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Rheumatology > Approach To Arthralgia > Flashcards

Approach To Arthralgia Flashcards

1
Q

What is the most common rheumatic disease

A
  1. Non articular disorders
  2. Osteoarthritis
  3. RA
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2
Q

What is important to ask about on history in rheumatology

A

Acute/Chronic

Distribution:periperal/axial, large or small, symmetrical or assymetrical, mono/oligo/poly

Symptoms: better or worse on activity, early morning stiffness>1hr/<30min

Extra articular features: skin rashes, eyes, fam hx, constitutional Symptoms

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3
Q

True or false: inflammatory rheumatic problems get worse on activity

A

False, gets better

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4
Q

What are differentials for chronic, symmetrical polyarthritis?

A

RA
SLE
Psoriatic arthritis

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5
Q

What is a typical distribution in a chronic rheumatic problem

A

Peripheral
Small bones
Symmetrical
Polyarthritis

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6
Q

What symptoms do chronic rheumatological problems have

A

Pain better on activity
EMS>1hr

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7
Q

How does a joint capsule look

A
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8
Q

What must be done under musculoskeletal exam

A

Look for swelling
Feel for swelling
Move

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9
Q

What is the first step in determining the cause of pain

A

Start with active movement and look for no limitation/no pain, no limitation with pain or limitation

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10
Q

What should be done if there is no limitation and no pain on active movement

A

Do resisted movement and if the is still no pain then it is reffered but if there is pain then it is CONTRACTILE

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11
Q

What is the problem if there is no limitation but pain on active movement

A

It is contractile

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12
Q

What should be done if there is limitation on active movement

A

Do passive movement and if there is limitation then it is either a capsular pattern (joint) or it is non capsular pattern (contractile).

If there is no limitation on passive movement then it is contractile

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13
Q

What are causes of referred pain

A

C spine
Heart
Oesophagus

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14
Q

What are causes of regional contractile pain

A

Regional pain syndrome like throcanteric bursitis

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15
Q

What is the cause of diffuse contractile pain

A

Fibromyalgia

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16
Q

What are the causes of inflammatory joint pain

A

Auto immune
Reactive
Crystal
Infective

17
Q

What are causes of degenerative joint pain

A

Primary or secondary osteoarthritis

18
Q

What are the five things you must inspect for

A

Attitude
Skin changes
Muscle wasting
Deformity
Swelling

19
Q

What are the 5 things you should palpate for

A

Tenderness
Swelling
Temperature
Detection of effusion
Crepitus on movement: coarse which is cartilage damage or fine which is peri articular structure

20
Q

What will arthritis do

A

Cause restriction of movement, BUT RESTRICTION OF MOVEMENT DOES NOT EQUATE TO ARTHRITIS

21
Q

How does tenderness location differ between joint and periarticular pain

A

Joint: joint line
Periarticular: periarticular

22
Q

How will restriction differ between joint and periarticular

A

Joint: active=passive
Periarticular: active>passive

23
Q

How does stress pain differ between joint and periarticular pain

A

Joint: capsular
Periarticular: single plane

24
Q

How does swelling differ between joint and periarticular

A

Joint: capsular
Periarticular: localised

25
Q

How does wasting differ from joint and periarticular

A

Joint: global
Periarticular: localised

26
Q

How does warmth differ between joint and periarticular

A

Joint: over joint
Periarticular: localised

27
Q

How does the crepitations differ between joint and periarticular

A

Joint: coarse
Periarticular: fine

28
Q

What is the pattern of joint involvement in osteoarthritis

A

Degenerative disease=cartilage loss
Morning stiffness less than 30min
Heberdens nodes
ASSYMETRICAL

29
Q

What is the pattern of joint involvement in Rheumatoid arthritis

A

Autoimmune=inflammed synovium
Morning stiffness more than 30 min
SYMMETRICAL
Extra articular involement

30
Q

What investigations can you do in rheumatology

A

ESR, CRP
RF/ ACCP(Rheumatoid) and ANA(SLE)
Aspiration joint crystals
Uric acid

Rheumatology (3 decks)

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