Inflammation withing the musculoskeletal system

Question 1

State the WHO classification of the rheumatic diseases

Answer 1

• Back pain
• Regional periarticular or ‘soft-tissue’ diseases
• Osteoarthritis and related disorders
• Inflammatory arthropathies
• Osteoporosis and metabolic bone diseases

Question 2

Define enthesitis

Answer 2

Inflammation where a tendon inserts into a bone

Question 3

Give an example of an ethesis involving the achilles tendon

Answer 3

• Enthesis is where a tendon inserts into bone

- eg the achilles tendon attaches to calcaneus (heel bone)

Question 4

Define olecranon bursitis

Answer 4

bursitis at the tip of the elbow

Question 5

Define tenosynovitis

Answer 5

-Inflammation of the synovium that surrounds the tendon, leading to joint pain,swelling & stiffness

Question 6

Define dactylitis

Answer 6

swelling of an entire digit eg finger

Question 7

Define spondylitis

Answer 7

Inflammatory condition of the spine. This is a degenerative change

Question 8

How can we categorise rheumatology

Answer 8

1. ) Non-inflammatory
   - drugs that modulate the immune system will have no effect
2. ) Inflammatory

Question 9

What are the 4 cardinal signs of inflammation

Answer 9

• Dolor= pain
• Calor=increased heat
• Tumor= swelling
• Rubor= redness

Question 10

State some inflammatory arthropathies

Answer 10

• RA
• Juvenile idiopathic arthritis
• Seronegative spondyloarthropathies
• Crystal arthritis
• Connective tissue diseases and vasculitides
• septic arthritis

Question 11

Outline multisystem diseases

Answer 11

• connective tissue diseases eg SLE, Scleroderma, dermatomyositis
• Vasculitis
• Relapsing polychondritis
• Periodic fever syndromes
• Sarcoid

Question 12

Explain how we come to a rheumatological diagnosis

Answer 12

• History
• Examination (urinalysis)
• Supporting evidence : radiological;antibodies
• Pathological: synovial fluid/biopsy; lupus nephritis, skin rash, myositis,vasculitis

Question 13

How can we define a clinical syndrome?

Answer 13

1. ) Onset
   - acute, chronic
2. ) Arthralgia or arthritis
   - is there definite joint swelling
3. ) Distribution
   - Mono,oligo or polyarticular
   - symmetrical
4. ) Other features
   - rashes, mouth ulcers etc

Question 14

Which autoimmune diseases is diurnal variation common to?

Answer 14

• Crohn’s disease
• Asthma
• Rheumatoid arthritis

Question 15

What presenting symptoms may someone with an autoimmune disease have

Answer 15

• Pain
• Swelling
• Stiffness
• Weakness
• Multisystem presentation: systemically unwell, PUO

Question 16

How can pain be described

Answer 16

'SOCRATES'
Site( joints-symmertrical/not; spine; muscles; everywhere)
Onset(sudden/gradual; progressive/recessive)
Character (paraesthesia)
Radiation
Association( any other symptoms?)
Time course(follow any pattern?)
Exacerbating/relieving factors
Severity

Question 17

Outline different patterns of joint involvement

Answer 17

• Very helpful in defining an arthritis
• Monoarticular ( 1 joint)
• Pauciarticulaer( up to 4 joints)
• Polyarticular(>4 joints)
• Aial ( predominantly spinal involvement)
• Symmetrical
• Large or small joints

Question 18

Outline some characteristic clinical signs of inflammation within the musculoskeletal system

Answer 18

• Sclerodactyl
• Nail changes
• Nodules
• Tophi
• Skin rashes ( photosensitive/vasculitic)

Question 19

what investigations can we use when diagnosing diseases associated with inflammation of the musculoskeletal system

Answer 19

• ESR/CRP
• FBC& biochemistry
• Antibodies( ANA, RhF, CCP, ENA,dsDNA, ANCA)
• Imaging
• Urine PCR/cytology
• Synvoial fluid analysis
• Biopsy( skin,synovium,kidney, muscle,lip)

Question 20

Describe the GALS examination

Answer 20

Gait
Arms
Legs
Spine

-Quick screening tool to detect locomotor abnormalities and functional disability in a patient