Flashcards in joint pain Deck (28):
how do we assess joint pain on history?
(location/articular/periarticular, inflammation present or absent, mono/oligo/polyarticular, duration, associated signs and symptoms)
inflammatory monoarthritis Dx
infectious (septic arthritis, gonococcal/lyme), crystal induced (gout), rheumatological (RA (although usually polyarthritis small joints), psoriatic arthritis, reactive arthritis, SLE).
noninflammatory monoarthritis DX
osteoarthritis which is occasionally swollen, trauma, bleeding and avascular necrosis.
is acute inflammatory mono arthritis serious?
yes. this is a medical emergency and indicates arthrocentesis and analysis of the synovial fluid. this can destroy joints within a few days.
turbid yellow fluid with low viscosity. cell count is high. PMN 90%. gram stain is negative. there will be a positive crystal analysis.
septic arthritis analysis
turbid yellow fluid with low viscosity. cell count will be high, 90% PMN, gram stain typically positive. crystal analysis negative.
psoriatic arthritis characteristics
chronic inflammatory seronegative arthritis negative RF and anti CCP. it is typically mono or asymmetric oligoarticular polyarticular symmetrical like RA but with DIP involvement.
other common associations with psoriatic arthritis
dactylitis or sausage finger, axial spinal, arthritis mutilans.
what is a specific test for RA?
cyclic citrullanated protein antibody. this is less sensitive and more specific that RF. there is a high-risk of RA if both are positive
reactive arthritis or reiter syndrome
urethritis, conjunctivitis, skin rash. can't pee, can't see, can't climb a tree. knees, ankles, and back involved more than small joints and hand. post infectious
what HLA is associated with reiter syndrome
what infections commonly cause reiters?
enterics such as shigella, campylobacter, yersinia, C. diff. chlamydia.
rheumatic fever characteristics
recurrent strep throat. fever, pinking skin. severe pain in ankle with small effusion present. high ESR, high ASO titer.
noninflammatory degenerative joint disease can be deforming. this is the most common type of arthritis with genetic or environmental factors.
presentation of osteoarthritis
AM stiffness about 10-15 min. better with rest, worse with prolonged activity. common in the hands and cervical and lumbar spine. it will occur in the weight-baring joints like hips and ankles.
where does osteoarthritis normally not occur?
rare in the ankles, wrist, metacarpalphalageal joints and glenohumeral joints.
what is the lab work for osteoarthritis
normal ESR and CRP, negative autoimmune. radiological findings include bony sclerosis and osteophyte.
what is normally not found in osteoarthritis?
there are usually no erosions.
serum negative spondylarthropathy
inflammatory arthritis of the spine, hips, sacroiliac, tendons, ankles, knees. less small joints involved. there is usually pain at night that is relieved by exercise or NSAID.
what HLA is involved in spondyloarthritis?
serum negative spondylarthropathy DX
psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease. and pure ankylosing spondylitis
which range of motion is limited in arthritis?
active and passive
which range of motion is limited in tendonitis or bursitis
usually active. passive is usually okay.
AM stiffness in osteoarthritis
less than 15 min
AM stiffness in inflammatory disease
is at least 30 min
symmetrical inflammatory arthritis mostly of the small joints of the hands present for 6 weeks.
which joints are never involved in RA
DIP and does not involve spine except for C1-C2 junction