ARTHRITIS Flashcards
OA DIAGNOSIS
You can diagnose OA clinically without imaging in people who
- are 45 or over and
- have activity-related joint pain and
- have either no morning joint-related stiffness OR morning stiffness that lasts no longer than 30 minutes
OA NON-PHARMA MANAGEMENT
Therapeutic exercise
- Doing regular and consistent exercise, even tho it may initially cause pain or discomfort, will be beneficial for their joints
- Long term adherence to an exercise plan increases its benefits by reducing pain and increasing functioning and QOL
Weight management
- Advice that weight loss will improve their QOL, physical function and reduce pain
OA ATYPICAL FEATURES
Hx of recent trauma
Prolonged morning joint-related stiffness
Rapid worsening of symptoms or deformity
Presence of a hot swollen joint
Concerns that may suggest infection or malignancy
RA DIAGNOSIS/REFERRAL
Refer to a specialist with any adult with suspected persistent synovitis (swelling) or undetermined cause, especially is
- Small joints of the hands or feet ate affected
- More than one joint is affected
- Delay of 3 months or longer between onset of symptoms and seeking medical advice
RA INVESTIGATIONS
Blood test for rheumatoid factor
Anti-CCP antibodies if rheumatoid factor is negative
RA PHARMA MANAGEMENT
cDMARD mono therapy using oral methotrexate, leflunomide or sulfasalazine
Esculate dose as tolerated
RA NON-PHARMA MANAGEMENT
Aim of physiotherapy is to:
- Improve general fitness and encourage regular exercise
- Learn exercises for enhancing joint flexibility, muscke strength and managing other functional impairments
Mediterranean diet (more bread, fruit, vegetables and fish, less meat, and replace butter and cheese with products based on veg and plant oils)
Although there is no strong evidence that the arthritis will benefit
GOUT DIAGNOSIS S&S
Suspect gout in people presenting with:
- Rapid onset (often overnight) of severe pain together with redness and swelling, in 1 or both 1st MTP joints
- Tophi (hard lumps that form under the skin due to a build up of uric acid crystals)
Also consider in people presenting with rapid onset of severe pain, redness or swelling in joints other than the 1st MTP joints - you should also assess the possibility of septic arthritis, calcium pyrophosphate crystal deposition and inflammatory arthritis in people with a painful, red, swollen joint
Consider chronic gouty arthritis in people presenting with chrinic inflammatory joint pain
GOUT TREATMENT FOR FLARE UPS
NSAID or a short course of oral corticosteroid is first line treatment
Consider a PPI for people who are taking NSAIDs to treat a gout flare
Ice packs
GOUT DIET AND LIFESTYLE
Not enough evidence to show that any specific diet prevents flares or lowers serum urate levels
Excessive body weight, obesity, or excessive alcohol consumption may exacerbate gout flares and symptoms
SPONDYLOARTHRITIS WHAT IS IT?
Group of inflammatory conditions that have a range of manifestations
Axial
- Radiographic axial spondyloarthritis (Ankylosing Spondylitis)
- Non-radiographic axial spondyloarthritis
Peripheral
- Psoriatic arthritis
- Reactive arthritis
- Enteropathic spondyloarthritis
SUSPECTING SPONDYLOARTHRITIS
S&S
- MSK - inflammatory back pain, enthesitis (painful inflammation of the enthesis (where tendons, ligaments, and joint capsules attach to bones), and dactylitis (painful swelling in the fingers or toes that can make them look like sausages)
- Extra-articular - uveitis (inflammation inside the eye) or psoriasis (including psoriatic nail symptoms)
SPONDYLOARTHRITIS RISK FACTORS
- Recent GU infection
- FHx of spondyloarthritis
- FHx of psoriasis
- HLA-B27 negative
AXIAL SPONDYLOARTHRITIS REFERRAL
LBP that started before the age of 45 and has lasted longer than 3 months - refer them to a rheumatologist if 4 or more of the following are also present
- LBP that started before the age of 35 years (this further increases the likelihood that back pain is due to spondyloarthritis compared with low back pain that started between 35 and 44 years)
- Waking during the second half of the night because of symptoms
- Buttock pain
- Improvement with movement
- Improvement within 48 hours of taking NSAIDs
- A first-degree relative with spondyloarthritis
- Current or past arthritis
- Current or past enthesitis
- Current or past psoriasis
PERIPHERAL SPONDYLOARTHRITIS REFERRAL
Urgently refer someone with suspected new-onset inflammatory arthritis to a rheumatologist unless one of the following is also suspected
- RA
- Gout
- Acute calcium pyrophosphate (CPP) arthritis - pseudo gout
SPONDYLOARTHRITIS REFERRAL
- Refer someone with dactylitis for a spondyloarthritis assessment
Refer someone with enthesitis without apparent mechanical cause if :
- It is persistent OR
- It is in multiple sites OR
- Any of the following are also present:
- Back pain without apparent mechanical cause
- Current or past uveitis
- Current or past psoriasis
- GI or GU infection
- IBD
- A first-degree relative with spondyloarthritis or psoriasis.
SPONDYLOARTHRITIS NON-PHARMA MANAGEMENT
Physio treatment can include
- Stretching, strengthening and postural exercises
- Deep breathing
- Spinal extension
- ROM exercises for the Lsp, Tsp and Csp
- Aerobic exercises
Hydrotherapy
