On average 1 in 8 clients that a musculoskeletal physiotherapist sees has a rheumatological condition. Rheumatological conditions often present with a diverse range of symptoms and a long history of painful joints/muscles which can go undiagnosed for many years. Modern physiotherapists are aware of these symptoms and are able to identify when it is appropriate to refer for further investigation and treatment with a GP or rheumatology specialist.
Rheumatoid Arthritis
Symptoms and other factors
Joint pain in toes, ankles, knees, fingers, thumb, wrist, elbow
Early morning joint stiffness lasting more than 30 minutes
Joints can become swollen, hot and tender to touch
Tiredness and a lack of energy
High temperature
Sweating
Poor appetite
Weight loss
Dry eyes
Chest pain
Osteoarthritis
Symptoms and other factors
Joint pain
Morning joint pain/stiffness lasting less than 15 mins
Difficulty getting in a comfortable position at night
Pain worse with activity, better with rest
More likely in older adults - usually starts from late 40's onwards
Family history of osteoarthritis
Joint may make grating or cracking sounds
Osteoporosis
Symptoms and other factors
Can be present without symptoms!
History of broken bones from low-trauma accidents
Uncommon before 50 years of age
Female 2:1 Male
Early menopause
Low bodyweight
Crohn's disease/colitis
Smoking
High alcohol intake
Inflammatory arthropathies
Previous history of eating disorders or food intolerances
Family history of osteoporosis or a parent with fractured hip (neck of femur)
Psoriatic Arthritis
Symptoms and other factors
Joint pain in fingers, thumbs, wrist, elbow,shoulder, toes, ankle, knee, hip
Early morning stiffness for more than 30 mins
Inflammatory back pain
May also have psoriasis (skin rash), or family history of psoriasis
Family history of inflammatory arthropathy (rheumatoid arthritis etc)
Seen in ages 10-20 and 30-50
Fatigue
Tender points on muscle insertions - eg achilles tendon, elbow tendons
"Sausage" fingers (dactylitis)
Nail changes
Axial Spondyloarthritis
Symptoms and other factors
Back pain for more than 3 months
Aged 45 or younger
Male 2:1 Female
Early morning spinal stiffness lasting more than 30 minutes
Night pain in the second half of the night
Weight loss, especially in the early stages
Fatigue or tiredness
Feeling feverish and experiencing night sweats
Buttock pain, leg pain
May also have psoriasis (skin rash) Crohn's disease, colitis , eye conditions
Lupus
Symptoms and other factors
Joint pain, stiffness or difficulty moving- especially in the morning and can take between minutes to hours to wear off
Joint swelling, warmth or tenderness to touch
Rashes from sunlight/UV light (including the classical "butterfly" rash on the cheeks and nose)hes from sunlight/UV light (including the classical "butterfly" rash on the cheeks and nose)
Flu like symptoms and or night sweats
Headaches, migraines
Fatigue (80-90% of people with lupus report this is their main symptom) - tiredness so severe it makes daily activities difficult
Brain fog - difficulty with memory or concentrating
Previous history of miscarriages
Cardiovascular disease
Dry eyes or mouth - sensation of sand in the eyes, regularly waking at night to drink water
Mouth or nasal ulcers - shallow or recurring ulcers or sores that won't heal
Unexplained weight gain or weight loss
Inflammation of the tissues covering internal organs with associated chest and/or abdominal pain
Seizures, mental illness or other cerebral problems
Kidney problems
Depression
Hair loss
Haematological disorders including anaemia
Swollen glands
Poor blood circulation causing the tips of fingers and toes to turn white then blue on exposure to cold (Raynauds)
Fibromyalgia syndrome
Symptoms and other factors
Widespread pain over 4/5 areas of the body - joints or muscles
Pain for more than 3 months
Fatigue
Memory and concentration difficulties
Age of onset 20-50 years
Female 9:1 Male
Polymyalgia Rheumatica
Symptoms and other factors
Shoulder pain in both shoulders (90%) or one shoulder (10%)
Pelvic girdle / hip pain
Both shoulder and/or pelvic stiffness
Symptoms worse in early morning for more than 30 mins
General feeling of unwellness
Depression
Loss of appetite
Sjorgens syndrome
Symptoms and other factors
Muscle pain
Multiple joint pains
Fatigue
Dry eyes and/or mouth
Other autoimmune condition
Female 9:1 Male
Family history of Sjorgens or other autoimmune condition
Gout and Pseudogout
Symptoms and other factors
Pain in joint(s) of big toe, mid foot, ankle, knee, thumb, fingers, elbow
Sudden start of pain often at night
Swelling, heat, redness, pain peaking after a few hours
Attack usually last a few days then settles
Occurs twice as often in men than women, women rarely experience gout before menopause
Family history of gout
High alcohol intake
Overweight
Diabetes
Vascular conditions (blood)