Flashcards in Arthritis Deck (17):
What history is paramount in assessing joint pains?
Acute or chronic ??
- Acute ? (<6/52, more likely infectious, viral, or drug induced)
- Chronic ? (>6/52, more likely inflammatory arthropathy)
Joint involvement (mono, pauci, or polyarticular)
Symmetrical vs asymmetrical
Large or sml joints
Migratory or persistent
Relapsing or remitting, or persistent
Mechanical or inflammatory
Arthritis (swelling of joints) or arthralgia (pain only)
Joint pain.. what are the red flags?
Constitutional symptoms (night sweats, fevers, loss of weight)
Joint pain > than expected from examination (? neuropathic component)
Acutely hot, swollen joints (? septic arthritis)- usually monoartthritis
Joint pains... what are the yellow flags?
Symptoms out of proportion with clinical findings (??anxiety, depression or fibromyalgia)
What do you need to be cautious of if there was a preceeding illness before the joint pains?
What is OA?
OA is not just a disease of the cartilage but affects the whole joint (including bone, synovium muscles and ligaments)
Symptoms of OA vary greatly from person to person
It is NOT an inevitable part of getting older
How do you diagnose OA?
OA can usually be diagnosed clinically in primary care without the need for x-ray, MRI or other investigations if a person:
- is 45 or over
- has activity-related joint pain
- has no/limited (<30min) morning joint-related stiffness
- has no atypical features
Based on the 2010 ACR/ELAR, how is RA diagnosed?
Must Get >6 points for definite diagnosis
Must have >1 joint with synovitis with no better explanation AND
- number of joints involved
- positive serology
- abnormal inflammatory markers
- duration of symptoms >6 weeks
What is RA?
Common, chronic, systemic autoimmune condition affecting 1-2 % of population
Any age, but peak is 30's-50's
Symmetrical, sml joint arthritis
Mornign stiffness, fatigue, weight loss
RA is an independent RF for CVD, osteoporosis
What are the most common joints involved in OA?
1st CMC of thumb
1st MTP of great toe
DIPs of hands
What are the clinical features of OA?
Pain: worse by end of day, aggravated by use, relieved by rest, worse in cold and damp
Variable morning stiffness
What are the signs of OA?
Hard and bony swelling?
Mild signs of inflammation
NO systemic manifestations
What XRAY findings indicate OA?
Joint space narrowing
Cystic areas in the subchondral bone
Altered shape of the bone ends
What is the most common type of arthritis?
What is the commonest polyarthritis?
What symptoms suggest a diagnosis of RA?
Insidious onset of pain and stiffness of small joints of hands and feet
Mainly small symmetrical joint involvement
Peak onset = 30-50yo
Females to male 3:1
Malaise, weakness, weight loss, fatigue
What signs suggest a diagnosis of RA?
Soft tissue swelling (effusion and synovial swelling) esp of wrist, MCP and PIP joints
Tenderness on pressure or movement
Limitation of movement
Later stages: deformity, subluxation, instability, or ankylosing
Normochromic, normocytic anaemia
RF in 70-80%
Anti CCP antibodies
XRAy changes: erosion of joint margin, loss of joint space, extra-articular OP, cysts
Look for swan necking, boutonnier and z deformities, ulnar deviation