ICL 8.6: Introduction to Rheumatology Flashcards
(48 cards)
what is rheumatology?
a subspecialty in Internal Medicine, with a focus on studying autoimmune conditions that cause muscle, skin and joint pain
often, the diseases are multi-system conditions with multiple organ involvement such as SLE
rheumatology also deals with musculoskeletal conditions
what should you ask during an HPI of a suspected rheumatoid disease?
- mode of onset, severity, quality, alleviating and aggravating factors, etc
- sequence of development of different features
- duration
which conditions are associated with rheumatoid diseases?
- psoriasis
2. IBD
what should you look for during a physical exam of a rheumatoid patient?
- the number of affected joints
mono-articular, oligoarticular, polyarticular
- distribution
symmetrical, asymmetrical, axial spine, large joints
- joints vs. periarticular structures
proper joint or tendons
- any systemic involvement
kidneys, lungs, heart, brain, GI tract, etc.
what questions do you need to get answered while trying to diagnose a rheumatoid condition?
Is this a musculoskeletal problem?
Is the condition articular or periarticular?
Is the condition mechanical (arthrosis) or inflammatory?
Does it affect appendicular or axial structures or both?
Is there a disease of another system?
what is articular joint pain?
pain is localized to joint line
there is pain with active AND passive range of motion
patient will present with swelling, crepitation, locking, instability or deformity
what is non-articular joint pain?
patient will have pain with active but NOT passive ROM
tenderness in adjacent structures
there will also be other physical findings in remote areas
how can you tell if a patient is having joint of periarticular problems?
joint = both passive and active motion hurt
periarticular = only passive action will hurt
how can you differentiate between inflammatory and non-inflammatory symptoms?
INFLAMMATORY
1. erythema
- warmth
- swelling
- stiffness after prolonged rest, morning sickness –> better with activity
- fatigue
NON-INFLAMMATORY
1. pain without swelling
- pain is aggravated with activity
what CBC results would indicate a rheumatoid condition? what rheumatoid condition?
- anemia, thrombocytosis –> inflammation
- neutropenia, thrombocytopenia –> Felty’s syndrome
- hemolysis, thrombocytopenia –> SLE
- elevated ESR, CRP –> inflammation
which rheumatoid condition do CCP antibodies indicate?
ACCP = anti-cyclic citrullinated peptide
CCP antibodies are positive in 40% of rheumatoid factor (RF) negative RA patients
CCP is far more specific for RA than RF is but a negative result does not exclude the diagnosis of RA
RF is found in which conditions? what’s its sensitivity?
- sjogren syndrome (90%)
- RA (80%)
- IPF (60%)
- bacterial endocarditis (40%)
what are the normal and abnormal WBC levels in synovial fluid? which conditions do abnormal WBC counts indicate?
WBC <200 = normal
WBC 200-3,000 = OA
WBC 3,000-15,000 = inflammatory condition
WBC >20,000 consider infection and gout
so if someone has arthritis, you need to aspirate the joint so you can get a WBC count or stain
synovial fluid analysis is very helpful, especially to exclude infection and gout
other than a WBC count, what other synovial fluid analysis can you do?
- crystals
2. gram stain and culture
what does a monosodium urate crystal in synovial fluid look like?
spindle = a line
what does a calcium pyrophosphate crystal in synovial fluid look like?
rhombus
what is osteoarthritis? what causes it?
it’s the degeneration of joint cartilage and the underlying bone, most common from middle age onward
primarily idiopathic from wear and tear
but can also be secondary from trauma or metabolic conditions
what are Heberden’s nodules?
bony swelling at DIP joint of the hands seen in osteoarthritis
what is Bouchard’s nodules?
bony swelling at PIP joint of the hands seen in osteoarthritis
which parts of the body are commonly effected by osteoarthritis?
- neck
- lumbar spine
- fingers = DIP, PIP, and thumb, NOT MCP joints
- big toe
which two conditions can cause arthritis of the DIP joint?
- osteoarthris
- psoriatic arthritis
OA is non-inflammatory while PA is inflammatory
what is fibromyalgia?
chronic musculoskeletal pain syndrome of unknown etiology but there’s often an association with stress like trauma, or sexual abuse
presentation is characterized by diffuse pain, tender points, fatigue, and sleep disturbances
patients will have pain NOT localized in the joints; it’s more diffuse and it’s like everywhere hurts
what patient population is effected by fibromyalgia?
prevalence is 5% with a female to male predominance of 8:1
mean age is 30-60
what’s the pathophysiology of fibromyalgia?
the normal pain pathway has sensory stimulus that activates sensory receptors in the skin/joint which is then transmitted to the DRG and throughout he spinothalamic tract to the sensory cortex where we get pain but the corticospinal tract decreases this pain
with fibromyalgia there’s an increase of the spinothalamic tract and decrease of the corticospinal tract = increased pain
so there’s Increased release of pain neurotransmitters
glutamate and substance P that leads to increased pain perception
so there’s no problems with the joints or muscles, it’s a neurological problem!
