Sjögren's syndrome physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination of patients with is usually remarkable for dryness of eyes, lips, | Physical examination of patients with is usually remarkable for dryness of all [[mucous membranes]] such as mouth, eyes, lips, anal and rectal. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with | *Physical examination of patients with is usually remarkable for dryness of all [[mucous membranes]] such as mouth, eyes, lips, anal and rectal. | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with Sjögren's syndrome usually appear good. <ref name="pmid16453296">{{cite journal |vauthors=Lopate G, Pestronk A, Al-Lozi M, Lynch T, Florence J, Miller T, Levine T, Rampy T, Beson B, Ramneantu I |title=Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndrome |journal=Muscle Nerve |volume=33 |issue=5 |pages=672–6 |date=May 2006 |pmid=16453296 |doi=10.1002/mus.20514 |url=}}</ref><ref name="pmid19254127">{{cite journal |vauthors=Antoniazzi RP, Miranda LA, Zanatta FB, Islabão AG, Gustafsson A, Chiapinotto GA, Oppermann RV |title=Periodontal conditions of individuals with Sjögren's syndrome |journal=J. Periodontol. |volume=80 |issue=3 |pages=429–35 |date=March 2009 |pmid=19254127 |doi=10.1902/jop.2009.080350 |url=}}</ref><ref name="pmid19307256">{{cite journal |vauthors=Riccieri V, Sciarra I, Ceccarelli F, Alessandri C, Croia C, Vasile M, Modesti MG, Priori R, Valesini G |title=Nailfold capillaroscopy abnormalities are associated with the presence of anti-endothelial cell antibodies in Sjogren's syndrome |journal=Rheumatology (Oxford) |volume=48 |issue=6 |pages=704–6 |date=June 2009 |pmid=19307256 |doi=10.1093/rheumatology/kep051 |url=}}</ref><ref name="pmid18085734">{{cite journal |vauthors=Ren H, Wang WM, Chen XN, Zhang W, Pan XX, Wang XL, Lin Y, Zhang S, Chen N |title=Renal involvement and followup of 130 patients with primary Sjögren's syndrome |journal=J. Rheumatol. |volume=35 |issue=2 |pages=278–84 |date=February 2008 |pmid=18085734 |doi= |url=}}</ref><ref name="pmid16397619">{{cite journal |vauthors=Versura P, Frigato M, Cellini M, Mulè R, Malavolta N, Campos EC |title=Diagnostic performance of tear function tests in Sjogren's syndrome patients |journal=Eye (Lond) |volume=21 |issue=2 |pages=229–37 |date=February 2007 |pmid=16397619 |doi=10.1038/sj.eye.6702204 |url=}}</ref><ref name="pmid18599017">{{cite journal |vauthors=Lemp MA |title=Advances in understanding and managing dry eye disease |journal=Am. J. Ophthalmol. |volume=146 |issue=3 |pages=350–356 |date=September 2008 |pmid=18599017 |doi=10.1016/j.ajo.2008.05.016 |url=}}</ref> | *Patients with Sjögren's syndrome usually appear good. <ref name="pmid16453296">{{cite journal |vauthors=Lopate G, Pestronk A, Al-Lozi M, Lynch T, Florence J, Miller T, Levine T, Rampy T, Beson B, Ramneantu I |title=Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndrome |journal=Muscle Nerve |volume=33 |issue=5 |pages=672–6 |date=May 2006 |pmid=16453296 |doi=10.1002/mus.20514 |url=}}</ref><ref name="pmid19254127">{{cite journal |vauthors=Antoniazzi RP, Miranda LA, Zanatta FB, Islabão AG, Gustafsson A, Chiapinotto GA, Oppermann RV |title=Periodontal conditions of individuals with Sjögren's syndrome |journal=J. Periodontol. |volume=80 |issue=3 |pages=429–35 |date=March 2009 |pmid=19254127 |doi=10.1902/jop.2009.080350 |url=}}</ref><ref name="pmid19307256">{{cite journal |vauthors=Riccieri V, Sciarra I, Ceccarelli F, Alessandri C, Croia C, Vasile M, Modesti MG, Priori R, Valesini G |title=Nailfold capillaroscopy abnormalities are associated with the presence of anti-endothelial cell antibodies in Sjogren's syndrome |journal=Rheumatology (Oxford) |volume=48 |issue=6 |pages=704–6 |date=June 2009 |pmid=19307256 |doi=10.1093/rheumatology/kep051 |url=}}</ref><ref name="pmid18085734">{{cite journal |vauthors=Ren H, Wang WM, Chen XN, Zhang W, Pan XX, Wang XL, Lin Y, Zhang S, Chen N |title=Renal involvement and followup of 130 patients with primary Sjögren's syndrome |journal=J. Rheumatol. |volume=35 |issue=2 |pages=278–84 |date=February 2008 |pmid=18085734 |doi= |url=}}</ref><ref name="pmid16397619">{{cite journal |vauthors=Versura P, Frigato M, Cellini M, Mulè R, Malavolta N, Campos EC |title=Diagnostic performance of tear function tests in Sjogren's syndrome patients |journal=Eye (Lond) |volume=21 |issue=2 |pages=229–37 |date=February 2007 |pmid=16397619 |doi=10.1038/sj.eye.6702204 |url=}}</ref><ref name="pmid18599017">{{cite journal |vauthors=Lemp MA |title=Advances in understanding and managing dry eye disease |journal=Am. J. Ophthalmol. |volume=146 |issue=3 |pages=350–356 |date=September 2008 |pmid=18599017 |doi=10.1016/j.ajo.2008.05.016 |url=}}</ref> | ||
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===Skin=== | ===Skin=== | ||
*Dryness of the skin | *Dryness of the skin | ||
*Scaling | *[[Scaling skin|Scaling]] | ||
*Partial or complete loss of sweating | *Partial or complete loss of [[sweating]] | ||
*Dry, sparse, and brittle hair may be present | *Dry, sparse, and brittle hair may be present | ||
*Diffuse alopecia may involve the scalp, limbs, axillae, or pubis | *Diffuse [[alopecia]] may involve the scalp, limbs, [[axillae]], or [[pubis]] | ||
*Nail folds may show capillaroscopic abnormalities | *Nail folds may show capillaroscopic abnormalities | ||
*Nonpalpable or palpable, vasculitic purpura, with lesions that are typically 2-3 mm in diameter and located on the lower extremities may be present | *Nonpalpable or palpable, vasculitic purpura, with lesions that are typically 2-3 mm in diameter and located on the lower extremities may be present | ||
*Annular erythema with scales, localized especially on the face and neck | *Annular [[erythema]] with scales, localized especially on the face and neck | ||
===HEENT=== | ===HEENT=== | ||
| Line 33: | Line 33: | ||
*Red, dry, and scaly lips | *Red, dry, and scaly lips | ||
*Cracks at the corners of the mouth | *Cracks at the corners of the mouth | ||
*Chronic oral candidiasis | *Chronic [[oral]] [[candidiasis]] | ||
*Atrophic changes in the mucous membranes of the upper respiratory tract | *Atrophic changes in the mucous membranes of the upper respiratory tract | ||
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===Lungs=== | ===Lungs=== | ||
*Bibasilar rales | *Bibasilar [[rales]] | ||
*[[Wheezing]] may be present | *[[Wheezing]] may be present | ||
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===Genitourinary=== | ===Genitourinary=== | ||
*Irritated bladder | *Irritated [[bladder]] | ||
*Suprapubic pain | *Suprapubic pain | ||
*Atrophic changes in the vulva and vagin | *Atrophic changes in the [[vulva]] and [[Vagina|vagin]] | ||
*Dryness of the anal and rectal mucous membranes | *Dryness of the [[anal]] and [[rectal]] [[mucous membranes]] | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Patient is usually oriented to persons, place, and time. | *Patient is usually oriented to persons, place, and time. | ||
*Glasgow coma scale is 15/15 | *Glasgow coma scale is 15/15 | ||
*Paraparesis maybe present | *[[Paraparesis]] maybe present | ||
*Paraplegia may be present | *Paraplegia may be present | ||
===Extremities=== | ===Extremities=== | ||
*Symmetrical, polyarticular, inflammatory arthritis | *Symmetrical, polyarticular, [[inflammatory arthritis]] | ||
==References== | ==References== | ||
Revision as of 19:16, 9 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Physical examination of patients with is usually remarkable for dryness of all mucous membranes such as mouth, eyes, lips, anal and rectal.
