Mixed connective tissue disease physical examination

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

Overview

Physical examination of patients with MCTD is usually remarkable by clinical features seen in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), dermatomyositis (DM), polymyositis, and scleroderma. Physical examination in patients with MCTD include tachycardia, tachypnea, periungual telangiectasia, sclerodactyly, jugular vein distention, rhonchi and wheezing, Joint swelling and tenderness, and joints erythema and effusion.

Physical Examination

• Physical examination of patients with MCTD is usually remarkable by clinical features seen in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), dermatomyositis (DM), polymyositis, and scleroderma.

Appearance of the Patient

• Patient appears well in the earlier stages of the disease
• Patient appears ill in the late stages of the disease due to multi-organ involvement

Vital Signs

• Tachycardia
• Tachypnea

Skin

• Periungual telangiectasias and erythema may be present
• Skin may be Pallor
  • Secondary to anemia
• Sclerodactyly
• Skin ulceration

HEENT

• HEENT examination of patients with mixed connective tissue disease is usually normal.

Neck

• Lymphadenopathy
• Jugular venous distension
  • Suggests pulmonary hypertension

Lungs

• Bibasilar crackles
• Rhonchi
• Wheezing may be present

Heart

• Cardiovascular examination of patients with mixed connective tissue disease is usually normal.

Abdomen

• Abdominal examination of patients with mixed connective tissue disease is usually normal.

Genitourinary

• Genitourinary examination of patients with mixed connective tissue disease is usually normal.

Extremities

• Joint swelling and tenderness
  • Features of rheumatologic disease
• Arthritis
  • Symmetric and polyarticular
  • Mostly involve knees, carpal joints, and joints of the fingers, especially the proximal interphalangeal (PIP) joint
  • Decrease range of motion
• Joints erythema
  • Due to synovitis
• Joint effusion