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Flashcards in Arthritis Deck (17):
1

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)

2

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

3

Joint pains... what are the yellow flags?

Symptoms out of proportion with clinical findings (??anxiety, depression or fibromyalgia)

4

What do you need to be cautious of if there was a preceeding illness before the joint pains?

Viral polyarthritis
Reactive arthritis

5

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

6

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

7

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
4 areas:
- number of joints involved
- positive serology
- abnormal inflammatory markers
- duration of symptoms >6 weeks

8

What is RA?

Common, chronic, systemic autoimmune condition affecting 1-2 % of population
Any age, but peak is 30's-50's
F>M
Cause unknown
Genetic susceptibility
Symmetrical, sml joint arthritis
Mornign stiffness, fatigue, weight loss
RA is an independent RF for CVD, osteoporosis

9

What are the most common joints involved in OA?

1st CMC of thumb
1st MTP of great toe
DIPs of hands

10

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
Variable disability

11

What are the signs of OA?

Hard and bony swelling?
Crepitus
Mild signs of inflammation
Restricted movements
Joint deformity
NO systemic manifestations

12

What XRAY findings indicate OA?

Joint space narrowing
Subchondral sclerosis
Osteophytes
Cystic areas in the subchondral bone
Altered shape of the bone ends

13

What is the most common type of arthritis?

OA

14

What is the commonest polyarthritis?

RA

15

What symptoms suggest a diagnosis of RA?

Insidious onset of pain and stiffness of small joints of hands and feet
Persistent pain
Mainly small symmetrical joint involvement
Peak onset = 30-50yo
Females to male 3:1
Morning stiffness
Malaise, weakness, weight loss, fatigue

16

What signs suggest a diagnosis of RA?

Soft tissue swelling (effusion and synovial swelling) esp of wrist, MCP and PIP joints
Warmth
Tenderness on pressure or movement
Limitation of movement
Muscle wasting
Later stages: deformity, subluxation, instability, or ankylosing
Raised ESR/CRP
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

17

What significant non-articular clinical manifestations can occur with RA?

Anaemia
Inflammation of the eye
Sjogren's syndrome (dry eyes and mouth)
Lymphadenopathy
Pleural effision
Fibrosing alveolitis
Pulmonary nodules
Amyloidosis (kidneys)
Vasculitis
Pericarditis
Myocarditis
Splenomegaly
Subcutaneous nodules
Tenosynovitis
Carpal tunnel
Raynaud's phenoenon
Baker's cyst
Peripheral sensory neuropathy
Mononeuritis multiplex