
|-
|[[Neuropathy]]
|
*[[Numbness]] and [[tingling]]
*[[Paresthesia]]
|
*Abnormal [[EMG]]
|}
{| class="wikitable"
!Causes of
lung cavities
!Differentiating Features
!Differentiating radiological findings
!Diagnosis
confirmation
|-
|
*[[Malignancy]] ([[Lung cancer|Primary lung cance<nowiki/>r]])<ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
|
*Elderly male or female <ref name="pmid4353362">{{cite journal |vauthors=Chaudhuri MR |title=Primary pulmonary cavitating carcinomas |journal=Thorax |volume=28 |issue=3 |pages=354–66 |year=1973 |pmid=4353362 |pmc=470041 |doi= |url=}}</ref>
*Chronic smokers
*Presents with a [[low-grade fever]], absence of [[leukocytosis]], systemic complaints [[weight loss]], [[fatigue]]
*Absence of factors that predispose to [[gastric content aspiration]], no response to [[antibiotics]] within 10 days
*[[Hemoptysis]] is commonly associated with [[bronchogenic carcinoma]]
|
*A coin-shaped lesion with thick wall(>15mm) is seen on CXR with less ground glass opacities <ref name="pmid8572761">{{cite journal |vauthors=Mouroux J, Padovani B, Elkaïm D, Richelme H |title=Should cavitated bronchopulmonary cancers be considered a separate entity? |journal=Ann. Thorac. Surg. |volume=61 |issue=2 |pages=530–2 |year=1996 |pmid=8572761 |doi=10.1016/0003-4975(95)00973-6 |url=}}</ref> <ref name="pmid16183941">{{cite journal |vauthors=Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM |title=Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome |journal=Radiology |volume=237 |issue=1 |pages=342–7 |year=2005 |pmid=16183941 |doi=10.1148/radiol.2371041650 |url=}}</ref>
*[[Bronchoalveolar lavage]] [[cytology]] shows malignant cells
|
*[[Biopsy]] of lung
|-
|
*Pulmonary [[Tuberculosis, pulmonary|Tuberculosis]]
|
*Mostly in endemic areas
*Symptoms include [[productive cough]],[[night sweats]], [[fever]] and [[weight loss]]
|
*CXR and CT demonstrates [[Internal|cavities]] in the upper lobe of the lung
|
*[[Sputum]] smear positive for [[acid-fast bacilli]] and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
|-
|
*[[Necrotizing Pulmonary Infections|Necrotizing]] [[Pneumonia]]
|
*Any age group
*Acute, [[fulminant]] life threating complication of prior infection
*>100.4F fever, with [[Hemodynamically unstable|hemodynamic]] instability
*Worsening [[pneumonia]]-like symptoms
|
*CXR demonstrates multiple cavitary lesions
*[[Pleural effusion]] and [[empyema]] are common findings
|
*[[Complete blood count|CBC]] is positive for causative organism 
|-
|
*Loculated [[empyema]]
|
* Children and elderly are at risk
*Pleuritic [[chest pain]], [[dry cough]], [[fever]] with chills
*Dullness to [[Percussion of the lungs|percussion]] decreased [[breath sounds]], and reduced vocal resonance on examination
|
*[[Empyema]] appears lenticular in shape and has a thin wall with smooth luminal margins
|
*[[Thoracocentesis]]
|-
|
*[[Granulomatosis with polyangiitis]] ([[Wegener's granulomatosis|Wegener's]])<ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
|
*Women are more commonly effected than man.<ref name="pmid12541109">{{cite journal |vauthors=Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ |title=Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients |journal=Eur Radiol |volume=13 |issue=1 |pages=43–51 |year=2003 |pmid=12541109 |doi=10.1007/s00330-002-1422-2 |url=}}</ref>
*Kidneys are also involved
*Upper respiratory tract symptoms , perforation of [[nasal septum]], [[chronic sinusitis]], [[otitis media]], [[mastoiditis]].
*Lower respiratory tract symptoms, [[hemoptysis]],  [[cough]], [[dyspnea]].
*Renal symptoms, [[hematuria]], red cell [[casts]]
|
*Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR
|
*Positive for [[P-ANCA]]
*Biopsy of the tissue involved shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref>
|-
|
*[[Rheumatoid nodule]]
