2/2007When patient should be referred to rheumatologist?Classification and early diagnosis of rheumatic diseases

WITOLD TŁUSTOCHOWICZ (Klinika Chorób Wewnętrznych i Reumatologii Wojskowego Instytutu Medycznego; Kierownik: prof. dr hab. med. Witold Tłustochowicz)

Summary
The classification of rheumatic diseases comprises more than 200 nosological units, most of which share symptoms. In the everyday medical practice it is very important to be able to differentiate the conditions which need to be treated early and aggressively if a patient’s disability and premature death are to be prevented. This practically boils down to differentiating arthritis, where early treatment – even before the diagnosis – determines remote effects, from degenerative diseases, where conservative treatment and body weight loss are recommended. The basis for the diagnosis is to take the history of a patient accurately and perform a physical examination properly. Arthritis cannot be diagnosed if a physician does not recognize its manifestations both in physical examinations and laboratory tests. The inflammatory process has to be confirmed by findings in such test as ESR and CRP concentration. Other blood tests, imaging examinations and so on can be helpful in differentiating particular diseases. The paper describes what information should be obtained from a patient, what should be of particular concern during the physical examination, which other diagnostic examination are important in the diagnostic process and have to be done immediately, and which are meaningful in the differential diagnostics only.

Key words: arthritis, diagnostic procedures, physical examination, laboratory tests