Rheumatology Tutorial
Systemic lupus erythematosus
Pericardial friction rub
Malar rash
The malar rash is also known as the “butterfly rash,” and is characterized by erythema that involves the cheeks and bridge of the nose, sparing the nasolabial folds. It is associated with systemic lupus erythematosus.
Rheumatoid arthritis
Synovitis
Rheumatoid arthritis causes inflammatory arthritis, characterized by erythema, pain, and edema of the involved joint on examination.
Rheumatoid nodules
Subcutaneous nodules are common in patients with rheumatoid arthritis, usually occurring over pressure points such as the elbows.
Ulnar deviation
Rheumatoid arthritis causes characteristic deformities of the hand, including ulnar deviation hand and fingers.
Swan neck deformity
The swan neck deformity is characterized by hyperextension of the PIP joint with flexion of the DIP joint.
Boutonnière’s deformity
Boutonnière’s deformity is characterized by flexion of the PIP joint with hyperextension of the DIP joint.
Gout
Synovitis
Gout causes inflammatory arthritis, characterized by erythema, pain, and edema of the involved joint on examination.
Tophi
Tophi are deposits of urate crystals in the joints and soft tissues. They are a manifestation of longstanding and poorly controlled gout. Patients with tophaceous gout can experience polyarticular attacks and symptoms between attacks. Tophi are typically painless but may become acutely inflamed.
Dermatomyositis
Gottron’s papules
Gottron’s papules are violaceous and scaly papules over the dorsum of the metacarpophalangeal and interphalangeal joints.
Heliotrope rash
The heliotrope rash describes a lilac-colored change in the skin over the eyelids and around the eyes, sometimes with edema.
Shawl sign
The shawl sign is an erythematous rash over the shoulders and upper arms.
V sign
The V sign is an erythematous rash over the neck and chest.
Vasculitis
Large-vessel vasculitis
Enlarged temporal artery. In patients with giant cell arteritis, the temporal artery may be tender, thickened, or nodular on examination.
Medium-vessel
Livedo reticularis- A lace-like rash characteristic of medium-vessel vasculitis and other conditions.
Small-vessel
Palpable purpura- Non-blanching erythema from bleeding into the skin. Can be nonpalpable, as in hematomas, or palpable, as seen in immune-complex disease such as vasculitis.
Sarcoidosis
Lofgren’s syndrome
Löfgren’s syndrome is an acute form of sarcoidosis characterized by the triad of arthritis (most often involving both ankle joints) or periarthritis, erythema nodosum, and bilateral hilar lymphadenopathy.
Cutaneous manifestations.
Adult-onset Still’s disease
Evanescent rash
A transient, evanescent, salmon-colored macular or maculopapular skin rash.
Scleroderma
Sclerodactyly
Skin thickening and hardening, giving the skin a shiny appearance and leading to curling of the fingers with loss of mobility.
Mouth tightening
Patients with systemic sclerosis may develop skin tightening around the mouth, causing it to become smaller and narrower.
Nail capillary abnormalities
Patients with systemic sclerosis may develop dilation and other abnormalities of the nail bed capillaries.
Salt and pepper skin changes
Patients with systemic sclerosis may develop mixed hyper -and hypo-xfsynovitispigmentation of the skin, referred to as “salt and pepper.”
Cutaneous calcinosis
Patients with systemic sclerosis may develop deposition of calcium in the skin and subcutaneous tissues.
Telangiectasias
Visible dilated skin vessels.
Psoriasis
Psoriatic arthritis
Synovitis
Psoriasis causes inflammatory arthritis, characterized by erythema, pain, and edema of the involved joint on examination.
Onycholysis
Painless detachment of the nail from the nail bed.
Nail pitting
Visible depressions on the surface of the nail.
Oil drop sign
Areas of discoloration involving the nail bed.
Reactive arthritis
Synovitis
Psoriasis causes inflammatory arthritis, characterized by erythema, pain, and edema of the involved joint on examination.
Oral ulcers
Behcet’s disease
Recurrent painful oral ulcers are often the earliest manifestation of Behçet’s disease (ultimately occurring in up to 90% of patients). Genital ulcers also affect most patients and are more specific than oral ulcers. Ocular disease involving the retina and uvea occurs commonly and can lead to blindness. Cutaneous manifestations are also common and include papulopustular rash, acne-like lesions, and erythema nodosum (especially in women).
Erythema ab igne
A skin condition related to prolonged exposure to heat (eg, hot packs applied to the skin), characterized by reticulated erythema, hyperpigmentation, scaling, and telangiectasias.
Poliosis
A patch of hair, whether involving the head, eyebrows, or eyelashes, in which there is a decreased amount or absence of melanin. It can be associated with rheumatologic conditions such as vitiligo and sarcoidosis.
Eosinophilic fasciitis
A condition in which fascial tissue becomes inflamed as a result of the accumulation of eosinophils, manifesting as swollen skin overlying the affected area.