|
*Elderly females of 40-50 age group
*Manifestation of [[rheumatoid arthritis]]
*Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet with morning stiffness are common manifestations.
|
*Pulmonary nodules with cavitation are located in the upper lobe ([[Caplan syndrome]]) on Xray.
|
*Positive for both [[rheumatoid factor]] and anticyclic citrullinated peptide [[Antibody|antibody.]]
|-
|
*[[Sarcoidosis]]
|
*More common in African-American females
*Often [[asymptomatic]] except for [[Lymphadenopathy|enlarged lymph nodes]]<ref name="pmid11734441">{{cite journal |vauthors=Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R |title=Clinical characteristics of patients in a case control study of sarcoidosis |journal=Am. J. Respir. Crit. Care Med. |volume=164 |issue=10 Pt 1 |pages=1885–9 |year=2001 |pmid=11734441 |doi=10.1164/ajrccm.164.10.2104046 |url=}}</ref>
*Associated with [[restrictive lung disease]]
*[[Erythema nodosum]]
*[[Lupus pernio]] (skin lesions on face resembling lupus)
*[[Bell's palsy|Bell palsy]]
*[[Epithelioid]] [[granuloma]]<nowiki/>s containing microscopic [[Schaumann bodies|Schaumann]] and asteroid bodies
|
*On CXR bilateral [[Lymphadenopathy|adenopathy]] and coarse reticular opacities are seen.
*CT of the chest demonstrates extensive [[Hilar lymphadenopathy|hilar]] and mediastinal adenopathy
*Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref>
|
*Biopsy of lung shows non-[[caseating]] [[granuloma]]
|-
|
*[[Bronchiolitis obliterans]] ([[Cryptogenic organizing pneumonia]])<ref name="pmid9724431">{{cite journal |vauthors=Murphy J, Schnyder P, Herold C, Flower C |title=Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma |journal=Eur Radiol |volume=8 |issue=7 |pages=1165–9 |year=1998 |pmid=9724431 |doi=10.1007/s003300050527 |url=}}</ref><ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
|
*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]]
*It is caused by [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]]
*People working in industries are at high risk
*Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,<ref name="pmid2805873">{{cite journal |vauthors=Cordier JF, Loire R, Brune J |title=Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients |journal=Chest |volume=96 |issue=5 |pages=999–1004 |year=1989 |pmid=2805873 |doi= |url=}}</ref>
|
*Common appearance on CT is patchy [[Consolidation (medicine)|consolidation,]]<nowiki/>often accompanied by ground-glass opacities and nodules.<ref name="pmid8109493">{{cite journal |vauthors=Lee KS, Kullnig P, Hartman TE, Müller NL |title=Cryptogenic organizing pneumonia: CT findings in 43 patients |journal=AJR Am J Roentgenol |volume=162 |issue=3 |pages=543–6 |year=1994 |pmid=8109493 |doi=10.2214/ajr.162.3.8109493 |url=}}</ref>
|
*Biopsy of the lung <ref name="pmid19561910">{{cite journal |vauthors=Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN |title=Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review |journal=Ann Thorac Med |volume=3 |issue=2 |pages=67–75 |year=2008 |pmid=19561910 |pmc=2700454 |doi=10.4103/1817-1737.39641 |url=}}</ref>
*[[Pulmonary function tests]] demonstrate low fev1/fvc
|-
|
*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]<ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref>
|
*Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
*Clinical presentation varies, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]].
*Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical.
|
*Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.<ref name="pmid2787035">{{cite journal |vauthors=Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR |title=Pulmonary histiocytosis X: comparison of radiographic and CT findings |journal=Radiology |volume=172 |issue=1 |pages=249–54 |year=1989 |pmid=2787035 |doi=10.1148/radiology.172.1.2787035 |url=}}</ref>
