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Learning Objectives > Joint Pain > Flashcards

Joint Pain Flashcards

1
Q

Type of collagen that is used to build bone (primarily)

A

Collagen 1

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2
Q

Bones that form via membranous ossification?

A

Skull, mandible, clavicle

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3
Q

What forms the urate crystals?

A

Breakdown of pyramidines - can see after heavy drinking, consuming lots of fats, can also see in chemotherapy patients

Can form tophi, first episode usually mono-articular, then can reoccur in a chronic form, distal great toe - big joint far from heart - drink lots of water

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4
Q

Pathogen spread via bacteraemia to cause a septic joints?

A

Gonorrhoea- can see skin lesions, as well as joint inflammation, and poly-articular, general malaise

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5
Q

What is rheumatic fever? Sx?

A

Group A strep (S. pyogenes) + autoimmune response - can lead to mitral valve stenosis/ myocarditis

Jones criteria - joints -migratory poly arthritis, heart, subcutaneous nodules, erythema marginatum, Sydenham chorea

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6
Q

What toxin is produced by group A strep?

A

M-protein

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7
Q

Risk factors for Ankylosing Spondylitis

A

Males, younger, autoimmune type 1 (bone) and 2 (cartilage) collagen, related to HLA- B27, but is RF negative

Insidious onset, better with exercise, presents with iritis, crohn’s often
Start with osteophytes, progresses to syndoesophytes

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8
Q

Psoriatic arthritis sx?

A

RH negative, can also be associated with HLA-B27, may or may not have the rash, joint erosion and deformity (pencil and cup)

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9
Q

Rheumatoid Arthritis Pathophysiology ?

A

Autoimmune, HLA associated, smoking, can be related to pathogen
Collagen structure change and attack, RF factor positive
Forms a pannus in the joint which leads to inflammation and synovial thickening

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10
Q

Sx of RA?

A

Can have extra-articular
Pleural effusions, liver - less iron absorption, pericarditis, nodules, plaques in blood vessels, fever, loss of muscle mass
Symmetrical multiple joints, common in hands

Flares - chronic, stiff after inactivity (AM stiffness), hand deformity EROSIVE

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11
Q

Red flags for limb pain?

A

POOP,&raquo_space;»>

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12
Q

Polymyositis vs dermatomyositis

A

Both have proximal, bilateral, symmetrical weakness

But dermatomyositis has skin symptoms.

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13
Q

OA Sx?

A

Inflammation + wear and tear, osteophytes, narrowing of the joint spaces, BUT not erosive, chronic and progressive, hx of fracture, obesity

T-spine sparing

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14
Q

Fibromyalgia sx?

A

Multiple MSK pain, ++fatigue and sleep disturbance, somatic, multiple cognitive disturbances, psychiatric sx, women young to middle aged the most common. Central sensitization. Past trauma, genetic or family factors.

FOR 3 MONTHS

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15
Q

Polymyalgia Rheumatica sx?

A

Increased inflammation ESR/CRP, aching shoulders hips and neck - morning stiffness - articular structures, abrupt onset, Bsx.

Watch out for Giant Cell Arteritis. Give them steroids low dose

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16
Q

Compartment syndrome sx?

A

POOP (pain out of proportion), think trauma or vascular disorders/ inflammation, loss of pulses below the site of the compartment

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17
Q

Tx for RA

A

DMARDS, biologics, analgesia, can use hydroxychloroquine, methotrexate

Classically it is a combo of methotrexate and NSAIDS

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18
Q

Gout Tx?

A

Allopurinol, stops the production of uric acid - preventative ONLY NOT DURING ATTACK
Colchicine - reduces inflammation, diarrhea - TI
Indomethicin
Prednisone

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19
Q

Sx of septic arthritis?

A

Mono-articular, pre-existing infection, most often due to S.Aureus or Streptococcus,

Look for single swollen joint (usually knee) with warmth restricted motion and fever. Collect fluid/ x-ray start on 7-14 Abx

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20
Q

Sx of gout flare after initial mono-articular presentation?

A

12 years after, can have tophi, kidney (colicky flank pain, stones, decreased urine output) complications, can reoccur in other joints.

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21
Q

Urate crystals under polarized light microscope?

A

Negatively birefringent

22
Q

STI which can lead to polyarticular joint pain?

A

Disseminated gonococcoemia - triad of tenosynovitis, polyarthralgias and dermatitis

Usually distal joints are effected.

23
Q

Scarlet fever sx?

A

Post strep infection - blanching sandpaper like body rash, strawberry tongue, circumoral pallor.

