Conditions that cause joint pain

Question 1

Assessment findings for OA: Subjective

Answer 1

> 45, activity-related pain, gradual onset- could have an identifiable trigger, persistent pain >6/52, either no morning joint-related stiffness or morning stiffness lasting no longer than 30 mins, noisy joints, can be worse on cold whether true locking= need surgical opinion

Question 2

Assessment findings for OA: Objective

Answer 2

Palpable swelling/osteophytes, crepitus, tender joint line on palpation, ROM can be limited by pain and/or stiffness actively and passively
reduced strength secondary to pain or weakness
reduced functional ability

Question 3

OA treatment- advise

Answer 3

enhance understanding of the condition and its management
counter misconceptions
ensure that positive behavioural changes, such as exercise, weight loss and use of suitable footwear and pacing, are apprioratley targeted.
Weight loss- 5-10% loss = substantial improvements

Question 4

OA treatment- exercisee

Answer 4

local muscle strengthening, general aerobic fitness

Question 5

OA treatment- injection and surgery

Answer 5

CSI as an adjunct for core treatments for the relief of moderate to severe pain in people
Surgery- refer only after core treatments. Only if symptoms have a substantial impact on QOL.

Question 6

Features of inflammation (RA not OA)

Answer 6

Heat, redness, swelling and pain
Stiffness (early morning >30 mins)
Night pain (2nd part of night)
better with activity
worse with rest
better with anti inflammatory

Question 7

SCREENDEM Tool for inflammatory disorders

Answer 7

Skin Colitis Relatives Eyes Early morning stiffness
Dactylitis
Enthesis
Movement and medication effect

Question 8

Risk facators RA

Answer 8

women more than men
40-60

Question 9

Main symptoms

Answer 9

joint pain and stiffness, joint swelling, warmth and redness, small joint involvement hands and feet

Question 10

Symptoms of axial spondyloarthritis

Answer 10

patients talk about stiffness, nocturnal pattern, better with activity, worse with rest, insidious onset >45, improvement with anti inflam, persistence for more than 3 months (can be relapse-remitting), weight loss, fatigue or tiredness, feeling feverish or night sweats

Question 11

psoriac arthritis

Answer 11

an immune conditon where skin replacement process speeds up. The accumulation of skin cells build ups to form raised plaques on skin, which can be flaky,scaly, red and itchy
Eczema= flexor side, psoriasis= extensor side

Question 12

Gout

Answer 12

is caused by deposition of urate crystals in joints and soft tissues
gout is associated with increased morbiditiy and mortality, and is an independent risk factor for increased risk of CVD
Risk factors- BMI, Alchol, familiy history, DM & vascular condition

Question 13

Acute gout flare up

Answer 13

onset of severe pain, swelling and erythema within a joint, classically in LL
Maximal severity is reached usually within 24 hours with resolution over several days/weeks, male>female,

Question 14

Acute Gout management

Answer 14

Rest ice elevation, NSAIDS
Joint aspiration, CSI
Lifestyle- hydration, diet change, weight less
Preventative management- medications such as allopurinol

Question 15

Connective tissue disorders- Polymyalgia rheumaticia

Answer 15

acute onset of bilat shoulder and/or bilat buttock pain and stiffness
early morning stiffness >45 mins,
night pain with severe stiffness
fever, weight loss and fatigue
>50, females>male,
treated with steriods

Question 16

Giant cell arteritis- symptoms

Answer 16

Up to 1 in 5 people with PMR develop a more serious
condition called giant cell/temporal arteritis where the
arteries in the head and neck become inflamed.

Question 17

Giant cell arteritis- symptoms

Answer 17

severe headache- scalp tenderness, pain in jaw muscles when eating/chewing, problems with sight, night sweats
Requires immediate medical attention

Question 18

Physiotherapy management for rheumatoid conditions

Answer 18

EDUCATE!!
 EXERCISE –
Inflammation likes
exercise!!
 Lifestyle advice –
smoking cessation,
diet, weight
management, reduce
alcohol intake
 Signpost to resources
 Involve other
professions where
appropriate – Dietetics,
Clinical Psychology

Question 19

fibromyalgia

Answer 19

causes widespread joint pain. Long term conditon that causes pain and tenderness all over body. women>men. Linked too: such as arthritis, a traumatic event, and mental
health and wellbeing.

Question 20

diagnosis

Answer 20

no test for diagnosis- blood tests/scan to rule out other conditions
Diagnostic conditions: widespred pain index and symptoms severity score, generalised pain in 4/5 regions, symptoms present >3 months