The following are three rare treatable connective
tissue disorders, which could be strongly suspected and even diagnosed by clinical examination:

1. PMR (Polymyalgia Rheumatica) - In private practice, it is very common to see patients having bilateral frozen shoulder (one old but recovered incompletely and 2nd with fresh symptoms).
   It is very important to remember that in such a patient who is middle aged or elderly, who not only has symptoms like bilateral frozen shoulder, but also has:
   
   1. Severe early morning stiffness of the shoulders lasting for ½ - 1 hour
   2. Body ache and aches over rest of the trunk, joints
   3. Symptoms of fever with loss of appetite, loss of weight, etc. then the disease of PMR should be strongly suspected. A raised ESR is enough to confirm the diagnosis and to start with the therapeutic test of Prednisolone 10 mg daily, and the patient will be free of symptoms within 10 days.
2. Periarteritis Nodosa - Hypertension is very common in 20-30% of the population but if a young or middle aged hypertensive patient comes for severe systemic symptoms of weakness, paraesthesias, joint pains, loss of appetite, loss of weight, fever, oedema anywhere, dyspnoea on exertion and has anaemia on examination or diminished ankle or knee jerks - all these symptoms call for excluding Periarteritis Nodosa by asking for CBC, routine urine exam, HBs Ag, ANCA, EMG-nerve conduction studies and possibly Visceral Angiography (CT), followed in the end by tissue biopsy.
3. Wegner’s Granulomatosis - should be suspected in any patient who has a lung shadow but the sputum repeatedly shows absence of AFB. The systemic symptoms of such a patient are even more than a patient of pulmonary Koch’s with severe bodyache, joint pains, oedema of the legs, some skin signs and fever with loss of appetite and weight which have not responded to AKT.
   If the diagnosis is confirmed with positive ANCA test and positive HBs Ag or anti HCV, the patient will respond well to a combination of steroids and cyclophosphamide or Azathioprin.