Other connective tissue diseases and overlap syndromes

1. Scleroderma (progressive systemic sclerosis) often produces arthralgias and morning stiffness, but signs of joint inflammation are uncommon. The diagnosis of scleroderma is based on a history of Raynaud's phenomenon, multisystem illness involving the lungs, kidneys, and gastrointestinal tract, and characteristic skin findings.

2. Polymyositis. Arthralgias may be reported in about one-third of patients with polymyositis, but joint problems are not a major aspect of this disease.

3. Overlap syndrome is a term that recognizes that connective tissue diseases such as RA, SLE, scleroderma, and polymyositis have overlapping clinical and serologic features.

D. Seronegative spondyloarthropathies (see section...!.I.!..,B..5). In patients with psoriatic arthritis, Reiter's syndrome, or ankylosing spondylitis, a chronic phase may develop. Characteristic features include sacroiliitis, asymmetric oligoarthritis or polyarthritis of the lower extremities, and spondylitis. Even Reiter's disease, with its typical episodic flares of activity, becomes chronic in nearly 75% of patients.

E. Crystalline disease (see sectionJJI.B..^). As acute gouty attacks become more frequent, the joints may no longer return to normal. Patients begin to experience constant symptoms, including morning stiffness. Radiographs of patients with untreated chronic tophaceous gout can sometimes demonstrate joint changes similar to those of RA; such abnormalities may also be seen with the symmetric, polyarticular variant of CPPD deposition disease.

F. Osteoarthritis. Despite the lack of systemic features, osteoarthritis in some people can be diffuse in distribution, mildly inflammatory, and associated with significant, if slowly progressive, deformity and disability. The joint distribution typically involves the first carpometacarpal joint of the thumb; first metatarsophalangeal joint; distal and proximal interphalangeal joints of the hands, hips, and knees; and the cervical and lumbar spine (see CMpiei..!!).

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