220. Approach to Joint Pain

Question 1

Diseases with Symmetric Polyarticular Inflammatory Joint Pain

Answer 1

RA, Systemic Rheumatic Disease (Autoimmune c.t. disease), Infectious Arthritis (Viral, Hep B/C, HIV, Parvovirus)

Question 2

Diseases with Asymmetric Oligoarticular Inflammatory Joint Pain

Answer 2

Psoriatic Arthritis
Enteropathic Arthritis of IBD
Infectious Arthritis (GC, Lyme, Fungal/Mycobacterial)
Gout

Question 3

Characteristics of Inflammatory Joint Pain

Answer 3

Stiffness >1hr in morning/after rest
Sx improve with activity, worsen with rest
responsive to steriods
(RA, spondyloarthropathies, ct disease)

Question 4

Characteristics of other joint pain (non-inflammatory)

Answer 4

Stiffness <30 min
Sx worsen with activity and improve with rest
Less responsive to steroids
(OA, fracture/injury, osteonecrosis, amyloidosis, tumor/malignancy)

Question 5

What is ESR? What can change it?

Answer 5

ESR: non specific marker of inflammation (how long it takes blood sample to settle)
Increases with age, higher in women
higher in DM, ESRD, pregnancy, obesity
Lowered by CHF, sickled erythrocytes (settle faster)

Question 6

CRP - differences from ESR

Answer 6

levels change more quickly than ESR, more sensitive, less variable
Affected by age/gender
increased in heart disease, infection, malignancy, obesity, DM, smoking

Question 7

Arthrocentesis - Synovial Fluid Analysis

Group 1 vs 2 vs 3

Answer 7

1: Clear to slightly turbid, <2000 WBC, <20% PMNs, noninflammatory
2: slightly turbid, 2k-50k WBC, 20-75% PMNs, inflammatory
3: turbid 50k-100k WBC, <75% PMNs, blood/pyarthrosis - more concerned for infection