1- Diagnosis and Evaluation of Joint Problems Flashcards
What are the two clinical clues most helpful for diagnosis?
- Joint Pattern
- Presence or absence of extra-articular manifestations
What does inflammation consist of?
redness, warmth, swelling, and morning stiffness of at least 30 min duration
What could fever be a result of?
Gout, Still disease
What could rash be a result of?
SLE, Psoriatic arthritis
What could nodules be a result of?
Rheumatoid arthritis
What could neuropathy be a result of?
Polyarteritis nodosa
If inflammation is present, what is the representative disease?
Rheumatoid arthritis, systemic lupus erythematosus, gout
If inflammation is absent, what is the representative disease?
Osteoarthritis
If the number of joints involved in monoarticular, what is the representative disease?
Gout, trauma, septic arthritis, Lyme disease, osteoarthritis
If the number of joints involved is oligoarticular (2-4 joints), what is the representative disease?
Reactive arthritis, psoriatic arthritis, inflammatory bowel disease
If the number of joints involved is polyarticular (>5 joints), what is the representative disease?
Rheumatoid arthritis, systemic lupus erythematosus
If the site of joint involvement is the distal interphalangeal joints, what is the representative disease?
Osteoarthritis, psoriatic arthritis (not rheumatoid)
If the site of joint involvement is the metacarpophalangeal joints or the wrist, what is the representative disease?
Rheumatoid arthritis, systemic lupus erythematosus, calcium pyrophosphate deposition disease (not osteoarthritis)
If the site of joint involvement is the first metatarsalphalangeal joint, what is the representative disease?
Gout, osteoarthritis
If diagnosis is uncertain, what should be examined?
synovial fluid
What precautions should one take with the aspirating needle when performing arthocentesis?
The aspirating needle should never pass through overlying cellulitis or psoriatic plaque.
Normal Joint Fluid:
- volume
- color
- clarity
- WBC
- polymorphonuclear leukocytes
- culture
- < 3.5
- transparent
- clear
- < 200
- < 25%
- negative
Group I (Inflammatory) Joint Fluid
- volume
- color
- clarity
- WBC
- polymorphonuclear leukocytes
- culture
- Often > 3/5
- transparent
- yellow
- < 2000
- < 25%
- Negative
Group II (Inflammatory) Joint Fluid
- volume
- color
- clarity
- WBC
- polymorphonuclear leukocytes
- culture
- Often > 3/5
- translucent to opaque
- yellow to opalescent
- 2000-75,000
- 50% or more
- negative
Group III (Purulent) Joint Fluid
- volume
- color
- clarity
- WBC
- polymorphonuclear leukocytes
- culture
- Often > 3.5
- opaque
- yellow to green
- > 100,000
- 75% or more
- usually positive
When performing microscopic examination, what does monosodium urate represent?
gout, negatively birefringent
When performing microscopic examination, what does calcium pyrophosphate represent?
pseudogout, positive birefringent
Which group does this belong in?
Degenerative Joint Disease
Group 1 (Noninflammatory)
Which group does this belong in?
Trauma
Group 1 (Noninflammatory)
Which group does this belong in?
Rheumatoid Arthritis
Group II (Inflammatory)
Which group does this belong in?
Acute crystal-induced synovitis (gout and pseudogout)
Group II (Inflammatory)
Which group does this belong in?
Reactive Arthritis
Group II (Inflammatory)
Which group does this belong in?
Pyogenic bacterial infections
Group III (Purulent)
