arthritis symptoms pictures

Understanding arthritis symptoms pictures is crucial for early detection and effective management of various inflammatory and degenerative joint conditions. This comprehensive guide details the visual manifestations of different arthritis types, offering in-depth insights into what to look for on your skin, in your joints, and the surrounding tissues to facilitate timely intervention.

arthritis Symptoms Pictures

Identifying the visual cues associated with arthritis is a cornerstone of early diagnosis and effective management. When observing potential arthritis symptoms pictures, healthcare professionals and individuals often focus on specific changes in and around the joints. These visual indicators can vary significantly depending on the type of arthritis but frequently include a range of noticeable alterations.

A primary visual symptom is joint swelling, which can manifest in diverse ways. In inflammatory arthritis, such as rheumatoid arthritis (RA) or psoriatic arthritis (PsA), swelling often presents as a soft, boggy, or fusiform (spindle-shaped) enlargement of the affected joint. For instance, in RA, the proximal interphalangeal (PIP) joints and metacarpophalangeal (MCP) joints of the hands frequently display this symmetrical, swollen appearance. The skin over these swollen joints may appear taut and shiny due to fluid accumulation. In contrast, osteoarthritis (OA) swelling might be harder and bony, particularly at the distal interphalangeal (DIP) and PIP joints, where bony growths known as Heberden’s and Bouchard’s nodes develop. Gout attacks, another form of arthritis, are characterized by extremely acute, painful swelling, often in the big toe (podagra), accompanied by vivid redness and intense heat, making even light touch unbearable.

Redness (erythema) is another common visual sign, typically indicating inflammation. This symptom is prominent in acute inflammatory arthritides. For example, during a gout flare-up, the affected joint can turn a striking purplish-red hue. Septic arthritis, caused by infection, also presents with marked redness, warmth, and severe pain. In rheumatoid arthritis, persistent inflammation can lead to a less intense but noticeable erythema over affected joints, reflecting the underlying inflammatory process.

Deformities are advanced visual symptoms that emerge from chronic, untreated arthritis, particularly inflammatory types like RA. These irreversible changes significantly impact joint function and appearance. Common deformities include:

• Ulnar Deviation: Fingers bend towards the ulnar bone (little finger side) at the MCP joints, creating a characteristic “drift.”
• Swan-Neck Deformity: The DIP joint flexes, the PIP joint hyperextends, and the MCP joint flexes, resembling a swan’s neck.
• Boutonnière Deformity: The PIP joint is fixed in flexion, and the DIP joint is hyperextended, often affecting finger strength and dexterity.
• Z-Thumb Deformity: Flexion of the MCP joint and hyperextension of the interphalangeal joint of the thumb.
• Heberden’s Nodes: Bony enlargements at the DIP joints, characteristic of osteoarthritis, often visible as hard, painless lumps.
• Bouchard’s Nodes: Similar bony enlargements but located at the PIP joints, also common in osteoarthritis.

Nodules are specific visual manifestations seen in certain types of arthritis. Rheumatoid nodules are firm, non-tender lumps that develop under the skin, most commonly over pressure points like the elbows, knuckles, and Achilles tendons. They can vary in size from a pea to a golf ball. In gout, crystal deposits can form visible lumps called tophi. These chalky, whitish deposits typically appear on the ear helix, fingers, toes, elbows, and around joint capsules, sometimes breaking through the skin and discharging a white, paste-like material.

Muscle wasting (atrophy) can become visually apparent around severely affected and underused joints. Chronic pain and inflammation lead to decreased movement and muscle disuse, causing the muscles supporting the joint to shrink. This thinning of muscle mass can accentuate the appearance of swollen joints, making the contrast even more striking in arthritis symptoms pictures.

Other visual cues include shiny or stretched skin over swollen joints, especially if there is significant effusions or edema. Bruising may also be observed, particularly in individuals on certain medications or those with underlying vascular fragility.

Recognizing these diverse visual signs is critical for differentiating between arthritis types and guiding diagnostic efforts. A thorough visual examination, often supported by detailed arthritis symptoms pictures, forms an essential part of the diagnostic process, helping clinicians understand the extent and nature of the disease.

