Mixed connective tissue disease physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination of patients with MCTD is usually remarkable by clinical features seen in [[Systemic lupus erythematosus|systemic lupus erythematosus (SLE)]], [[Rheumatoid arthritis|rheumatoid arthritis (RA)]], [[Dermatomyositis|dermatomyositis (DM)]], [[polymyositis]], and [[scleroderma]]. Physical examination in patients with MCTD include [[tachycardia]], [[tachypnea]], periungual [[telangiectasia]], [[sclerodactyly]], [[Jugular venous pressure|jugular vein distention]], [[rhonchi]] and [[Wheeze|wheezing]], [[joint swelling]] and [[tenderness]], and joints [[erythema]] | Physical examination of patients with MCTD is usually remarkable by clinical features seen in [[Systemic lupus erythematosus|systemic lupus erythematosus (SLE)]], [[Rheumatoid arthritis|rheumatoid arthritis (RA)]], [[Dermatomyositis|dermatomyositis (DM)]], [[polymyositis]], and [[scleroderma]]. Physical examination in patients with MCTD include [[tachycardia]], [[tachypnea]], periungual [[telangiectasia]], [[sclerodactyly]], [[Jugular venous pressure|jugular vein distention]], [[rhonchi]] and [[Wheeze|wheezing]], [[joint swelling]] and [[tenderness]], and joints [[erythema]]. | ||
==Physical Examination== | ==Physical Examination== | ||
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===Skin<ref name="pmid23756459">{{cite journal |vauthors=Dabiri G, Falanga V |title=Connective tissue ulcers |journal=J Tissue Viability |volume=22 |issue=4 |pages=92–102 |date=November 2013 |pmid=23756459 |pmc=3930159 |doi=10.1016/j.jtv.2013.04.003 |url=}}</ref><ref name="pmid7385833">{{cite journal |vauthors=Prystowsky SD |title=Mixed connective tissue disease |journal=West. J. Med. |volume=132 |issue=4 |pages=288–93 |date=April 1980 |pmid=7385833 |pmc=1272064 |doi= |url=}}</ref>=== | ===Skin<ref name="pmid23756459">{{cite journal |vauthors=Dabiri G, Falanga V |title=Connective tissue ulcers |journal=J Tissue Viability |volume=22 |issue=4 |pages=92–102 |date=November 2013 |pmid=23756459 |pmc=3930159 |doi=10.1016/j.jtv.2013.04.003 |url=}}</ref><ref name="pmid7385833">{{cite journal |vauthors=Prystowsky SD |title=Mixed connective tissue disease |journal=West. J. Med. |volume=132 |issue=4 |pages=288–93 |date=April 1980 |pmid=7385833 |pmc=1272064 |doi= |url=}}</ref>=== | ||
* [[Calcinosis]] | * [[Calcinosis]] | ||
* [[Telangiectasia]] | * [[Telangiectasia]] | ||
| Line 34: | Line 33: | ||
* [[Lymphadenopathy]] | * [[Lymphadenopathy]] | ||
* [[Jugular venous distension]] (suggests [[pulmonary hypertension]]) | * [[Jugular venous distension]] (suggests [[pulmonary hypertension]]) | ||
===Lungs<ref name=" | ===Lungs<ref name="pmid15716315">{{cite journal |vauthors=Bodolay E, Szekanecz Z, Dévényi K, Galuska L, Csípo I, Vègh J, Garai I, Szegedi G |title=Evaluation of interstitial lung disease in mixed connective tissue disease (MCTD) |journal=Rheumatology (Oxford) |volume=44 |issue=5 |pages=656–61 |date=May 2005 |pmid=15716315 |doi=10.1093/rheumatology/keh575 |url=}}</ref>=== | ||
* Bibasilar [[Rales|crackles]] | * Bibasilar [[Rales|crackles]] | ||
*[[Rhonchi]] | *[[Rhonchi]] | ||
*[[Wheezing]] may be present | *[[Wheezing]] may be present | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with mixed connective tissue disease is usually normal. | * Cardiovascular examination of patients with mixed connective tissue disease is usually normal. | ||
| Line 45: | Line 45: | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with mixed connective tissue disease is usually normal. | * Genitourinary examination of patients with mixed connective tissue disease is usually normal. | ||
