Approach To Arthralgia Flashcards
What is the most common rheumatic disease
- Non articular disorders
- Osteoarthritis
- RA
What is important to ask about on history in rheumatology
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
True or false: inflammatory rheumatic problems get worse on activity
False, gets better
What are differentials for chronic, symmetrical polyarthritis?
RA
SLE
Psoriatic arthritis
What is a typical distribution in a chronic rheumatic problem
Peripheral
Small bones
Symmetrical
Polyarthritis
What symptoms do chronic rheumatological problems have
Pain better on activity
EMS>1hr
How does a joint capsule look
What must be done under musculoskeletal exam
Look for swelling
Feel for swelling
Move
What is the first step in determining the cause of pain
Start with active movement and look for no limitation/no pain, no limitation with pain or limitation
What should be done if there is no limitation and no pain on active movement
Do resisted movement and if the is still no pain then it is reffered but if there is pain then it is CONTRACTILE
What is the problem if there is no limitation but pain on active movement
It is contractile
What should be done if there is limitation on active movement
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
What are causes of referred pain
C spine
Heart
Oesophagus
What are causes of regional contractile pain
Regional pain syndrome like throcanteric bursitis
What is the cause of diffuse contractile pain
Fibromyalgia
What are the causes of inflammatory joint pain
Auto immune
Reactive
Crystal
Infective
What are causes of degenerative joint pain
Primary or secondary osteoarthritis
What are the five things you must inspect for
Attitude
Skin changes
Muscle wasting
Deformity
Swelling
What are the 5 things you should palpate for
Tenderness
Swelling
Temperature
Detection of effusion
Crepitus on movement: coarse which is cartilage damage or fine which is peri articular structure
What will arthritis do
Cause restriction of movement, BUT RESTRICTION OF MOVEMENT DOES NOT EQUATE TO ARTHRITIS
How does tenderness location differ between joint and periarticular pain
Joint: joint line
Periarticular: periarticular
How will restriction differ between joint and periarticular
Joint: active=passive
Periarticular: active>passive
How does stress pain differ between joint and periarticular pain
Joint: capsular
Periarticular: single plane
How does swelling differ between joint and periarticular
Joint: capsular
Periarticular: localised
How does wasting differ from joint and periarticular
Joint: global
Periarticular: localised
How does warmth differ between joint and periarticular
Joint: over joint
Periarticular: localised
How does the crepitations differ between joint and periarticular
Joint: coarse
Periarticular: fine
What is the pattern of joint involvement in osteoarthritis
Degenerative disease=cartilage loss
Morning stiffness less than 30min
Heberdens nodes
ASSYMETRICAL
What is the pattern of joint involvement in Rheumatoid arthritis
Autoimmune=inflammed synovium
Morning stiffness more than 30 min
SYMMETRICAL
Extra articular involement
What investigations can you do in rheumatology
ESR, CRP
RF/ ACCP(Rheumatoid) and ANA(SLE)
Aspiration joint crystals
Uric acid
