The GALS Screen Flashcards

1
Q

Define the following terms:

a. Arthritis
b. Arthralgia
c. Subluxation
d. Synovitis
e. Dislocation

A

a. Arthritis
Refers to definite inflammation of a joint
b. Arthralgia
Refers to pain within a joint without demonstrable inflammation by physical examination
c. Subluxation
Partial dislocation of a joint
d. Synovitis
Inflammation of the synovium
e. Dislocation
Articulating surfaces are displaced and are no longer in contac

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2
Q

What does GALS stand for?

A

Gait
Arms
Legs
Spine

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3
Q

What is gout caused by?

A

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

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4
Q

What are the key clinical features of gout?

A

Tophi – subcutaneous depositions of aggregated monosodium urate crystals
Gouty arthritis

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5
Q

Which joint is commonly affected by gouty arthritis?

A

1st Metatarsophalangeal joint – this is called podagra

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6
Q

List some signs of irreversible joint damage.

A

Joint deformity
Crepitus
Loss of joint range or abnormal movement

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7
Q

List some signs of a mechanical defect in the joint.

A

Painful restriction of movement in the absence of features of inflammation
Instability

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8
Q

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

A

2-4

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9
Q

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

A

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

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10
Q

What is the main extra-articular feature of gout?

A

Tophi – subcutaneous deposits of uric acid

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11
Q

What are the two types of synovial lining cell?

A

Typa A – macrophage-like

Type B – fibroblast-like (secrete hyaluronic acid)

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12
Q

What is a synovial effusion?

A

Abnormal increase in synovial fluid volume

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13
Q

State two causes of spinal effusion and describe the synovial fluid composition in each of them.

A

Abnormal mechanical stimulation – can stimulate the fibroblasts to produce more hyaluronic acid – normal composition
Inflammation – inflammatory exudate – abnormal composition with inflammatory mediators and reduced hyaluronic acid

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14
Q

What features of the synovial fluid are examined to determine the cause of the synovial effusion?

A

How turbid it is
The presence and quantity of inflammatory cells (neutrophils in particular)
Non-inflammatory – slightly turbid – osteoarthritis or mechanical defects
Inflammatory – turbid – reactive arthritis or gout
Infection – very turbid – bacterial infection

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15
Q

When is synovial fluid examination performed?

A

When joint infection is suspected

Useful for confirming diagnosis of crystal arthritis

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16
Q

What are some contraindications for arthrocentesis?

A

Conditions that increase bleeding e.g. coagulopathy or anti-coagulant drugs
Overlying skin infection

17
Q

List some possible complications of arthrocentesis

A

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

18
Q

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

A

Polarising light microscopy

19
Q

How is gout distinguished from pseudogout in synovial fluid examination?

A
Gout  
 Urate crystals 
 Needle shaped 
 Negative birefringence (polarising light microscopy)
Pseudogout 
 Calcium pyrophosphate dehydrate (CPPD) crystals  
 Brick shaped  
 Positive birefringence
20
Q

What is a common feature of most connective tissue diseases?

A

Raynaud’s phenomenon (intermittent vasospasm of the digits on exposure to the cold)

21
Q

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

A
Autoimmune exocrinopathy  
Symptoms: 
Dry eyes (xerophthalmia) 
Dry mouth (xerostomia) 
Parotid gland enlargement  
Extra-glandular features: non-erosive arthritis + Raynaud’s
22
Q

Which antibodies are associated with Sjogren’s syndrome?

A

ANA
Anti-Ro
Anti-La
Rheumatoid factor

23
Q

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

A

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

24
Q

Describe the skin changes that take place in dermatomyositis.

A

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)

25
Q

Which antibodies are associated with inflammatory muscle disease? what other clin findings from tests are there?

A

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

26
Q

What other diseases is inflammatory muscle disease associated with?

A

Pulmonary fibrosis and Malignancy

27
Q

What is systemic sclerosis?

A

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

28
Q

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

A

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

29
Q

What is overlap syndrome? Example and antibodies associated

A

When feature of more than one connective tissue disease are present

  • mixed connective tissue disease: have features of SLE, sleroderma, rhem arth and polymyositis
  • linked by anti-u1-RNP antibody