|
*Biopsy of the lung
|}
<small>
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
|-
|
|'''History of Psoriasis'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|[[Enthesopathy|'''Enthesopathy''']]
|'''[[Dactylitis]]'''
|'''[[Nail (anatomy)|Nail]] [[Dystrophy]]'''
|'''[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] association'''
|'''[[Upper extremity]]-hands'''
|'''[[Lower extremity]]'''
|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Spine]]'''
|'''[[Osteopenia]]'''
|'''[[Joint]] Space'''
|'''[[Ankylosis]]'''
|'''[[Periostitis]]'''
|'''[[Soft tissue]] swelling'''
|'''[[ESR]]'''
|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[HLA-B27]]'''
|-
|'''[[Psoriatic arthritis]]'''
| +
| +
| ++
| +
| +
| +
| +
| +++ ([[Distal interphalangeal joints|DIP]]/[[Proximal interphalangeal joints|PIP]])
| +++
| ++ (Unilateral)
| ++
| -
| ++ (Widening)
| ++
| +++ (Fluffy)
| ++
| +
| -
|30-75%
|-
|'''[[Rheumatoid arthritis]]'''
| -
| ++
| +
| -
| -
| -
| -
| +++
([[MCP joints|MCP]]/[[wrist]])
| +++
| + (Unilateral)
| ++([[Cervical spine|Cervical]])
| +++
| +++ (Narrowing)
| +
| + (Linear)
| +++
| +++
| +++
|6-8%
|-
|'''[[Ankylosing spondylitis]]'''
| -
| +++
| -
| +
| -
| -
| -
| +
| +
| +++ (Bilateral)
| +++
| +++
| ++ (Narrowing)
| +++
| +++ (Fluffy)
| +
| +++
| -
|90%
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
| -
| +++
| -
| +
| +
| -
| -
| ++
| +++
| ++ (Unilateral)
| +
| +
| + (Narrowing)
| -
| +++ (Fluffy)
| ++
| ++
| -
|75%
|}
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
{| class="wikitable"
!Disease
!Differentiating signs and symptoms
!Diagnostic findings
|-
|[[Fibromyalgia]]
|
* Symptoms have been present at a similar level for at least 3 months.
* Chronic [[musculoskeletal pain]] with multiple tender points
* [[Stiffness]], [[numbness]], and [[fatigue]]
* [[Headaches]]
* [[Sleep disorder]]
|
*All lab tests are normal
|-
|[[Rheumatoid arthritis]]
|
* Multiple [[joint swelling]]
* Morning [[stiffness]]
* [[Rheumatoid nodules]]
|
* [[Rheumatoid factor|RF]] or [[Anti-citrullinated protein antibody|anti-cyclic citrullinated protein (CCP) antibody]] is positive.
* Markers of systemic inflammation ([[ESR]], [[CRP]]) are typically elevated.
|-
|[[SLE]]
|
* [[Maculopapular rash]]
* Multi-system involvement
|
*Positive anti-Smith [[antibodies]]
|-
|[[Chronic fatigue syndrome]]
|Fatigue plus 4 of the following symptoms:
*Short-term [[memory loss]]
*[[Sore throat]]
*Tender [[lymph nodes]] in the neck or armpit
*[[Muscle pain]]
*[[Joint pain]] without [[swelling]] or [[Redness of the skin|redness]]
*[[Headaches]]
*[[Insomnia]]
*[[Malaise]]
|
*Diagnosis of exclusions
*Symptoms must present for more than 6 months
|-
|[[Spondyloarthritis]]
|
* [[Axial skeleton|Axial skeletal]] pain and [[stiffness]]
* Restricted spinal motion
|
* Elevated [[ESR]] or [[CRP]]
* Negative [[RF]]
* [[Bamboo spine]] on [[x-ray]]
|-
|[[Polymyalgia rheumatica]]
|
* Older at onset
* Generalized [[stiffness]]
|
* An elevated [[erythrocyte sedimentation rate]] ([[ESR]]) OR [[C-reactive protein]] (CRP)
* Response to [[corticosteroids]]
|-
|[[Osteoarthritis]]
|
* Localized [[joint pain]]
* Restricted to affect joints
* Older at onset
|
* [[X-ray]] of the involved joints demonstrate degenerative changes
|-
|[[Hypothyroidism]]
|
*Systemic symptoms such as [[weight gain]], [[constipation]], [[dry skin]]
*[[Myalgia|Muscular aching]] and prominent [[fatigue]] that improves on replacement of [[thyroid hormone]].
|
*[[TSH]] is elevated and free [[T4]] is low.
|-
|Myopathaies ([[polymyositis]] and [[dermatomyositis]])
|
*Pelvic and shoulder girdle [[muscle weakness]]
*[[Rash]]
|
*[[Muscle biopsy]] confirms the diagnosis
*Elevated [[CPK|CPK enzyme]]
|-
|[[Neuropathy]]
|
*[[Numbness]] and [[tingling]]
*[[Paresthesia]]
|
*Abnormal [[EMG]]
|}


