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Difficulty: EasyRheumatology and Immunology

Match each classic physical examination or imaging finding to its most likely rheumatologic diagnosis.

  • Heliotrope rash and Gottron papulesDermatomyositis
  • Malar rash sparing the nasolabial foldsSystemic lupus erythematosus
  • Acute, exquisitely tender swelling of the first metatarsophalangeal jointGout
  • Progressive lower back pain with morning stiffness and sacroiliitis on imagingAnkylosing spondylitis

Answer

Heliotrope rash/Gottron papules matches with Dermatomyositis; Malar rash matches with Systemic lupus erythematosus; Acute first MTP swelling (podagra) matches with Gout; Sacroiliitis matches with Ankylosing spondylitis.
Each provided clinical vignette highlights the most iconic and highly tested physical examination or imaging finding for its respective rheumatologic condition, requiring direct pattern recognition.

Step-by-Step Solution

1
Evaluate the cutaneous findings of a heliotrope rash and Gottron papules.
Identified as dermatomyositis.
These are highly specific pathognomonic skin signs of this inflammatory myopathy.
2
Evaluate the malar rash that spares the nasolabial folds.
Identified as systemic lupus erythematosus.
Sparing of the nasolabial folds distinguishes the SLE malar rash from conditions like rosacea or seborrheic dermatitis.
3
Evaluate the acute swelling of the first metatarsophalangeal joint.
Identified as gout.
This specific joint involvement is called podagra, characteristic of monosodium urate crystal deposition.
4
Evaluate the progressive lower back pain with sacroiliitis.
Identified as ankylosing spondylitis.
This is a seronegative spondyloarthropathy characterized by inflammation of the axial skeleton, particularly the sacroiliac joints.

Key Concept

Classic clinical presentations in rheumatology
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Topics

Rheumatology and Immunology

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