Joint pain Flashcards
(6 cards)
OA of hip
usually anterior/groin pain
Posterior/buttock pain suggest SI joint problem or lumbar radiculopathy
OA treatment
Tx osteoarthritis:
a) lifestyle: exercise, weight loss, supportive devices, thermal modalities, modification of activities of daily living
b) pharmacological
i. topical: capsaicin, menthol and salicylate based medications
ii. oral: acetaminophen, NSAIDs, COX-2 inhibitors, glucosamine sulphate, tramadol, opioids
iii. intra-articular: corticosteroid injections (limited to 4 per joint per year), hyaluronan derivatives
iv. structure modifying: doxycyline (collagenase inhibitor)
c) surgery: removal of loose bodies, stabilization of joints, osteotomy, redistribution of joint forces, relief of neural
impingement, joint replacement
SLE vs. RA
Deformity is reducible, and non-erosive
Lime’s disease
Borrelia burgdorferi, 3 phases
1) erythema migricans (below has central clearing and necrotic center). Treat with doxycycline
2) early disseminated characterized by multiple erythema migrans, lymphocytic meningitis, cranial nerve palsies (particularly facial), radiculopathy. These are the classic presentations. May have carditis (AV block) and variety of eye diseases such as conjunctivitis. treat with ceftriaxone
3) late disease involving persistent arthritis of one of a few large joints (notably knees), usually not painful. May range from subjective joint pain to erosive disease. In a small percentage of cases may get erosion of cartilage and bone. May get fibromyalgia post lyme disease. Neurologic problems such as subtle cognitive disturbances, chronic axonal polyneoropathy may develop. Treat with ceftriaxone if neurologic disease, otherwise doxycycline.
4) post-lyme disease syndrome is headache, fatigue, arthralgias (non-specific symptoms) that improve gradually over 6 months to 1 year.
Still’s disease diagnosis
Yamaguchi criteria: need total 5, at least 2 majors
Dx: presentation of characteristic features with exclusion of similar features
major criteria:
a) fever >39 degrees Celcius lasting >1 wk
b) arthritis or arthralgias lasting >2 wks
c) macular or maculopapular non-pruritic salmon pink eruption over the trunk or extremities during febrile episodes
d) leukocytosis (>10 000/microliter) with >80% granulocytes
minor criteria:
a) sore throat
b) lymphadenopathy or splenomegaly
c) abnormal liver chemistries (AST, ALT, LDH)
d) ANA and RF negative
PAN diagnosis
ANA/ANCA negative usually
Dx: 3/10 of the following with no other explainable cause for symptoms
a) weight loss >4 kg since illness began
b) livedo reticularis: mottled reticular pattern over skin of the extremities or torso
c) testicular pain or tenderness
d) myalgias, weakness or leg tenderness
e) mononeuropathy or polyneuropathy
f) diastolic BP >90 mmHg
g) elevated BUN or creatinine
h) hepatitis B virus Ag or Ab in serum not from vaccination
i) arteriographic abnormality: microaneurisms, stenosis/beaded pattern
j) biopsy: PMNs in the artery wall
