Per Fingerzeig zur Diagnose

Zusammenfassung

Inspektion und Palpation der Finger zählen zu den wesentlichen Werkzeugen der körper-lichen Untersuchung des Rheumatologen. Dies liegt daran, dass sehr typische und für bestimmte Diagnosen hochspezifische Befunde an den Fingern erhoben werden können. Mit etwas Erfahrung bzw. Kenntnis der möglichen Befunde können dabei mit einem Blick Diagnosen gestellt, bzw. zumindest wichtige diagnostische Hinweise dafür gefunden werden. Die wichtigsten dieser Befunde, deren Pathophysiologie und deren Bedeutung in den Klassifikationskriterien der entsprechenden Erkrankungen werden in dieser Übersicht dargestellt.

Summary

Inspection and palpation of the fingers belong to the main tools of physical examination for rheumatologists. This is because very typical and for often highly specific findings can be observed at the fingers. With some experience and knowledge of the possible manifestations it is possible to instantly make visual diagnosis or at least to give important hints for them. The most important findings, their pathophysiology and their importance for current classification criteria of rheumatic diseases are described in this article.

Schlüsselwörter

Blickdiagnostik - Finger - Inspektion - Palpation

Keywords

Visual diagnosis - finger - inspection - palpation

• Literatur

• 1 Aletaha D, Neogi T, Silman AJ. et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69 (09) 1580-1588.
• 2 Grunke M, Antoni CE, Kavanaugh A. et al. Standardization of joint examination technique leads to a significant decrease in variability among different examiners. J Rheumatol 2010; 37 (04) 860-864.
• 3 Taylor W, Gladman D, Helliwell P. et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006; 54 (08) 2665-2673.
• 4 McGonagle D, Lories RJ, Tan AL, Benjamin M. The concept of a „synovio-entheseal comple’ and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum 2007; 56 (08) 2482-2491.
• 5 Tan AL, Fukuba E, Halliday NA. et al. High-resolution MRI assessment of dactylitis in psoriatic arthritis shows flexor tendon pulley and sheath-related enthesitis. Ann Rheum Dis 2015; 74 (01) 185-189.
• 6 Chandran V, Gladman DD, Helliwell PS, Gudbjornsson B. Arthritis mutilans: a report from the GRAPPA 2012 annual meeting. J Rheumatol 2013; 40 (08) 1419-1422.
• 7 Haddad A, Johnson SR, Somaily M. et al. Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review. J Rheumatol 2015; 42 (08) 1432-1438.
• 8 Shmerling RH, Stern SH, Gravallese EM, Kantrowitz FG. Tophaceous deposition in the finger pads without gouty arthritis. Arch Intern Med 1988; 148 (08) 1830-1832.
• 9 López Redondo MJ, Requena L, Macía M. et al. Fingertip tophi without gouty arthritis. Dermatology 1993; 187 (02) 140-143.
• 10 Gallagher E, Ruiter T. „Gangrenous Finger“ Proven to be Acute Gout. Eplasty 2015; 15: ic29 eCollection 2015
• 11 Troyanov Y, Targoff IN, Payette MP. et al. Redefining dermatomyositis: a description of new diagnostic criteria that differentiate pure dermatomyositis from overlap myositis with dermatomyositis features. Medicine (Baltimore) 2014; 93 (24) 318-332.
• 12 Bachmeyer C, Tillie-Leblond I, Lacert A. et al. Int J Dermatol. „Mechanic’s hands“: a misleading cutaneous sign of the antisynthetase syndrome. Br J Dermatol 2007; 156 (01) 192-194.
• 13 Mii S, Kobayashi R, Nakano T. et al. A histopathologic study of mechanic’s hands associated with dermatomyositis: a report of five cases. Int J Dermatol 2009; 48 (11) 1177-1182.
• 14 Bouaziz JD, Barete S, Le Pelletier F. et al. Cutaneous lesions of the digits in systemic lupus erythematosus: 50 cases. Lupus 2007; 16 (03) 163-167.
• 15 Petri M, Orbai AM, Alarcón GS. et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64 (08) 2677-2686.
• 16 Boada A, Bielsa I, Fernández-Figueras MT, Ferrándiz C. Perniosis: clinical and histopathological analysis. Am J Dermatopathol 2010; 32 (01) 19-23.
• 17 Lee-Kirsch MA, Wolf C, Kretschmer S, Roers A. Type I interferonopathies - an expanding disease spectrum of immunodysregulation. Semin Immunopathol 2015. in Druck
• 18 Fiehn C, König N, Günther C. et al. A family with dominant chilblain lupus due to an activating mutation of STING - induction of interferon genes and interferon-induced genes is reversible by treatment with the JAK-inhibitor tofacitinib. Arthritis Rheumatol 2015. 67 (suppl 10)
• 19 Minier T, Guiducci S, Bellando-Randone S. et al. EUSTAR co-workers. Preliminary analysis of the very early diagnosis of systemic sclerosis (VEDOSS) EUSTAR multicentre study: evidence for puffy fingers as a pivotal sign for suspicion of systemic sclerosis. Ann Rheum Dis 2014; 73 (12) 2087-2093.
• 20 Alhajeri H, Hudson M, Fritzler M. et al. 2013 American College of Rheumatology/European League against rheumatism classification criteria for systemic sclerosis outperform the 1980 criteria: data from the Canadian Scleroderma Research Group. Arthritis Care Res (Hoboken) 2015; 67 (04) 582-587.
• 21 van den Hoogen F, Khanna D, Fransen J. et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72 (11) 1747-1755.
• 22 Wirz EG, Jaeger VK, Allanore Y. et al. EUSTAR coauthors. Incidence and predictors of cutaneous manifestations during the early course of systemic sclerosis: a 10-year longitudinal study from the EUSTAR database. Ann Rheum Dis 2015 Jul 31. [Epub ahead of print]
• 23 Remvig L, Jensen DV, Ward RC. Are diagnostic criteria for general joint hypermobility and benign joint hypermobility syndrome based on reproducible and valid tests? A review of the literature. J Rheumatol 2007; 34 (04) 798-803.
• 24 Rombaut L, Malfait F, Cools A. et al. Musculoskeletal complaints, physical activity and health-related quality of life among patients with the Ehlers-Danlos syndrome hypermobility type. Disabil Rehabil 2010; 32 (16) 1339-1345.