History

Physical exam

Labs

Radiology

RA

Symmetric

Polyarthritis (small joint involvement)

Morning stiffness

Effusive joints

Tendosynovitis

Nodules

Bone-on-bone crepitus

↑ ESR (50-60%)

RF (80%)

↓Hb, ↑ platelets, ↓ wbc

Demineralisation

Joint space narrowing

Erosions of subchondral bone

Absence of bone repair

SLE

Multisystem disease – rash, photosensitivity, Raynaud’s, alopecia, cardiac/pulmonary serositis, CNS symptoms, glomerulonephritis

Confirm historical findings 

Typically small joints

+/- effusive joints (look for soft tissue swelling)

↑ESR

↓Hb (autoimmune), ↓ platelets, ↓ wbc

ANA (95%)

↑C3,C4

Generally non-destructive/non-erosive

+/- osteoporosis

+/- soft tissue swelling

Scleroderma

Raynaud’s, stiffness of fingers, skin tightness, heartburn/dysphagia

Skin tightness on dorsum of hand, facial skin, telangiectasia, calcinosis, non-effusive joint

↑ESR

 ↑ platelets, ↓ Hb, normal wbc

ANA (>90%)

+/- pulmonary fibrosis

+/- oesophageal dysmotility

+/- Calcinosis

Dermatomyositis

Heliotrope rash (eye lids), Gottron’s papules, macular erythema & poikiloderma (shoulders, neck, chest), proximal muscle weakness, +/- pain

Rash, proximal muscle weakness

↑ ESR

Normal platelets, ↓ Hb, normal wbc

CPK ↑ (80%)

ANA (30%)

+/- Oesophageal dysmotility

+/- interstitial lung disease