A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further:
- Inspection (viewing) [It is typical of rheumatoid arthritis that the specific joint symptoms are symmetrical (bilateral). However, in about one-third of patients, symptoms may initially be limited to one joint or a few joints].
- Skin (normal: intact; [abrasions/sores, redness, hematomas (bruises), scars]) and mucous membranes [subcutaneous rheumatoid nodules – subcutaneous, coarse, shifting nodules, develop in 20 to 30 percent of patients; anemia (anemia)]
- Gait pattern (fluid, limping).
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor)) [Gaenslen’s sign or also “transverse pressure pain”; due to the inflamed metatarsophalangeal joints, the strong handshake is felt as painful; this sign can also be triggered on the forefeet]
- Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; joint (joint effusion); soft tissue swelling; pressure painfulness (localization!) [In the early phase, mostly the smaller joints are affected, such as wrists, finger base or finger middle joints and toe base joints; later also wrists, elbows, knees, ankle joints. This results in:
- Arthralgia (joint pain)
- Joint swelling
- Pressure painfulness of the joints movement restrictions
- Stiffness of joints – morning stiffness lasting more than 60 minutes is almost always a sign of inflammatory joint disease]
- Measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is expressed as the maximum displacement of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
- Auscultation (listening) of the lungs [pleurisy (pleurisy); pulmonary fibrosis (connective tissue-scarring remodeling of lung tissue)]
- Auscultation of the heart [perimyocarditis (inflammation of the myocardial layers underlying the inner leaflet of the pericardium)]
- Abdominal (stomach) examination [hepatitis (liver inflammation); splenomegaly (spleen enlargement)?]
- Auscultation (listening) of the abdomen [vascular or stenotic sounds?]
- Percussion (tapping) of the abdomen.
- Meteorism (flatulence): hypersonoric tapping sound.
- Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
- If necessary, ophthalmological examination [due toSjögren’s syndrome with associated keratoconjunctivitis sicca (dry eye)].
- If necessary, neurological examination [due topolyneuropathy (disease of peripheral nerves)]
- Inspection (viewing) [It is typical of rheumatoid arthritis that the specific joint symptoms are symmetrical (bilateral). However, in about one-third of patients, symptoms may initially be limited to one joint or a few joints].
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