==References==
==References==

Latest revision as of 22:09, 24 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Differentiating Rheumatoid arthritis from other Diseases


Differential diagnosis

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History of Psoriasis Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Psoriatic arthritis + + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis - ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis - +++ - + - - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%
Reactive arthritis (Reiter's syndrome) - +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%

Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent

Disease Differentiating signs and symptoms Diagnostic findings
Fibromyalgia
  • All lab tests are normal
Rheumatoid arthritis
  • Markers of systemic inflammation (ESR, CRP) are typically elevated.
SLE
Chronic fatigue syndrome Fatigue plus 4 of the following symptoms:
  • Diagnosis of exclusions
  • Symptoms must present for more than 6 months
Spondyloarthritis
Polymyalgia rheumatica
Osteoarthritis
  • Localized joint pain
  • Restricted to affect joints
  • Older at onset
  • X-ray of the involved joints demonstrate degenerative changes
Hypothyroidism
  • TSH is elevated and free T4 is low.
Myopathaies (polymyositis and dermatomyositis)
Neuropathy
Causes of

lung cavities

Differentiating Features Differentiating radiological findings Diagnosis

confirmation

  • CXR and CT demonstrates cavities in the upper lobe of the lung
  • Sputum smear positive for acid-fast bacilli and nucleic acid amplification tests (NAAT) is used on sputum or any sterile fluid for rapid diagnosis and is positive for mycobacteria.
  • Any age group
  • Acute, fulminant life threating complication of prior infection
  • >100.4F fever, with hemodynamic instability
  • Worsening pneumonia-like symptoms
  • CBC is positive for causative organism
  • Children and elderly are at risk
  • Empyema appears lenticular in shape and has a thin wall with smooth luminal margins
  • Pulmonary nodules with cavities and infiltrates are a frequent manifestation on CXR
  • Elderly females of 40-50 age group
  • Manifestation of rheumatoid arthritis
  • Presents with other systemic symptoms including symmetric arthritis of the small joints of the hands and feet with morning stiffness are common manifestations.
  • Pulmonary nodules with cavitation are located in the upper lobe (Caplan syndrome) on Xray.
  • On CXR bilateral adenopathy and coarse reticular opacities are seen.
  • CT of the chest demonstrates extensive hilar and mediastinal adenopathy
  • Additional findings on CT include fibrosis (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.[9]
  • Common appearance on CT is patchy consolidation,often accompanied by ground-glass opacities and nodules.[13]
  • Exclusively afflicts smokers, with a peak age of onset of between 20 and 40 years.
  • Clinical presentation varies, but symptoms generally include months of dry cough, fever, night sweats and weight loss.
  • Skin is involved in 80% of the cases, scaly erythematous rash is typical.
  • Thin-walled cystic cavities are the usual radiographic manifestation, observed in over 50% of patients by either CXR or CT scans.[15]
  • Biopsy of the lung