Physical Examination
- Physical examination of patients with is usually remarkable for dryness of all mucous membranes such as mouth, eyes, lips, anal and rectal.
Appearance of the Patient
Vital Signs
- Vital sign might be normal.
Skin
- Dryness of the skin
- Scaling
- Partial or complete loss of sweating
- Dry, sparse, and brittle hair may be present
- Diffuse alopecia may involve the scalp, limbs, axillae, or pubis
- Nail folds may show capillaroscopic abnormalities
- Nonpalpable or palpable, vasculitic purpura, with lesions that are typically 2-3 mm in diameter and located on the lower extremities may be present
- Annular erythema with scales, localized especially on the face and neck
HEENT
- Mucous dryness
- Red, smooth, and dry tongue
- Hyperlobulated tongue with loss of filiform papillae, and absence of salivary pooling under the tongue
- Dental caries
- Gingival inflammation
- Parotid duct narrowing
- Red, dry, and scaly lips
- Cracks at the corners of the mouth
- Chronic oral candidiasis
- Atrophic changes in the mucous membranes of the upper respiratory tract
Neck
- Bilateral parotid gland enlargement
Lungs
Heart
- Cardiovascular examination of patients with Sjögren's syndrome is usually normal.
Abdomen
- Splenomegaly
Back
- Back examination of patients with Sjögren's syndrome is usually normal.
Genitourinary
- Irritated bladder
- Suprapubic pain
- Atrophic changes in the vulva and vagin
- Dryness of the anal and rectal mucous membranes
Neuromuscular
- Patient is usually oriented to persons, place, and time.
- Glasgow coma scale is 15/15
- Paraparesis maybe present
- Paraplegia may be present
Extremities
- Symmetrical, polyarticular, inflammatory arthritis
References
- ↑ Lopate G, Pestronk A, Al-Lozi M, Lynch T, Florence J, Miller T, Levine T, Rampy T, Beson B, Ramneantu I (May 2006). "Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndrome". Muscle Nerve. 33 (5): 672–6. doi:10.1002/mus.20514. PMID 16453296.
- ↑ Antoniazzi RP, Miranda LA, Zanatta FB, Islabão AG, Gustafsson A, Chiapinotto GA, Oppermann RV (March 2009). "Periodontal conditions of individuals with Sjögren's syndrome". J. Periodontol. 80 (3): 429–35. doi:10.1902/jop.2009.080350. PMID 19254127.
- ↑ Riccieri V, Sciarra I, Ceccarelli F, Alessandri C, Croia C, Vasile M, Modesti MG, Priori R, Valesini G (June 2009). "Nailfold capillaroscopy abnormalities are associated with the presence of anti-endothelial cell antibodies in Sjogren's syndrome". Rheumatology (Oxford). 48 (6): 704–6. doi:10.1093/rheumatology/kep051. PMID 19307256.
- ↑ Ren H, Wang WM, Chen XN, Zhang W, Pan XX, Wang XL, Lin Y, Zhang S, Chen N (February 2008). "Renal involvement and followup of 130 patients with primary Sjögren's syndrome". J. Rheumatol. 35 (2): 278–84. PMID 18085734.
- ↑ Versura P, Frigato M, Cellini M, Mulè R, Malavolta N, Campos EC (February 2007). "Diagnostic performance of tear function tests in Sjogren's syndrome patients". Eye (Lond). 21 (2): 229–37. doi:10.1038/sj.eye.6702204. PMID 16397619.
- ↑ Lemp MA (September 2008). "Advances in understanding and managing dry eye disease". Am. J. Ophthalmol. 146 (3): 350–356. doi:10.1016/j.ajo.2008.05.016. PMID 18599017.