Clinical features of inflammatory connective tissue diseases

The diagnosis of an inflammatory connective tissue disease is predominantly based on clinical assessment. These diseases share many clinical features, in particular:

• arthralgias—pain in one or more joints
• myalgias—pain in one or more muscles
• rash and photosensitivity
• arthritis—inflammation in one or more joints; less common than arthralgias and myalgias; rarely erosive arthritis
• fatigue
• Raynaud phenomenon—vasospasm of the digits
• sicca symptoms—dry mouth or dry eyes caused by exocrine gland dysfunction, particularly of the salivary or lacrimal glands.

The shared features make the diagnosis of a specific inflammatory connective tissue disease difficult, particularly early in the course of the disease before specific clinical features develop.

The presenting symptoms of inflammatory connective tissue diseases may be nonspecific (eg fatigue, pain, paraesthesia, dry eyes). People whose only symptom is fatigue are unlikely to have a specific inflammatory connective tissue disease. A thorough history and physical examination is essential to distinguish between symptoms and signs of an inflammatory connective tissue disease, versus a nonspecific systemic upset.

Management for the common clinical symptoms of inflammatory connective tissue diseases is discussed separately.