2017 Exam Flashcards
5 things in a joint that can cause pain.
- Joint Capsule
- Periosteum
- Ligs
- Subchondral Bone
- Synovium
4 Pathophysiological Dz processes of a joint.
- Synovitis
- Enthesopathy
- Xstal desposition
- Infection
- Strucutral / Mechanical derangement
4 Key Events in Synovitis
- Neovascularisation
- Synovial infiltration of T-lymphocyes, B-cells and Macrophages
- Synovial cell hyperplasia
- Formation of a ‘pannus’ leading to marginal bone and cartilage erosion.
Compare Joint Stiffness in OA & RA.
List 6 descriptors that aid in the diagnosis of a painjul joint.
-
Duration of symptoms
- Acute or chronic
-
Joint involvement
- Migratory, additive, intermittent
-
Number of joints involved
- Monoarthritis, oligoarthritis (pauciarthritis), polyarthritis
-
Symmetry of joint involvement
- Symmetric or asymmetric
-
Joint distribution
- Peripheral joints, axial joints
-
Distinctive presentation
- Enthesitis
- Dactylitis
- Tendonitis
- Back pain
-
Extra-articular manifestations
- Systemic, skin lesions, ocular lesions
Define the following terms relating to types arthritis:
- Monoarthritis
- Oligoarthritis
- Polyarthritis.
- Monoarthritis: involves 1 joint (i.e. OA)
- Oligoarthritis: involves 2-4 Jts (aka pauciarticular arthritis, i.e. Asymm. PsA)
- Polyarthritis: involves >5 joints (i.e. RA)
List 3 manifestations and 3 conditions for which each presents.
Occular Lesions:
- RA (scleritis)
- AS (anterior uveitis)
- ReA (conjunctivitis)
Systemic SSx:
- RA
- ReA
- SLE
Skin Lesions SSx:
- SLE
- RA
- PMDM
List 4 conditions which may produce a skin rash as a manifestation.
SLE- Malar Rash
DM- Helitrope around the orbit
DM- Gottron’s Papules
PsA- Psoriasis
List 3 Types of Joint Pain
- Inflammatory
- non-inflammatory
- arthralgia
List 3 SSx of Joint Disease
- Pain
- Swelling
- Stiffness
- Reduced RoM
- Crepitus
List 3 Classifications for Jt Involvement
- migratory
- additive
- intermittent
List categories of by which rheumatic manifestations ban be divided.
- Constitutional
- Xtra Articular
- Articular
Define a CRP test.
- CRP is an acute phase reactant protein synthesised in the liver following release of cytokines (i.e. IL-1, IL-6).
- CRP is a test that detects the presence of inflammation.
Define an ESR Test.
- ESR is a measure of distance RBC’s fall through a Westergren tube in 1 hour.
- ESR provides a rough measure of abnormal concentrations of acute phase proteins and Ig’s in serum.
- Systemic indicator of tissue damage and inflammation
Compare CRP to ESR.
- Both CRP and ESR useful in omintoring Dz acitivty in rheumatologic conditions such as RA, PMR, GCA.
Serum CRP levels:
- are more sensitive for the evaluation and monitoring of inflammation than ESR
- independent of factors that affect ESR (e.g. anaemia, cardiac failure and haemoglobinopathies)
- correlate better with disease activity
- mirror the extent of the tissue damage, thus extensive tissue damage will result in an elevated CRP which
- will remain elevated for a long period of time
- rise 4 to 6 hours after tissue injury (i.e. much earlier than other acute-phase reactants)
- fall earlier than ESR
- not affected by the administration of steroidal and nonsteroidal anti-inflammatory drugs, immunosuppressants etc. (unless of course the underlying condition is affected by these drugs)
List 5 indications for Joint Aspiration.
To aid in diagnosing the conditions listed above.
To aid in the differential diagnosis of gout and pseudogout.
To detect the presence of gonococci, a major cause of joint infection.
To establish the diagnosis of infection, crystal-induced arthritis, synovitis, or neoplasms involving the joint.
To identify the cause of joint effusion.
To follow the progression of joint disease.
To inject anti-inflammatory medications (mostly corticosteroids) into a joint.