24
Q

Pathophysiology of ankylosing spondylitis

A

Autoimmune response destroys the fibroblasts and replaces them with fibrin which makes a band around the joints and limits ROM - osteoblasts will then ossify the fibrin.

25
Q

Sx of ankylosing spondylitis

A

Back pain, before 40, insidous, improved with exercise, not with rest, pain at night, responsive to NSAIDS

Look for hx - IBD, psoriasis, iritis

Investigate - ESR/CRP, X-ray

26
Q

Pathophysiology of psoriatic arthritis

A

inflammatory response in the body leads to T-cells can get into the joints and activate osteoblasts and clasts which will erode the joint

Should be RH and CYP negative (to differentiate from RA)

27
Q

Pathophysiology of RA?

A

Inflammation (smoking, pathogen, genetic) causes changes in collagen and immune system attacks with adaptive immune system leads to proliferation of synovial cells - makes a pannus = damage and erosion.

28
Q

Classic presentation of dermatomyositis?

A

Heliotrope rash, mechanics hands, gottron’s sign

29
Q

Tx for fibromyalgia?

A

Exercise and education, help with comorbidities, start on an SNRI - classically duloxetine

30
Q

What do you need to keep in mind with PMR?

A

Increased risk of Giant Cell Arteritis - be sure to screen regularly for SX

  • Tx for GCA is high dose steroids, PMR is low dose steroids
31
Q

Compartment syndrome causes?

A

Trauma, infection, burn, most common in leg, can also happen with massive fluid resuscitation

32
Q

Sx of compartment syndrome?

A

Loss of pulses distally, tense compartment, pain with passive stretch, loss of sensation and weakness, can measure pressure with manometer

33
Q

Tx of compartment syndrome

A

Fascitomy

34
Q

Things you can test in synovial fluid?

A

Culture and gram stains
Cell count and differential
Crystal examination

35
Q

Sx of septic arthritis?

A

Mono-articular, pre-existing infection, most often due to S.Aureus or Streptococcus,

Look for single swollen joint (usually knee) with warmth restricted motion and fever. Collect fluid/ x-ray start on 7-14 Abx

36
Q

Sx of gout flare after initial mono-articular presentation?

A

12 years after, can have tophi, kidney (colicky flank pain, stones, decreased urine output) complications, can reoccur in other joints.

37
Q

Urate crystals under polarized light microscope?

A

Negatively birefringent

38
Q

STI which can lead to polyarticular joint pain?

A

Disseminated gonococcoemia - triad of tenosynovitis, polyarthralgias and dermatitis

Usually distal joints are effected.

39
Q

Scarlet fever sx?

A

Post strep infection - blanching sandpaper like body rash, strawberry tongue, circumoral pallor.

40
Q

Pathophysiology of ankylosing spondylitis

A

Autoimmune response destroys the fibroblasts and replaces them with fibrin which makes a band around the joints and limits ROM - osteoblasts will then ossify the fibrin.

41
Q

Sx of ankylosing spondylitis

A

Back pain, before 40, insidous, improved with exercise, not with rest, pain at night, responsive to NSAIDS

Look for hx - IBD, psoriasis, iritis

Investigate - ESR/CRP, X-ray

42
Q

Pathophysiology of psoriatic arthritis

A

inflammatory response in the body leads to T-cells can get into the joints and activate osteoblasts and clasts which will erode the joint

Should be RH and CYP negative (to differentiate from RA)

43
Q

Pathophysiology of RA?

A

Inflammation (smoking, pathogen, genetic) causes changes in collagen and immune system attacks with adaptive immune system leads to proliferation of synovial cells - makes a pannus = damage and erosion.

44
Q

Classic presentation of dermatomyositis?

A

Heliotrope rash, mechanics hands, gottron’s sign

45
Q

Tx for fibromyalgia?

A

Exercise and education, help with comorbidities, start on an SNRI - classically duloxetine

46
Q

What do you need to keep in mind with PMR?

A

Increased risk of Giant Cell Arteritis - be sure to screen regularly for SX

  • Tx for GCA is high dose steroids, PMR is low dose steroids
47
Q

Compartment syndrome causes?

A

Trauma, infection, burn, most common in leg, can also happen with massive fluid resuscitation

48
Q

Sx of compartment syndrome?

A

Loss of pulses distally, tense compartment, pain with passive stretch, loss of sensation and weakness, can measure pressure with manometer

49
Q

Tx of compartment syndrome

A

Fascitomy

50
Q

Things you can test in synovial fluid?

A

Culture and gram stains
Cell count and differential
Crystal examination

Learning Objectives (29 decks)

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