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IP International Journal of Orthopaedic Rheumatology


Two-step Diagnostic Strategy in Rheumatology


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Author Details: Shiva Shankar Jha

Volume : 2

Issue : 1

Online ISSN : 2581-9151

Print ISSN : 2581-8112

Article First Page : 55

Article End Page : 59


Abstract

Introduction: Reaching a specific diagnosis in any field of medical science is a learning process and diagnosis in rheumatology may have a steep learning curve. An easy solution for arriving at diagnosis in rheumatology is recommended to adopt two-step diagnosis.
Discussion: The first step based on symptoms and their duration defines the generic type of pathology in question and basic symptoms are related to anatomic compartment as source of symptom. After this first step, final diagnosis is not too far away. At the end of this first step, patient’s condition is described as a rule, needing not more than ten words.
In the second step, detailed investigation to distinguish between conditions causing these symptoms is proceeded and explored leading to a differential diagnosis map, which is based on available rheumatological knowledge. The way it is structured should be on line of reasoning.
Structuring of clinical reasoning process necessarily improves with experience but rheumatic diseases are known to defy any rigid syndromic classification and systemic lupus erythematosus is a classical example presenting with predominant articular symptoms or a variety of extra articular symptoms.
Conclusion: Diagnosis of the syndrome and disease itself always requires a thorough well-planned questioning. It is not possible without a careful general examination of all the areas with presenting symptoms and thorough investigations.