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Chiropractic Research Review

Evaluation of Rheumatic Disease

Rheumatic disease comprises more than 120 disorders affecting soft tissues and joints. Common to many of the rheumatic diseases are such characteristics as inflammation, chronic pain, and progressive physical impairments of joints and soft tissues.



The clinical presentation of the patient with rheumatic disease can be complex. Because a number of rheumatic disorders present initially with diffuse pain, constitutional symptoms and joint complaints, clinical presentations at this stage are often similar and nonspecific.
This paper reviews current literature of suspected rheumatic disease in the chiropractic setting. Included is a discussion of:

* differential diagnosis;
* clinical history;
* physical examination;
* screening and specific examination for rheumatic disease;
* laboratory and radiology evaluation; and
* categorization of rheumatic conditions.

Conclusions: Clinical assessment remains the mainstay of diagnosis in most rheumatic diseases. Historical features should be used to determine joint involvement, response to activity, and systemic involvement; physical examination should focus on determining the extent of neuromusculoskeletal dysfunction in major organ systems. The authors emphasize that "careful ongoing clinical exploration of the illness... including laboratory testing and diagnostic imaging, in conjunction with the knowledge of the natural history of the suspect diseases, facilitates accurate diagnosis and appropriate management."

Note: Included in the text is a chart providing differential diagnoses for rheumatic disease.

Crawford CM, Caputo LA, Littlejohn GO. Clinical assessment in rheumatic disease. Topics in Clinical Chiropractic 2000:7(2), pp1-12. Reprints: (800) 638-8437

Chiropractic Research Review

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