Signs of arthritis Pictures

Observing specific signs of arthritis pictures can provide valuable clues about the underlying inflammatory or degenerative processes affecting the joints and surrounding tissues. These visual indicators go beyond general swelling and redness, often pointing to the specific characteristics of different arthritic conditions. Understanding these detailed manifestations is essential for accurate diagnosis and management of joint disease.

One of the most striking visual signs is the pattern of joint involvement. In rheumatoid arthritis (RA), symptoms typically present as symmetrical polyarthritis, meaning the same joints on both sides of the body (e.g., both hands, both feet) are affected simultaneously. The small joints of the hands (MCPs, PIPs) and feet (MTPs) are classic sites, often showing fusiform swelling and tenderness. In contrast, psoriatic arthritis (PsA) often presents with asymmetrical oligoarthritis, affecting fewer joints and typically in an uneven pattern. PsA can also manifest as dactylitis, where an entire finger or toe appears uniformly swollen like a “sausage digit,” a highly characteristic visual sign. Osteoarthritis (OA) typically affects weight-bearing joints (knees, hips, spine) and the DIP/PIP joints of the hands, often unilaterally or bilaterally but not necessarily symmetrically in the same way as RA.

Heat and tenderness, though not always directly visible in a static picture, are palpable signs that often accompany visual cues like redness and swelling. An acutely inflamed joint, such as during a gout attack or a flare of inflammatory arthritis, will feel significantly warmer to the touch compared to surrounding skin. This heat is a direct result of increased blood flow to the inflamed area. Tenderness, while felt rather than seen, often corresponds to visibly swollen or reddened areas, indicating active inflammation.

Specific cutaneous manifestations are vital signs of arthritis pictures, particularly in conditions like systemic lupus erythematosus (SLE) and psoriatic arthritis. The butterfly-shaped malar rash across the cheeks and bridge of the nose is highly indicative of lupus. Discoid lupus lesions, which are red, raised patches with adherent scales and follicular plugging that can lead to scarring and permanent hair loss, are another key visual. Photosensitivity rashes, developing after sun exposure, also point towards lupus. For psoriatic arthritis, the presence of psoriasis plaques on the skin is a major diagnostic criterion. These distinct red patches covered with silvery scales are often found on extensor surfaces (elbows, knees), scalp, and lower back. Nail changes associated with psoriasis, such as pitting, onycholysis (separation of the nail from the nail bed), oil spots, and thickening, are powerful visual indicators that directly link skin psoriasis to potential joint involvement.

Another crucial visual sign in gout is the presence of tophi. These are painless, hard nodules of uric acid crystals that form under the skin or within joints and connective tissues. Tophi appear as yellowish or white lumps and are most commonly seen on the outer ear helix, around finger joints, toes, elbows, and sometimes within the olecranon bursa. Their presence confirms chronic hyperuricemia and often indicates advanced gout. In extreme cases, tophi can ulcerate and discharge a chalky, toothpaste-like substance.

Rheumatoid nodules, as previously mentioned, are firm, movable, or fixed subcutaneous lumps that typically appear on extensor surfaces (e.g., elbows, forearms) or other pressure points. While not always symptomatic, their presence strongly supports a diagnosis of rheumatoid arthritis, especially in conjunction with other joint symptoms. They vary in size and can sometimes ulcerate.

Enthesitis, inflammation where tendons or ligaments attach to bone, is a hallmark of spondyloarthropathies, including psoriatic arthritis and ankylosing spondylitis. While not always externally visible, severe cases can show localized swelling and tenderness at the tendon insertion sites. Common locations include the Achilles tendon, plantar fascia (causing heel pain), and elbow tendons (tennis elbow or golfer’s elbow-like symptoms).

Changes in joint mobility and posture, though dynamic, can also be inferred from static signs of arthritis pictures. A person with severe arthritis might exhibit:

• A guarded posture to protect painful joints.
• Visible stiffness or awkwardness in hand or foot positioning.
• Limited range of motion that can be observed if comparing a healthy joint to an affected one.
• In advanced ankylosing spondylitis, a severely stooped posture (kyphosis) due to spinal fusion.

These specific visual signs, when carefully assessed, significantly contribute to the diagnostic pathway for arthritis, allowing for better classification and tailored treatment strategies.

