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Flashcards in Approach - Joint pain Deck (6)
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What are the (3) types of joint disorders?

•Disorders of the cartilage
–eg osteoarthritis
•Disorders of the synovial membrane
–eg rheumatoid arthritis
•Disorders of the synovial fluid
–eg gout, septic arthritis


(3) findings of OA on XR

1. osteophytes
2. Reduced joint space
3. Sclerosis of subchondral bone


A 32yo female, 6 wks of gradually worsening pain & stiffness in joints of hands, wrist & feet. Worse in the morning for several hours & improves a little after lunch time. FMHx of RA. 5-10cigarettes per day, no rashes/bowel symptoms. Sleeping poorly & not coping. Previously well.

(4) DDx? Ix?

–Rheumatoid arthritis
–Systemic lupus erythematosus
–Viral arthritis (parvovirus, Ross River Virus etc)
–Psoriatic arthritis

•Rheumatoid factor
•CCP antibody


Sensitivity & specificity of rheumatoid factor in RA

•Sensitivity – 70%
•Specificity – 80%


Sensitivity & specificity of CCP antibodies in RA

•Sensitivity – 70%
•Specificity – 90%

I.e. same specificity as rheumatoid factor but more specific.


How do you diagnose RA?

ACR 1987 Classification criteria for rheumatoid arthritis

Patients must have 4 of 7 criteria:
•Morning stiffness of greater than 1 hour*
•Swelling in 3 or more joints*
•Swelling in hand joints*
•Symmetric joint swelling*
•Erosions or decalcification on X-ray
•Rheumatoid nodules
•Abnormal serum rheumatoid factor

* Must be present for at least 6 weeks

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