inpatient / Rheumatology and immunology

Rheumatology Review of Systems

Last Updated: 1/20/2023

-- Personal Hx: *** arthritis, gout, SLE, RA, ankylosing spondylitis
-- Family Hx: *** arthritis, gout, SLE, RA, ankylosing spondylitis
-- Joint Pain/Swelling: *** joints, symmetry, timing, deformities, ulnar deviation; RA - MCP, PIP, wrist, rarely DIP; Ankylosing Spondylitis - sacroiliac joint
-- Morning Stiffness: *** how long until back to normal; usually >30 minutes and improves with activity
-- Raynaud's: *** color changes of hands or feet in cold; associated with scleroderma/CREST, SLE, RA, MCTD, Sjogren, cryoglobulinemia
-- Fingernail or Distal Finger Pitting: *** present in CREST and psoriatic arthritis; mechanic's hand in myositis
-- Sclerodactyly: *** present in CREST
-- Fevers: *** subjective vs objective, timing; associated with most rheum diseases
-- Night Sweats: *** associated with RA, vasculitis
-- Rashes: *** location; malar "butterfly" rash in SLE; discoid in SLE; palpable purpura in vasculitis; photosensitive in SLE and myositis; Gottron Papules on hands and heliotrope rash in dermatomyositis
-- Vision Changes: *** double, blurred; inflammation of ophthalmic artery in GCA; uveitis and retinitis seen in Behcet
-- Dry/Itchy Eyes: *** seen in Sjogrens
-- Dry Mouth (Xerostomia): *** increased dental caries, parotid enlargement; associated with Sjogren
-- Oral/Nasal Ulcers: *** associated with GPA (also saddle nose deformity), SLE; painful aphthous ulcers in Behcet disease
-- Cough: *** GPA can cause cough and hemoptysis; EGPA can cause adult asthma attacks; RA can cause effusions; RA and myositis can cause ILD/organizing PNA
-- Weight Changes: ***; weight loss in RA, SLE
-- Dysphagia/Reflux: *** associated with CREST
-- Pain in Jaw with Chewing: *** associated with GCA
-- Frothy Urine: *** GPA can cause glomerulonephritis, hematuria; IgA and other vasculidities can cause nephritic syndrome
-- New Weakness or Numbness: *** general weakness (SLE, RA, polymyalgia rheumatica); symmetrical proximal weakness (myopathy);

-- ANA - speckled (SLE, scleroderma, Sjogrens, MCTD); homogenous (SLE); nucleolar (scleroderma)
-- SLE - anti-dsDNA (active), anti-Sm (chronic), anti-histone (drug-induced) 
-- Rheumatoid Arthritis - RF, CCP
-- Sjogrens - anti-RO/SSA, anti-La/SSB
-- Diffuse Cutaneous Systemic Sclerosis - anti-scl70/topoisimerase 1
-- Limited Cutaneous Systemic Sclerosis - anti-centromere
-- Polymositis and Dermatomyositis - anti-Jo1, anti-Mi2
-- Myositis - anti-SRP
-- Mixed Connective Tissue Disease (MCTD) - anti u1-snRNP
-- Microscopic polyangiitis - pANCA (MPO)
-- Polyarteritis nodosa - pANCA (MPO)
-- Granulomatous polyangiitis - cANCA (PR3)
-- Eosinophulic granulomatosis with polyangiitis - both cANCA and pANCA

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