Antiphospholipid syndrome physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Antiphospholipid syndrome}} | {{Antiphospholipid syndrome}} | ||
{{CMG}}{{AE}}{{FT}} | {{CMG}}; {{AE}}{{FT}} | ||
==Overview== | ==Overview== | ||
Physical examination shows no pathognomonic physical findings of APS; however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations. | Physical examination shows no pathognomonic physical findings of antiphospholipid syndrome (APS); however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations. | ||
==Physical Examination== | ==Physical Examination== | ||
| Line 14: | Line 14: | ||
===Vital Signs=== | ===Vital Signs=== | ||
*Low-grade fever may be present in case of infectious cause of APS | *Low-grade fever may be present in case of infectious cause of APS. | ||
===Cutaneous manifestations=== | ===Cutaneous manifestations=== | ||
Skin examination of patients with APS is usually positive for: | Skin examination of patients with APS is usually positive for:<ref name="pmid11953980">{{cite journal| author=Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT et al.| title=Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. | journal=Arthritis Rheum | year= 2002 | volume= 46 | issue= 4 | pages= 1019-27 | pmid=11953980 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11953980 }} </ref><ref name="pmid20822807">{{cite journal| author=Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA| title=Antiphospholipid syndrome. | journal=Lancet | year= 2010 | volume= 376 | issue= 9751 | pages= 1498-509 | pmid=20822807 | doi=10.1016/S0140-6736(10)60709-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20822807 }} </ref><ref name="pmid27334977">{{cite journal| author=Negrini S, Pappalardo F, Murdaca G, Indiveri F, Puppo F| title=The antiphospholipid syndrome: from pathophysiology to treatment. | journal=Clin Exp Med | year= 2017 | volume= 17 | issue= 3 | pages= 257-267 | pmid=27334977 | doi=10.1007/s10238-016-0430-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27334977 }} </ref> | ||
*Venous thromboembolism | *[[Venous thromboembolism]] | ||
*Livedo reticularis | *[[Livedoid vasculitis|Livedo reticularis]] | ||
*Purpura | *[[Purpura]] | ||
*Superficial thrombophelibitis | *Superficial thrombophelibitis | ||
*Leg ulcers | *Leg ulcers | ||
*Splinter hemorrhages | *[[Splinter hemorrhage|Splinter]] [[Bleeding|hemorrhages]] | ||
*Gangrene of the distal extremities | *[[Gangrene]] of the distal extremities | ||
*Leg swelling | *Leg swelling | ||
===HEENT=== | ===HEENT=== | ||
Abnormal fundoscopic examination findings: | Abnormal fundoscopic examination findings:<ref name="pmid17101948">{{cite journal| author=Tektonidou MG, Varsou N, Kotoulas G, Antoniou A, Moutsopoulos HM| title=Cognitive deficits in patients with antiphospholipid syndrome: association with clinical, laboratory, and brain magnetic resonance imaging findings. | journal=Arch Intern Med | year= 2006 | volume= 166 | issue= 20 | pages= 2278-84 | pmid=17101948 | doi=10.1001/archinte.166.20.2278 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17101948 }} </ref> | ||
*Retinal artery occlusion findings | *[[Retinal]] artery occlusion findings | ||
*Retinal vein thrombosis findings | *Retinal vein [[thrombosis]] findings | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with APS | * Neck examination of patients with APS can show [[lymphadenopathy]]. | ||
===Lungs=== | ===Lungs=== | ||
Pulmonary examination of patients with APS may show the following findings: | Pulmonary examination of patients with APS may show the following findings: | ||
*Tachypnea in case of pulmonary embolism. | *[[Tachypnea]] in case of pulmonary embolism. | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with APS shows findings consistent with | * Cardiovascular examination of patients with APS shows findings consistent with | ||
* | * Heart valve disease | ||
* [[Pericarditis]] | |||
===Abdomen=== | ===Abdomen=== | ||
* [[Hepatomegaly]]<ref name="pmid25641203">{{cite journal| author=Abreu MM, Danowski A, Wahl DG, Amigo MC, Tektonidou M, Pacheco MS et al.| title=The relevance of "non-criteria" clinical manifestations of antiphospholipid syndrome: 14th International Congress on Antiphospholipid Antibodies Technical Task Force Report on Antiphospholipid Syndrome Clinical Features. | journal=Autoimmun Rev | year= 2015 | volume= 14 | issue= 5 | pages= 401-14 | pmid=25641203 | doi=10.1016/j.autrev.2015.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25641203 }} </ref> | |||
* [[Splenomegaly]] | |||
*[[Abdominal tenderness]] in the lower abdominal quadrant in case of miscarriage or fetal loss. | *[[Abdominal tenderness]] in the lower abdominal quadrant in case of miscarriage or fetal loss. | ||
*[[Rebound tenderness]] | *[[Rebound tenderness]] | ||
| Line 53: | Line 57: | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neurological exam findings consistent with stroke or transient ischemic attack. | * Neurological exam findings consistent with [[stroke]] or [[Transient ischemic attack|transient]] ischemic attack.<ref name="pmid28769114">{{cite journal| author=Sciascia S, Amigo MC, Roccatello D, Khamashta M| title=Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances. | journal=Nat Rev Rheumatol | year= 2017 | volume= 13 | issue= 9 | pages= 548-560 | pmid=28769114 | doi=10.1038/nrrheum.2017.124 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28769114 }} </ref> | ||
* Migraine | * [[Migraine]] | ||
* Vascular dementia | * [[Multi-infarct dementia|Vascular dementia]] | ||
* Pre-eclampsia or eclampsia | * [[Pre-eclampsia]] or [[eclampsia]] | ||
==References== | ==References== | ||
Latest revision as of 20:26, 24 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]
Overview
Physical examination shows no pathognomonic physical findings of antiphospholipid syndrome (APS); however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations.