Early arthritis Photos

Early detection of arthritis is paramount for preventing irreversible joint damage and improving long-term outcomes. The challenge lies in recognizing subtle visual cues that may appear non-specific in early arthritis photos. However, understanding these initial signs can prompt timely medical evaluation and intervention. It’s crucial to look for minor changes that, while not dramatic, signify the onset of inflammatory or degenerative processes.

One of the most common early visual signs is subtle joint swelling. Unlike the overt, boggy swelling of established arthritis, early swelling might be minimal—a slight puffiness around a joint, especially noticeable in smaller joints like those of the fingers or toes. This puffiness might be more apparent in the morning or after periods of rest, subsiding somewhat during the day. In the hands, early rheumatoid arthritis can manifest as symmetrical, subtle swelling of the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joints, sometimes described as a “soft” or “spongy” feel upon palpation, rather than a firm, obvious lump. These changes might be asymmetrical in early psoriatic arthritis.

Mild redness (erythema) is another early indicator, often accompanying the subtle swelling. This might not be a vivid crimson but rather a faint pinkish hue over the affected joint. It’s a sign of increased blood flow due to inflammation. In early gout, the onset is typically acute and dramatic, but even here, the first visual clue might be a rapidly progressing redness and warmth in a single joint, most commonly the big toe.

While not a direct visual sign, morning stiffness is a cardinal early symptom that often correlates with the visual signs of inflammation. Patients describe it as difficulty moving joints upon waking, lasting more than 30 minutes (inflammatory arthritis) or less (mechanical arthritis). While not photographed, the *effect* of morning stiffness might be subtly visible in an individual’s posture or initial movements captured in an early arthritis photo, such as difficulty fully extending fingers or a hesitant gait.

Tenderness to touch, although a subjective symptom, often accompanies early visual changes. A joint that is slightly swollen and subtly red will likely also be tender. This tenderness can be localized precisely to the joint line or over the tendons attached to the joint (enthesitis in spondyloarthropathies).

For individuals with psoriatic arthritis, early skin or nail changes related to psoriasis can precede joint symptoms by months or even years. Therefore, recognizing psoriatic lesions in early arthritis photos is crucial. These can be small, localized patches of red, scaly skin or subtle pitting and discoloration of the fingernails or toenails. Early onycholysis (separation of the nail from the nail bed) or subtle changes in nail texture can be important clues, even if joint pain is minimal.

Fatigue is a common and often debilitating early symptom of inflammatory arthritis, particularly rheumatoid arthritis. While not a visual sign on its own, chronic fatigue can manifest indirectly in a person’s overall appearance, such as listlessness or reduced activity levels captured in a series of pictures over time.

In systemic lupus erythematosus (SLE), early rashes can be subtle. The malar rash might start as a faint pink blush across the cheeks, sometimes exacerbated by sun exposure, rather than a pronounced butterfly pattern. Early photosensitivity reactions, where skin becomes red or develops a rash after minimal sun exposure, can also be an early clue, prompting suspicion of autoimmune conditions that may involve the joints.

Small, soft nodules might appear very early in some forms of arthritis. In juvenile idiopathic arthritis (JIA) for example, subtle, evanescent salmon-pink rashes that appear and disappear quickly can be an early visual sign of systemic JIA (Still’s disease). Similarly, early rheumatoid nodules might be very small, barely palpable bumps under the skin near a joint.

Key indicators to search for in early arthritis photos include:

• Localized, mild swelling or puffiness, especially around finger or toe joints.
• Faint pink or reddish discoloration over one or more joints.
• Subtle difficulty with fine motor tasks, implying underlying joint stiffness or pain.
• Any new, unexplained skin rash, particularly if scaly, red, or light-sensitive.
• New onset of nail pitting or discoloration.
• An overall look of fatigue or malaise alongside joint discomfort.
• Asymmetrical involvement of a single joint, such as one swollen finger (dactylitis), which could signal early psoriatic arthritis.

These early visual signs, though subtle, are critical alerts. Recognizing them allows for earlier medical consultation, potentially leading to a diagnosis and treatment plan before significant, irreversible joint damage occurs.

Skin rash arthritis Images

The intersection of skin manifestations and joint disease is a critical area for diagnosis and management, particularly when reviewing skin rash arthritis images. Many forms of inflammatory arthritis are accompanied by distinct dermatological symptoms, often providing crucial diagnostic clues. These rashes can precede, coincide with, or follow the onset of joint symptoms, and their specific appearance helps differentiate between various conditions.

