The GALS Screen

Question 1

Define arthritis

Answer 1

Refers to definite inflammation of a joint

Question 2

What does GALS stand for?

Answer 2

Gait
Arms
Legs
Spine

Question 3

What is gout caused by?

Answer 3

It is caused by deposition of monosodium urate (MSU) crystals as a result of hyperuricaemia

Question 4

Which joint is commonly affected by gouty arthritis?

Answer 4

1st Metatarsophalangeal joint – this is called podagra

Question 5

List some signs of irreversible joint damage.

Answer 5

Joint deformity
Crepitus
Loss of joint range or abnormal movement

Question 6

How many joints have to be involved for arthritis to be classifiedas ‘oligoarthritis’?

Answer 6

2-4

Question 7

Describe the pattern of arthritis in the following diseases including the joints that are commonly affected and spared:

a. Rheumatoid arthritis
b. Reactive arthritis
c. Gout

Answer 7

a. Rheumatoid arthritis
Symmetrical polyarthritis involving large and small joints
Joints spared: DIP, lumbar spine, thoracic spine
Joints involved: most others
b. Reactive arthritis
Lower limb asymmetrical oligoarthritis and axial involvement
c. Gout
Exclusive inflammation of the 1st metatarsophalangeal joint
Joints commonly spared: axial

Question 8

When is synovial fluid examination performed?

Answer 8

When joint infection is suspected

Useful for confirming diagnosis of crystal arthritis

Question 9

List some possible complications of arthrocentesis

Answer 9

Risk of introducing infection
Bleeding into the joint
Damage to structures of the joint

Question 10

What technique is used to detect crystals in the synovial fluid?

Answer 10

Polarising light microscopy

Question 11

How is gout distinguished from pseudogout in synovial fluid examination?

Answer 11

Gout  
 Urate crystals 
 Needle shaped 
 Negative birefringence (polarising light microscopy)
Pseudogout 
 Calcium pyrophosphate dehydrate (CPPD) crystals  
 Brick shaped  
 Positive birefringence

Question 12

What is Sjogren’s syndrome and what are its symptoms?

Answer 12

Autoimmune exocrinopathy  
Symptoms: 
Dry eyes (xerophthalmia) 
Dry mouth (xerostomia) 
Parotid gland enlargement  
Extra-glandular features: non-erosive arthritis + Raynaud’s

Question 13

Which antibodies are associated with Sjogren’s syndrome?

Answer 13

ANA
Anti-Ro
Anti-La
Rheumatoid factor

Question 14

What is inflammatory muscle disease and what are the two types?

Answer 14

Proximal muscle weakness due to autoimmune-mediated inflammation either with a rash (dermatomyositis) or without a rash (polymyositis)

Question 15

Describe the skin changes that take place in dermatomyositis.

Answer 15

Lilac rash on eyelid, malar region and naso-labial folds
Red or purple lesions on knuckles (Gottron’s papules)
Subcutaneous calcinosis
Mechanic’s hands (fissuring and cracking of the skin over the finger pads)

Question 16

Which antibodies are associated with inflammatory muscle disease?

Answer 16

ANA
Anti-tRNA transferase antibodies
NOTE: also associated with elevated creatine phosphokinase, abnormal EMG and abnormal muscle biopsy

Question 17

What is systemic sclerosis?

Answer 17

Thickened skin with Raynaud’s phenomenon Features include:
 Dermal fibrosis
 Cutaneous calcinosis
 Telangiectasia

Question 18

What are the two types of systemic sclerosis and what are the differences between them?

Answer 18

Diffused systemic sclerosis
 Fibrotic skin proximal to elbows or knees
 Anti-Scl-70 antibodies
 Pulmonary fibrosis and renal involvement
 SHORT history of Raynaud’s
Limited systemic sclerosis
 Fibrotic skin on hands, forearms, feet, neck and face
 Anti-centromere antibodies
 Pulmonary hypertension
 LONG history of Raynaud’s

Question 19

What is overlap syndrome?

Answer 19

When feature of more than one connective tissue disease are presen

Question 20

Define arthralgia

Answer 20

Joint pain without demonstratable inflammation on physical examination

Question 21

Dislocation

Answer 21

Articulating surfaces are displaced and no longer in contact

Question 22

Subluxation

Answer 22

Partial dislocation

Question 23

Synovitis

Answer 23

Inflammation of the synovium

Question 24

How to distinguish between gout and pseudogout

Answer 24

Birefringence test
Gout is negative
Pseudogout positive