25. Trouble articulaire / joint disorders Flashcards
Differentiate joint vs. soft tissue
Arthritis: Pain on ROM, decreased ROM, swelling, erythema
Soft tissue: ROM preserved, tendernes over bursae, tendons, or ligaments
general ddx 6
Trauma
Infection (Septic arthritis)
Crystal-induced arthritis
Osteoarthritis
Systemic disease
neoplasm
Hemarthrosis is associated with
intraarticular fractures, dislocations, ligamentous injury
type of septic arthitis
Gonoccocal
Non gonococcal
Other: Mycobacterial, fungal, Lyme
Gonoccocal septic arthitis triad
tenosynovitis, vesiculopustular skin lesions, and polyarthralgias
Non gonococcal bacterial infections should be suspected
IVDU, immunocompromised, prosthetic joint
Crystal-induced arthritis 2
Gout (monosodium urate crystal)
Pseudogout (CPPD) - calcium pyrophosphate
systemic artritis 9
Rheumatoid arthritis
Seronegative spondyloarthritis
Reactive arthritis ad max 6 weeks
Psoriatic arthritis
Inflammatory bowel disease-associated arthritis (ulcerative colitis or chron’s
Lupus
Wegener’s granulomatosis (WG)
Sarcoid periarthritis
Myelodysplastic and leukemic disorders
when to suspect spondyloarthritis
enthesitis,
dactylitis,
conjunctivitis/uveitis,
psoriasis
Hx red flags 6
Hot/swollen joints
Constitutional symptoms (high-grade fever, weight loss, malaise)
Morning stiffness >30 minutes
Night pain
Weakness
Neurological (burning pain, numbness, or paresthesia)
specific Extraarticular findings 3 gout/ OA/ a ankylosante/ lupus
Tophi (sp gout)
Skin changes:
Psoriasis,
Malar rash (butterfly rash - lupus)
Erythema nodosum - strep, sarcoidosis, TB
Eye involvement
Arthrose: Heberden (IPD) Bouchard (IPP)
what you are looking for a joint aspiration (4)
Gross appearance
Crystal analysis
White cell count and differential
<2,000/mm3 usually non-inflammatory
>20,000 suspect septic arthritis
Gram stain and Culture
investigations
CBC
LFT
ESR/CRP
ANA, RF, Anti-CCP
(HLA)-B27
Coags (in hemarthrosis)
monoarthropathy, rule out
STD - ITSS
Arthrite septique
ddx - referred pain
angina, slipped capital epiphysis presenting as knee pain, neuropathic pain
do not give NSAIDS to pt who have
renal failure
peptic ulcer disease
general mngt of pt with MSK pain
demande impact sur la vie quotidienne
donne des analgesiques
ressources + canes etc
diagnostique des lesions ligamentaires (investigation)
dx CLINIQUE
PAS de RX
Définition arthrite rheumatoide 5
Inflammatory arthritis involving 3+ joints
Duration >6w
Positive RF and/or anti-CCP
Elevated CRP/ESR
No evidence of other diseases (eg. psoriatic arthritis, viral polyarthritis, gout/pseudogout, SLE)
facteurs de risque RA 7
Age
Female
Family history
Smoking (both current and prior)
Early menarche (<10yo)
Very irregular menstrual periods
Nulliparous
RA extra-articular findings
Anemia
Subcutaneous (rheumatoid) nodules
Pleuropericarditis
Neuropathy
Episcleritis/scleritis
Splenomegaly
Sjögren’s syndrome
Vasculitis
Renal disease
what is Sjögren’s syndrome
immune system damages glands in your body that produce and control moisture, including in your:
Tear system.
Mouth (your salivary glands).
Nose.
Vagina.
so dry mouth, eyes, vagina, skin
epistaxis
lupus is associated with
Malar/discoid rash, oral ulcers,
anti-dsDNA, anti-Sm
Rheum arth physical exam findings - joints
Joint exam
Limited joint ROM
Synovial hypertrophy/thickening, effusion, inflammation, tenderness
Classically involving MCP, PIP, thumb IP, wrists, MTP (metatarsal joint pain)