Psoriatic Arthritis (PsA) is perhaps the most well-known example where skin and joint disease are intrinsically linked. In skin rash arthritis images related to PsA, you would primarily observe psoriasis plaques. These are:

• Erythematous plaques: Red, well-demarcated patches.
• Silvery scales: Covered with characteristic silvery-white scales, often thick and adherent.
• Common locations: Extensor surfaces (elbows, knees), scalp, lower back, navel, and genital areas.
• Inverse psoriasis: Smooth, red patches in skin folds (armpits, groin).
• Guttate psoriasis: Small, drop-like lesions that appear suddenly, often after an infection.

Beyond plaques, PsA also presents with distinctive nail changes visible in skin rash arthritis images:

• Nail pitting: Small indentations or pits on the nail surface.
• Onycholysis: Separation of the nail plate from the nail bed, often with a yellowish-pink discoloration (oil spot).
• Hyperkeratosis: Thickening of the nail.
• Subungual debris: Accumulation of dead skin cells under the nail.

Systemic Lupus Erythematosus (SLE) is another autoimmune condition frequently associated with arthritis and diverse skin rashes:

• Malar rash (butterfly rash): A classic erythematous rash across the bridge of the nose and cheeks, sparing the nasolabial folds. It can be flat or slightly raised and is often exacerbated by sun exposure.
• Discoid lupus erythematosus (DLE): Raised, disk-shaped, erythematous patches with adherent scales and follicular plugging. These can lead to scarring, hyperpigmentation or hypopigmentation, and permanent hair loss, especially on the scalp.
• Subacute cutaneous lupus erythematosus (SCLE): Non-scarring, photosensitive rashes that can be annular (ring-shaped) or papulosquamous (red, scaly papules).
• Vasculitic lesions: Small, painful red or purpuric spots, often on the fingertips, toes, or lower legs, indicating inflammation of blood vessels.
• Oral ulcers: Painless ulcers on the hard palate or buccal mucosa.

Rheumatoid Arthritis (RA), while primarily a joint disease, can also have dermatological manifestations, though less commonly in the form of a generalized rash. However, specific skin changes can be seen in skin rash arthritis images associated with RA:

• Rheumatoid nodules: Firm, subcutaneous nodules on pressure points.
• Rheumatoid vasculitis: A rare but serious complication, causing skin ulcers, purpura, digital infarcts, or palpable purpura due to inflammation of small to medium-sized blood vessels.
• Palmar erythema: Redness of the palms, sometimes associated with systemic inflammation.
• Thinning or fragile skin: Often a side effect of long-term corticosteroid use, leading to easy bruising or skin tears.

Juvenile Idiopathic Arthritis (JIA), particularly the systemic onset type (Still’s disease), often presents with characteristic rashes:

• Evanescent salmon-pink rash: A non-itchy, macular (flat), or slightly raised rash that appears quickly, often with fever, and disappears within hours. It’s typically found on the trunk and proximal extremities.
• Knee-jerk phenomenon: A subtle rash that can be elicited by scratching the skin.

Dermatomyositis is a chronic inflammatory disease affecting muscles and skin, often presenting with arthritis-like symptoms (arthralgias). Its distinct skin findings are crucial for diagnosis:

• Gottron’s papules: Erythematous-to-violaceous (purplish-red) papules or plaques over the knuckles, elbows, and knees, sometimes with scaling.
• Heliotrope rash: A violaceous eruption on the eyelids, sometimes with swelling.
• Shawl sign: A diffuse, flat, erythematous rash over the back and shoulders, exacerbated by sun exposure.
• V-neck sign: Similar rash on the chest.
• Periungual erythema: Redness around the nail folds, often with dilated capillary loops (visible with a dermatoscope).

Scleroderma (Systemic Sclerosis), a connective tissue disease that can cause arthritis, has prominent skin manifestations:

• Skin thickening/tightening: Initial puffiness of fingers, progressing to taut, shiny skin that restricts movement. Raynaud’s phenomenon (color changes in fingers/toes in response to cold/stress) is often an early sign.
• Telangiectasias: Small, dilated blood vessels (spider veins) on the face, hands, and mucous membranes.
• Calcinosis: White or yellowish calcium deposits under the skin, often on fingertips or over joints, which can sometimes ulcerate.

