Rheumatoid arthritis physical examination
|
Rheumatoid arthritis Microchapters | |
|
Diagnosis | |
|---|---|
|
Treatment | |
|
Case Studies | |
|
Rheumatoid arthritis physical examination On the Web | |
|
American Roentgen Ray Society Images of Rheumatoid arthritis physical examination | |
|
Risk calculators and risk factors for Rheumatoid arthritis physical examination | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Physical examination
Appearance of the Patient
- General fatigue and lassitude
Skin
- Rheumatoid nodule found over bony prominences, such as the olecranon, the calcaneal tuberosity, the metacarpophalangeal joints, or other areas that sustain repeated mechanical stress.
- Pyoderma gangrenosum, a necrotizing, ulcerative, noninfectious neutrophilic dermatosis.
- Erythema nodosum
- Lobular panniculitis
- Atrophy of digital skin
- Palmar erythema
- Diffuse thinning (rice paper skin), and skin fragility.
- Beading on the nails
Eyes
- Dry eyes
- Scleritis
- Keratoconjunctivitis sicca (dry eyes)
- Episcleritis and scleromalacia
Lungs
On Auscultation of lungs:
- Decreased breath sounds on both sides.
- Crackles may be present.
Abdomen
- On palpation:
Extremities
On inspection redness and swelling of the affected joints. On palpation:
- Tenderness
- Pain on movement
- Decreased range of movement
Deformity
- The fingers are typically deviated towards the little finger (ulnar deviation) and can assume unnatural shapes. Classical deformities in rheumatoid arthritis are the Boutonniere deformity (Hyperflexion at the proximal interphalangeal joint with hyperextension at the distal interphalangeal joint), swan neck deformity (Hyperextension at the proximal interphalangeal joint, hyperflexion at the distal interphalangeal joint).
- The thumb may develop a "Z-Thumb" deformity with fixed flexion and subluxation at the metacarpophalangeal joint, and hyperextension at the IP joint.