Approach to Polyarticular Pain

Question 1

DGI

Answer 1

Diesseminated gonococcal infection

Acute oligo pain

Sexually active young

Feve,r chills, malaise which dimininish as pain develops

Tenosynovitis of the wrist, MCP/PIP joints, ankels and MTP…only a few days in each joint

2-10 pustules/vesiculopustules on dorsal distal extremimities./.only 3-4 days

Question 2

Reactive arthritis

Answer 2

Acute oligo
Within a month after bacterial enteritis or urogen infection

Acute asymmetric of ankles and MTP with variable involvement of wrist, MCP and PIP joints

May have achilleles tendinitis or dactylitis and inflam low back pain

Question 3

Rheumatic fever

Answer 3

After strpe in children to young adults

Migratory asymmetric arthrtisi involving knees, ankles, elbows, and wrists

About a month long

Might get erythematum marginatum, subq nodules, carditis, or sydenham choreea

Question 4

Gout

Answer 4

After a year of recurrent attacks of monarthritis and asymmetric involvement of joints in same limb like

MTP, tarsal and anle

Less commonly, upper body wrists, MCP/PIP and knes

Question 5

Pseudogout

Answer 5

Asymmetric of multiple joints…normally larger like

Knee, wrist, elbow, and ankle

Question 6

Sarcoidosis

Answer 6

Acute form known as Lofgren syndrome in white women

Symmetric oligoarticular arthrits, bilateral hilar LAD and erythema nodosum

Question 7

Dx and managment of acute olgi pain

Answer 7

CBC, ESR, CRP to confirm inflamm

Younger screened for DGI and rective with urine PCR and urinalsys….also colected PCR from pharynx and rectum if think DGi

If joint effusion present, arthrocentesis for cell counts, crystals nad cultue

If think rheumatic, then throat culture fro mgroup A strep

Question 8

Viral arthrtisi

Answer 8

Just like RA with symmetric MCP, PIP, wrists, knees, and ankles

ParvoB19 will get exposed to childrne with actue febrile illness, slapped cheekc

Hep B - arthritis prior to jaundice so may have some systemic or urticarial

Most get better over 2-6 weeks

Question 9

RA

Answer 9

Insidious typically

Do not make diagnosis until after 6 weeks

Question 10

SLE

Answer 10

Polyarthrlagia or arthritis involving wrists, MCP, PIP, and kness

Tend to be migratory with pain rarely persisting for a long time

Rarely causes defomities (like RA)

Question 11

Dx and managemnt of acute poly

Answer 11

Assume viral in acute setting

If not better then, CBC, ESR, and CRP

Test for RF and ACPA

Also ANA, urinalysis, and measurement of creatinine

Question 12

Osteoarthtis

Answer 12

Bilateral hip and knee pain normally

1st CMC joint, DIp and PIP, spine

Pain is noninflam

Crepitus on PE

Pain to palp of periarticular soft tissues without signs of inflamm

Bony enlargemnt of PIP and DIP

reduced ROM

Question 13

Anklyosing

Answer 13

Under 40

Lumbar and sacriliac joints

Inflam

Enthesistis common (achilles, plantar, costochondritis)

Question 14

Reative

Answer 14

Between 3-4 months but up to 20% may get chornic

Question 15

Psoriatic arthritis

Answer 15

Nail pitting in over 90%

Joint typically after the skin

Question 16

Chronic tophaceous gout

Answer 16

Same joints as gout

Asymmetric involvent of less than 5 joints is typical

Question 17

Dx and mangment of chronic oligo

Answer 17

Osteoarthritis is most common

Arthrocentesis

X-rays

Question 18

CPPD

Answer 18

MCP, wrist, shoulders, and elbows separate from OA

Also have intermittnet flars of pseudogout

Question 19

Fibromyalgia

Answer 19

Widespread MSK pain

Most in muscles

Most are asymmetri but involve both sides of body above and below the waste

May have other comordibities

Question 20

RA

Answer 20

Most common inlam polyarthritis

Involvement of wrists, ankles, MCP and MTP joints vs. OA

Also elbow, shoulder, and knee

More than 1 hr morning stiffness

Low grade fevers and other constitutional sx

joint pain, swelling, reduced ROM typical

Question 21

SLE

Answer 21

Most have poly with wrists, MCP, PIP and jness

Migratoryh

Tender and swollen

Question 22

Dx of chronic poly

Answer 22

CBC, ESR, CRP

Test for RA with AVPA and RF

ANA, urnailsys and creatinine

X-ray can help to rule out CPPD

Question 23

Henoch-Schonlein purpura

Answer 23

IgA vasculitis

Between 3 and 15

Most get polyarthrlagias

Migratory asymmetric hips kness and ankles

No effusions

Palpable purpura, ab pain, hematuria

Renal dz

Question 24

JIA oliepi, CM, Lbas go

Answer 24

<5 Yrs, women

Knees, ankles, wrists, elbows

Uveitis in 10-20

ANA positive in 80%

Question 25

JIA poly ep, CM, labs

Answer 25

2-18 female

Younger have more knee, wrist, and ankel

Older have MCP, PIP, wrist, elbows, cervical spine, hips, kjnees, ankels

RF positive in 5-10%

Question 26

sJIA epi, CM, labs

Answer 26

Less than 10 y/o
Male and female equal

Dialy spiking fevers, rash, arthrlagias, LAD, spleno/hepatomegaly

Anemia, leukocytosis, thrombocytosis