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What should your history include when interviewing a patient for connective tissue disease?
A chronological history of symptom progression should include the joints that have been involved (including documentation of pain and/or swelling) as well as identifying precipitating factors, such as new drugs, recent infections, environmental exposures, diet, activity, travel history, or trauma.
Determine responsiveness to prior therapeutic modalities. Has the joint involvement been episodic, additive, or migratory in nature? Is the pattern of joint involvement mono, oligo, or polyarticular and/or in a symmetrical distribution? Is axial spinal involvement present? Identify any constitutional symptoms that suggest systemic illness, vasculitis, or paraneoplastic disease such as fever, weight loss, or fatigue. A complete review of systems is necessary to determine the organ systems that may be involved.
The Rheumatologic Review of Systems
| Organ System | Potential Clinical Manifestation |
|---|---|
| Skin | Malar rash, photosensitivity, alopecia, sclerodactyly, periungual erythema, Raynaud’s phenomenon, digital ulcers, psoriasis, purpura, nodules, genital lesions |
| HEENT: head, ears, eyes, nose, and throat | Mucosal ulcers or perforation, sicca, ocular discomfort or decreased visual acuity, change in hearing |
| Cardiorespiratory | Dyspnea, cough, hemoptysis, pleurisy or pericardial pain, edema, pulmonary emboli |
| Gastrointestinal | Reflux, dysphagia, abdominal pain, diarrhea, hematochezia, jaundice |
| Renal | Prior proteinuria, nephrolithiasis |
| Hematologic | Leukopenia, thrombocytopenia, anemia, fetal loss, deep vein thrombosis or pulmonary embolism, abnormal serologies |
| Neurologic | Neuropathies, weakness, transient ischemic attack, strokes, seizures, psychosis, cognitive deficits, temporal headaches |
| Family history: Ask about family history including various arthritides and other autoimmune diseases that tend to cluster in families. Social History: Identify high-risk practices such as intravenous drug abuse, multiple sexual partners, as well as risk factors for HIV, Hep B, Hep C, gonococcal, or chlamydial infection. |
Ask about functional losses including how their symptoms interfere with activities of daily living and ability to perform their job.