===Extremities<ref name="pmid718271">{{cite journal |vauthors=Bennett RM, O'Connell DJ |title=The arthritis of mixed connective tissue disease |journal=Ann. Rheum. Dis. |volume=37 |issue=5 |pages=397–403 |date=October 1978 |pmid=718271 |pmc=1000265 |doi= |url=}}</ref>=== | ===Extremities<ref name="pmid718271">{{cite journal |vauthors=Bennett RM, O'Connell DJ |title=The arthritis of mixed connective tissue disease |journal=Ann. Rheum. Dis. |volume=37 |issue=5 |pages=397–403 |date=October 1978 |pmid=718271 |pmc=1000265 |doi= |url=}}</ref><ref name="pmid758918">{{cite journal |vauthors=Ramos-Niembro F, Alarcón-Segovia D, Hernández-Ortíz J |title=Articular manifestations of mixed connective tissue disease |journal=Arthritis Rheum. |volume=22 |issue=1 |pages=43–51 |date=January 1979 |pmid=758918 |doi= |url=}}</ref><ref name="pmid24470658">{{cite journal |vauthors=Sen S, Sinhamahapatra P, Choudhury S, Gangopadhyay A, Bala S, Sircar G, Chatterjee G, Ghosh A |title=Cutaneous manifestations of mixed connective tissue disease: study from a tertiary care hospital in eastern India |journal=Indian J Dermatol |volume=59 |issue=1 |pages=35–40 |date=January 2014 |pmid=24470658 |pmc=3884926 |doi=10.4103/0019-5154.123491 |url=}}</ref>=== | ||
*[[Joint swelling]] and [[tenderness]] (features of [[rheumatologic disease]]) | *[[Joint swelling]] and [[tenderness]] (features of [[rheumatologic disease]]) | ||
*Edema of the hands | |||
* [[Arthritis]] | * [[Arthritis]] | ||
** Symmetric and polyarticular | ** Symmetric and polyarticular | ||
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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.
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[1]
Skin[2][3]
- Calcinosis
- Telangiectasia
- Malar rash
- Periungual telangiectasias and erythema may be present
- Skin may be pale (secondary to anemia)
- Sclerodactyly
- Skin ulceration
HEENT
- HEENT examination of patients with mixed connective tissue disease is usually normal.
Neck[4]
Lungs[1]
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[5][6][7]
- Joint swelling and tenderness (features of rheumatologic disease)
- Edema of the hands
- Arthritis
- Symmetric and polyarticular
- Majority of times involves knees, carpal joints, and joints of the fingers (especially the proximal interphalangeal (PIP) joint and metacarpophalangeal (MCP) joint)
- Decrease range of motion
- Joints erythema (due to synovitis)
References
- ↑ 1.0 1.1 Bodolay E, Szekanecz Z, Dévényi K, Galuska L, Csípo I, Vègh J, Garai I, Szegedi G (May 2005). "Evaluation of interstitial lung disease in mixed connective tissue disease (MCTD)". Rheumatology (Oxford). 44 (5): 656–61. doi:10.1093/rheumatology/keh575. PMID 15716315.
- ↑ Dabiri G, Falanga V (November 2013). "Connective tissue ulcers". J Tissue Viability. 22 (4): 92–102. doi:10.1016/j.jtv.2013.04.003. PMC 3930159. PMID 23756459.
- ↑ Prystowsky SD (April 1980). "Mixed connective tissue disease". West. J. Med. 132 (4): 288–93. PMC 1272064. PMID 7385833.
- ↑ Latuśkiewicz-Potemska J, Zygmunt A, Biernacka-Zielińska M, Stańczyk J, Smolewska E (October 2013). "Mixed connective tissue disease presenting with progressive scleroderma symptoms in a 10-year-old girl". Postepy Dermatol Alergol. 30 (5): 329–36. doi:10.5114/pdia.2013.38365. PMC 3858664. PMID 24353496.
- ↑ Bennett RM, O'Connell DJ (October 1978). "The arthritis of mixed connective tissue disease". Ann. Rheum. Dis. 37 (5): 397–403. PMC 1000265. PMID 718271.
- ↑ Ramos-Niembro F, Alarcón-Segovia D, Hernández-Ortíz J (January 1979). "Articular manifestations of mixed connective tissue disease". Arthritis Rheum. 22 (1): 43–51. PMID 758918.
- ↑ Sen S, Sinhamahapatra P, Choudhury S, Gangopadhyay A, Bala S, Sircar G, Chatterjee G, Ghosh A (January 2014). "Cutaneous manifestations of mixed connective tissue disease: study from a tertiary care hospital in eastern India". Indian J Dermatol. 59 (1): 35–40. doi:10.4103/0019-5154.123491. PMC 3884926. PMID 24470658.