Approach to Joint Pain Flashcards
What types of inflammatory joint pain are often symmetric and polyarticular?
- Rheumatoid Arthritis
- Systemic Rheumatic Disease
- Infectious Arthritis
- Polymyalgia Rheumatica
- Relapsing seronegative symmetrical synovitis with pitting edema
What types of inflammatory joint pain are often asymmetric and oligoarticular?
- Psoriatic arthritis
- Enteropathic arthritis of IBD
- Infectious arthritis from GC, lyme, fungal causes
- Crystalline arthritis
- Familial Mediterranean fever
What is the typical location and symmetry of rheumatoid arthritis?
Symmetric and polyarticular
What is the typical location and symmetry of psoriatic arthritis?
Asymmetric and oligoarticular
What is the typical location and symmetry of enteropathic arthritis?
Asymmetric and oligoarticular
What is the typical location and symmetry of infectious arthritis?
Could be either symmetric/polyarticular or asymmetric/oligoarticular depending on the source of infection
How long does morning stiffness last in inflammatory vs non-inflammatory joint pain?
Inflammatory: > 1 hour
Non-inflammatory: < 30 min
Which type of joint pain (inflammatory or non-inflammatory) improves with activity?
Inflammatory (non-inflammatory joint pain is worse with activity)
Which type of joint pain (inflammatory or non-inflammatory) improves with rest?
Non-inflammatory (inflammatory joint pain is worse with rest)
Which type of joint pain responds to steroids?
Inflammatory (non-inflammatory joint pain often does not respond to steroids)
What are common etiologies of inflammatory joint pain?
Rheumatoid arthritis, spondyloarthropathies (ex. psoriatic arthritis, ankylosing spondylitis, etc), and inflammatory arthritis in connective tissue disease
What are common etiologies of non-inflammatory joint pain?
Osteoarthritis, fracture/injury, osteonecrosis, amyloidosis, tumor/malignancy
Which condition do the following clinical images relate to?
Rheumatoid arthritis
What is an ESR test?
An erythrocyte sedimentation rate test that measures how long it takes for red blood cells to sink in a blood sample, indicating the presence or absence of inflammation. A low ESR suggests inflammation.
**can increase with age, be higher in women/patients with ESRD/DM2/pregnancy, be lower in patients with CHF or sickle cell**
What is a CRP test used for?
A C-Reactive protein test measures inflammation in the body. Presence of high levels of CRP indicates inflammation.
**More sensitive than ESR, less variable than ESR, affected by age/gender/heart disease/infection/malignancy/obesity/DM2/Smoking**
