Approach to Aches and Pains Flashcards
Other than the cardinal signs of inflammation, what are some characteristics of inflammatory disease related to aches and pains that can be elicited from a px Hx?
1) Morning stiffness (>45mins)
2) Pain better w movement
3) Insidious onset
What are some key risk factors that would make one suspect Polymyalgia rheumatica in a px with diffuse aches and pains?
1) > 60y/o
2) Proximal muscle myalgias and stiffness w/o specific muscle weakness
3) High ESR
4) Anemia
Other than MSK conditions, what are 5 differentials for diffuse aches and pains?
1) Thyroid disorders
2) Parathyroid disorders
3) Adrenal disorders
4) DM
5) Acromegaly
- screen for: eg. TSH, Ca, PO4, glucose, Na/K
True or false:
Px with HYPOthyroidism can present with diffuse arthralgias and myalgias with CK elevation.
True
What are 3 pharmaceutical causes of MSK pain?
1) HMG-CoA reductase inhibitors
2) Statins
3) Ethanol abuse
4) Zidovudine
5) Clofibrate
6) Cyclosporin A
7) Penicillamine
True or false: HMG-CoA reductase inhibitors only cause severe myalgias when the myositis is characterised by objectively elevated CK levels.
False.
HMG-CoA reductase inhibitors cause severe myalgias with or without evidence of objective myositis (CK need not be elevated)
What are 3 soft-tissue pain syndromes that can cause diffuse arthralgias and myalgias?
1) Fibromyalgia syndrome
2) Somatoform pain disorders
3) Hypermobility syndrome
4) Major depression a/w MSK pain
What are 5 characteristic of fibromyalgia sndrome?
1) Widespread MSK pain
2) Tenderness in specific regions (tender points)
3) No objective inflammation on PE
4) Normal labs
5) Decreased pain threshold and tolerance
6) a/w fatigue, sleep, somatic complaints
True or false:
px with fibromyalgia are usually prescribed corticosteroids rather than narcotics for pain relief.
False.
Both are not indicated in fibromyalgia
