Table 4.

Signs and symptoms to be assessed in the suspicion of a rheumatological disease.

Clinical manifestation of autoimmune disease	Description
Joint involvement	Any swollen or tender joint on examination excluding distal interphalangeal joints, first carpometacarpal joints, and first metatarsophalangeal joints are excluded from assessment. Synovitis could be confirmed by imaging (Definition according 2010 Rheumatoid Arthritis Classification Criteria)
Raynaud syndrome	A vascular disorder especially of the fingers and toes, that is characterized by pallor, cyanosis, and redness in succession usually upon exposure to cold
Puffy fingers or sclerodactyly	Swelling or thickening of fingers
Distal digital tip ulceration	Loss of epithelialization and tissues involving, in different degrees, the epidermis, the dermis, the subcutaneous tissue, and sometimes also involving the bone
Telangiectasia	Small dilated-blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 ml in diameter, especially localized on finger or face
Mechanics hand	Rough, cracked, hyperkeratotic, aspect of palmar areas of the fingers with fissures of the skin
Sicca syndrome	Sensation of dryness of eyes and/or mouth daily and persistent for 3 months (52)
Gottron signs	Fixed rash or patches on the extensor surfaces of the joints (especially elbows and/or knees)
Gottron papules	Erythematous to violaceous papules and plaques over the extensor surfaces of the metacarpophalangeal and interphalangeal joints
Eliotrophic rash	Violaceous erythema of the upper eyelids often with associated edema and telangiectasia
Fever	Unexplained by other causes
Muscle weakness	Weakness of proximal upper and lower extremities as Distal muscles are less involved. Weakness of neck flexors is usually more severe than of neck extensors (53)
Dysphagia	Difficulty in swallowing