Physical Examination
Physical examination shows no pathognomonic physical findings of APS; however, abnormal features may be found on examination that are related to infarction or ischemia of the skin, viscera, or the central nervous system leading to cutaneous and neurological manifestations.
Appearance of the Patient
- Patients with APS usually appear normal.
Vital Signs
- Low-grade fever may be present in case of infectious cause of APS.
Cutaneous manifestations
Skin examination of patients with APS is usually positive for:[1][2][3]
- Venous thromboembolism
- Livedo reticularis
- Purpura
- Superficial thrombophelibitis
- Leg ulcers
- Splinter hemorrhages
- Gangrene of the distal extremities
- Leg swelling
HEENT
Abnormal fundoscopic examination findings:[4]
- Retinal artery occlusion findings
- Retinal vein thrombosis findings
Neck
- Neck examination of patients with APS can show lymphadenopathy.
Lungs
Pulmonary examination of patients with APS may show the following findings:
- Tachypnea in case of pulmonary embolism.
Heart
- Cardiovascular examination of patients with APS shows findings consistent with
- Heart valve disease
- Pericarditis
Abdomen
- Abdominal tenderness in the lower abdominal quadrant in case of miscarriage or fetal loss.
- Rebound tenderness
- Guarding may be present
Back
- Back examination of patients with APS is usually normal.
Genitourinary
- Genitourinary examination of patients with APS is usually normal.
Neuromuscular
- Neurological exam findings consistent with stroke or transient ischemic attack.[6]
- Migraine
- Vascular dementia
- Pre-eclampsia or eclampsia
References
- ↑ Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT; et al. (2002). "Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients". Arthritis Rheum. 46 (4): 1019–27. PMID 11953980.
- ↑ Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA (2010). "Antiphospholipid syndrome". Lancet. 376 (9751): 1498–509. doi:10.1016/S0140-6736(10)60709-X. PMID 20822807.
- ↑ Negrini S, Pappalardo F, Murdaca G, Indiveri F, Puppo F (2017). "The antiphospholipid syndrome: from pathophysiology to treatment". Clin Exp Med. 17 (3): 257–267. doi:10.1007/s10238-016-0430-5. PMID 27334977.
- ↑ Tektonidou MG, Varsou N, Kotoulas G, Antoniou A, Moutsopoulos HM (2006). "Cognitive deficits in patients with antiphospholipid syndrome: association with clinical, laboratory, and brain magnetic resonance imaging findings". Arch Intern Med. 166 (20): 2278–84. doi:10.1001/archinte.166.20.2278. PMID 17101948.
- ↑ Abreu MM, Danowski A, Wahl DG, Amigo MC, Tektonidou M, Pacheco MS; et al. (2015). "The relevance of "non-criteria" clinical manifestations of antiphospholipid syndrome: 14th International Congress on Antiphospholipid Antibodies Technical Task Force Report on Antiphospholipid Syndrome Clinical Features". Autoimmun Rev. 14 (5): 401–14. doi:10.1016/j.autrev.2015.01.002. PMID 25641203.
- ↑ Sciascia S, Amigo MC, Roccatello D, Khamashta M (2017). "Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances". Nat Rev Rheumatol. 13 (9): 548–560. doi:10.1038/nrrheum.2017.124. PMID 28769114.