Other conditions with arthritis and skin rashes include:

• Erythema Nodosum: Painful, tender, red nodules, usually on the shins. Can be associated with sarcoidosis, inflammatory bowel disease, or infections, all of which can have associated arthritis.
• Sweet’s Syndrome (Acute Febrile Neutrophilic Dermatosis): Characterized by sudden onset of tender, erythematous plaques or nodules, fever, and neutrophilia, often with arthralgias.
• Behçet’s Disease: Recurrent oral and genital ulcers, skin lesions (erythema nodosum-like, papulopustular lesions), and often arthritis.

Examining skin rash arthritis images is an indispensable part of diagnosing many rheumatic conditions. The unique morphology, distribution, and associated features of these rashes provide critical clues that guide clinicians toward the correct diagnosis and appropriate treatment strategy for both the skin and joint involvement.

arthritis Treatment

Once arthritis symptoms, potentially identified through careful examination of arthritis symptoms pictures and further diagnostic tests, are confirmed, a comprehensive treatment plan is essential. The primary goals of arthritis treatment are to alleviate pain, reduce inflammation, prevent joint damage, improve joint function, and enhance the patient’s quality of life. Treatment strategies are highly individualized, depending on the specific type of arthritis, its severity, and the patient’s overall health.

Pharmacological Interventions

Medications form the cornerstone of arthritis treatment, targeting various aspects of the disease process. The choice of medication is crucial for effective management and for preventing the progression of visible symptoms like joint deformity and severe inflammation.

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs):
  • Mechanism: Reduce pain and inflammation by inhibiting cyclooxygenase (COX) enzymes.
  • Examples: Ibuprofen, naproxen, celecoxib.
  • Role: Often the first-line treatment for symptomatic relief in various arthritis types, helping to reduce visible redness and swelling, especially in inflammatory flares.
  • Considerations: Can have gastrointestinal, cardiovascular, and renal side effects with long-term use.
• Disease-Modifying Antirheumatic Drugs (DMARDs):
  • Mechanism: Slow down or stop the underlying inflammatory process that causes joint damage and deformity.
  • Conventional DMARDs Examples: Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide.
  • Role: Essential for rheumatoid arthritis, psoriatic arthritis, and other inflammatory arthritides to prevent the progression of joint destruction and visible deformities seen in advanced arthritis symptoms pictures. Methotrexate is also used for severe psoriasis.
  • Considerations: Require regular monitoring for side effects (e.g., liver function, blood counts).
• Biologic DMARDs (Biologics):
  • Mechanism: Target specific molecules in the immune system involved in inflammation (e.g., TNF-alpha, IL-6, T-cells, B-cells).
  • Examples: Adalimumab, etanercept, infliximab (TNF inhibitors); tocilizumab (IL-6 inhibitor); rituximab (B-cell depletor); abatacept (T-cell co-stimulation modulator); secukinumab, ixekizumab (IL-17 inhibitors); ustekinumab (IL-12/23 inhibitor).
  • Role: Used for moderate to severe inflammatory arthritis (RA, PsA, ankylosing spondylitis) when conventional DMARDs are insufficient. They are highly effective in reducing inflammation, preventing joint damage, and improving skin lesions associated with psoriatic arthritis.
  • Considerations: Administered via injection or infusion; risk of infections and other specific side effects.
• Targeted Synthetic DMARDs (tsDMARDs or JAK inhibitors):
  • Mechanism: Orally administered small molecules that inhibit Janus kinase (JAK) pathways involved in intracellular signaling of inflammatory cytokines.
  • Examples: Tofacitinib, baricitinib, upadacitinib.
  • Role: Used for moderate to severe RA and PsA, offering an alternative to biologics.
  • Considerations: Oral medication, but with specific side effect profiles requiring monitoring.
• Corticosteroids (e.g., Prednisone):
  • Mechanism: Potent anti-inflammatory and immunosuppressive agents.
  • Role: Used for acute flares of inflammatory arthritis (e.g., RA, lupus arthritis, gout) to rapidly control symptoms, including redness, swelling, and pain. Can be administered orally, intravenously, or via intra-articular injection (directly into the joint).
  • Considerations: Long-term use carries significant side effects (osteoporosis, weight gain, thinning skin, increased infection risk, diabetes).
• Uric Acid-Lowering Drugs (for Gout):
  • Mechanism: Reduce the production of uric acid or enhance its excretion to prevent crystal formation.
  • Examples: Allopurinol, febuxostat (xanthine oxidase inhibitors); probenecid (uricosuric agent).
  • Role: Essential for preventing recurrent gout attacks and dissolving visible tophi.
• Topical Treatments:
  • Mechanism: Applied directly to the skin to reduce localized pain, inflammation, or treat rashes.
  • Examples: Topical NSAIDs (diclofenac gel), capsaicin cream, corticosteroids (for psoriatic plaques or lupus rashes), calcineurin inhibitors.
  • Role: Provide symptomatic relief for superficial joint pain or manage specific skin rashes associated with arthritis without systemic side effects.

