Common Arthritides Flashcards
Evaluation of joint pain (5)
Articular or nonarticular?
Inflammatory or noninflammatory?
Acute or chronic?
Pattern of involvement
Associated symptoms or signs
Additional:
Articular problem usually indicates arthritis of some sort.
Exceptions include meniscal injuries in the knee, intra-articular loose body or fracture (including avascular necrosis of the bone), hemarthrosis and rare joint tumors.
Non-articular problems causing pain around a joint can include bursitis, tendonitis, enthesitis, ligamentous and muscular injuries or problems.
True joint problem should have restriction in all ROM vs tendonitis which may be just certain movements. Most painful is reaching the limit of joint motion.
Inflammatory – swelling, warmth, rarely redness (septic is red, not RA)
Acute < 6 weeks
Acute inflammation; septic, hemarthrosis, crystal arthropathy
Pattern – symmetry, size, number (oligoarticular is 2-4 joints), axial skeleton involvement (thoracic or lumbar spine or SI joints)
Chronic, inflammatory, symmetrical, small joint polyarthritis; RA, psoriatic arthritis, connective tissue disorders
Chronic, inflammatory, asymmetrical, large joint polyarthritis with spine involvement; seronegative spondyloarthropathies
Clinical features of rheumatoid arthritis (7)
Joint pain/swelling
Synovitis
Stiffness following inactivity
Joint swelling/tenderness
Systemic ‘flu-like’ features
Extra-articular features
Usually affects joints symmetrically
RA diagnostic criteria (7)
- must have at least 4/7 for 6 weeks
Morning stiffness
Arthritis of 3 or more joints
Arthritis of hand joints
Symmetric arthritis
Rheumatoid nodules
Serum rheumatoid factor
Radiographic changes
Extraarticular features of RA (6)
Skin: rheumatoid nodules, vasculitis
Sjorgen’s syndrome
Eyes: conjuctivitis, episcleritis, scleritis
Pulmonary: effusions, nodules, fibrosis, BOOP
Neurologic: peripheral neuropathy, atlantoaxial subluxation, CNS vasculitis
Cardiac: pericarditis, myocarditis, valvular disease, conduction abnormalities
What is Felty’s syndrome (4)?
RA + splenomegaly + cytopenias + higher risk for lymphoma
Lab investigation in RA
CBC
Serology:
RF - autoantibody against IgG
ESR
ANA
Management for RA (2)
Physiotherapy
Occupational therapy
Medication for RA
DMARDs - disease modifying anti-rheumatic drugs
simple analgesics and NSAIDs
steroids
hydroxychloroquine 200-400 mg/d
sulphasalazine 500-3000 mg/d
and methotrexate 15-25 mg/week
injectable gold salts
cyclosporine
azathioprine
cyclophosphamide
newer treatment: anti-cytokines (infliximab and etanercept)
What is the most prevalent arthritic condition in adult population?
Osteoarthritis
Symptoms of osteoarthritis (5)
- joint paint in weight bearing joints (spine, knee, hand, foot), improved by rest
- brief morning stiffness (5-10min)
- tender joints
- bony enlargement
- crepitus
Diagnostic criteria for osteoarthritis (7)
Pain in the knee + 3 of the following:
age > 50
< 30min morning stiffness
crepitus on active motion
bony tenderness
bony enlargement
no palpable warmth of synovium
X-ray findings on osteoarthritis (5)
primarily affects cartilage
focal erosive lesions
cartilage destruction and subchondral sclerosis
bone cyst formation
large osteophytes
Management of osteoarthritis (4)
patient education
aerobic exercise program
physical therapy
occupational therapy
Medication for osteoarthritis
Mild-moderate pain: paracetamol (up to 4g)
Moderate-severe pain: NSAID
Steroid injection if there is effusion, but no more than 4x per year
if this doesnt work III step is surgery
What are COXIBs? (2)
Specifically inhibit cyclo-oxygenase II enzyme
Beneficial in controlling pain and inflammation without interfering with platelet, upper GI tract, or renal function