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History of Psoriasis Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Psoriatic arthritis + + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis - ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis - +++ - + - - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%
Reactive arthritis (Reiter's syndrome) - +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%

Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent

Disease Differentiating signs and symptoms Diagnostic findings
Fibromyalgia
  • All lab tests are normal
Rheumatoid arthritis
  • Markers of systemic inflammation (ESR, CRP) are typically elevated.
SLE
Chronic fatigue syndrome Fatigue plus 4 of the following symptoms:
  • Diagnosis of exclusions
  • Symptoms must present for more than 6 months
Spondyloarthritis
Polymyalgia rheumatica
Osteoarthritis
  • Localized joint pain
  • Restricted to affect joints
  • Older at onset
  • X-ray of the involved joints demonstrate degenerative changes
Hypothyroidism
  • TSH is elevated and free T4 is low.
Myopathaies (polymyositis and dermatomyositis)
Neuropathy

References

  1. ↑ Arnett FC, Edworthy SM, Bloch DA; et al. (1988). "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis". Arthritis and Rheumatism. 31 (3): 315–24. PMID 3358796. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  2. ↑ Farmakis D, Polymeropoulos E, Polonifi A; et al. (2005). "Myelodysplastic syndrome associated with multiple autoimmune disorders". Clinical Rheumatology. 24 (4): 428–30. doi:10.1007/s10067-004-1059-4. PMID 15827686. Retrieved 2012-04-27. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
  4. ↑ Mouroux J, Padovani B, Elkaïm D, Richelme H (1996). "Should cavitated bronchopulmonary cancers be considered a separate entity?". Ann. Thorac. Surg. 61 (2): 530–2. doi:10.1016/0003-4975(95)00973-6. PMID 8572761.
  5. ↑ Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM (2005). "Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome". Radiology. 237 (1): 342–7. doi:10.1148/radiol.2371041650. PMID 16183941.
  6. ↑ 6.0 6.1 Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
  7. ↑ Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ (2003). "Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients". Eur Radiol. 13 (1): 43–51. doi:10.1007/s00330-002-1422-2. PMID 12541109.
  8. ↑ Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R (2001). "Clinical characteristics of patients in a case control study of sarcoidosis". Am. J. Respir. Crit. Care Med. 164 (10 Pt 1): 1885–9. doi:10.1164/ajrccm.164.10.2104046. PMID 11734441.
  9. ↑ Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H (1989). "Pulmonary sarcoidosis: evaluation with high-resolution CT". Radiology. 172 (2): 467–71. doi:10.1148/radiology.172.2.2748828. PMID 2748828.
  10. ↑ Murphy J, Schnyder P, Herold C, Flower C (1998). "Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma". Eur Radiol. 8 (7): 1165–9. doi:10.1007/s003300050527. PMID 9724431.
  11. ↑ 11.0 11.1 Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008). "Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review". Ann Thorac Med. 3 (2): 67–75. doi:10.4103/1817-1737.39641. PMC 2700454. PMID 19561910.
  12. ↑ Cordier JF, Loire R, Brune J (1989). "Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients". Chest. 96 (5): 999–1004. PMID 2805873.
  13. ↑ Lee KS, Kullnig P, Hartman TE, Müller NL (1994). "Cryptogenic organizing pneumonia: CT findings in 43 patients". AJR Am J Roentgenol. 162 (3): 543–6. doi:10.2214/ajr.162.3.8109493. PMID 8109493.
  14. ↑ Suri HS, Yi ES, Nowakowski GS, Vassallo R (2012). "Pulmonary langerhans cell histiocytosis". Orphanet J Rare Dis. 7: 16. doi:10.1186/1750-1172-7-16. PMC 3342091. PMID 22429393.
  15. ↑ Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR (1989). "Pulmonary histiocytosis X: comparison of radiographic and CT findings". Radiology. 172 (1): 249–54. doi:10.1148/radiology.172.1.2787035. PMID 2787035.

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