Non-Pharmacological Approaches

Complementary to medication, several non-pharmacological interventions are vital for managing arthritis symptoms and improving functional outcomes.

• Physical Therapy (PT):
  • Focus: Exercise programs to improve strength, flexibility, range of motion, and reduce pain.
  • Benefits: Helps maintain joint integrity, prevents muscle atrophy around affected joints, and improves functional mobility.
  • Techniques: Strengthening exercises, stretching, aerobic conditioning, joint mobilization.
• Occupational Therapy (OT):
  • Focus: Adapting daily activities and environments to reduce joint stress and conserve energy.
  • Benefits: Provides assistive devices (e.g., jar openers, long-handled shoehorns), splints, or braces to support joints, correct early deformities, and protect joints from further damage. This helps individuals maintain independence despite visible or functional limitations.
  • Techniques: Joint protection education, energy conservation strategies, adaptive equipment recommendations.
• Lifestyle Modifications:
  • Weight Management: Reducing excess weight significantly lessens stress on weight-bearing joints (knees, hips, spine), particularly crucial for osteoarthritis management.
  • Regular Exercise: Low-impact activities like swimming, cycling, and walking can improve joint flexibility, muscle strength, and overall well-being.
  • Dietary Changes: For gout, avoiding purine-rich foods (red meat, seafood, alcohol) helps manage uric acid levels. An anti-inflammatory diet (rich in fruits, vegetables, omega-3 fatty acids) may benefit some inflammatory arthritides.
  • Smoking Cessation: Smoking is a known risk factor for developing and worsening inflammatory arthritis like RA and PsA.
  • Stress Management: Chronic stress can exacerbate autoimmune conditions; techniques like meditation and mindfulness can be beneficial.
• Heat and Cold Therapy:
  • Heat: Warm baths, hot packs can relax muscles and increase blood flow, reducing stiffness and pain.
  • Cold: Ice packs can numb painful areas and reduce acute swelling and inflammation.

Surgical Interventions

For severe joint damage or deformity that significantly impairs function and does not respond to conservative measures, surgical options may be considered.

• Joint Replacement (Arthroplasty):
  • Procedure: Replaces damaged joint surfaces with prosthetic components (e.g., total knee replacement, total hip replacement).
  • Role: Provides significant pain relief and restores function in end-stage osteoarthritis and severe inflammatory arthritis. It also visually corrects severe deformities.
• Joint Fusion (Arthrodesis):
  • Procedure: Fuses bones in a joint together to eliminate movement, providing stability and pain relief.
  • Role: Used for smaller joints (e.g., wrist, fingers, ankles) when replacement isn’t feasible, often for severe deformities or instability.
• Synovectomy:
  • Procedure: Surgical removal of the inflamed synovium (joint lining).
  • Role: Can reduce pain and swelling in early inflammatory arthritis when medication is insufficient or for preventing damage.
• Tendon Repair:
  • Procedure: Surgical repair of torn or damaged tendons around arthritic joints.
  • Role: Addresses specific complications and can improve joint stability and function.

Effective arthritis treatment is a continuous process that often involves a multidisciplinary team, including rheumatologists, physical therapists, occupational therapists, orthopaedic surgeons, and primary care physicians. Regular monitoring and adjustments to the treatment plan are necessary to manage the disease effectively, control symptoms, and prevent the progression of visible damage evident in advanced arthritis symptoms pictures.