Clinical Approach to Rheum Flashcards
what locations are involved in degenerative disease (OA)
DIP, PIP, Cervical, Lumbar, Hips, Knees, MTPs.
Spares other areas (wrist, MCP, shoulders, elbows)
May only have stiffness for a couple minutes
what locations are involved in degenerative disease (RA)
Spares: DIPs, RA spares lumbar area
Hands often involved, NOT DIP joints typically
Duration of morning stiffness is much longer
hard enlargement (OA/RA)
OA
softer synovial involvement (OA/RA)
RA
differential for monoarhtritis
Microcrystalline
Gout- relatively younger ppl, 1st MTP joint
Pseudogout- calcium salt, more common in older pt
Septic Joint
Osteoarthritis- injury to a joint earlier in life
Lyme- most typically the knee
Injury/Internal Derangement/Overuse
differential for symmetrical polyarthritis
Rheumatoid Arthritis- if inflammatory looking
Osteoarthritis-bony looking
SLE
Juvenile Idiopathic Arthritis
Undifferentiated Connective Tissue Disease
differential for Asymmetrical Pauciarticular
Psoriatic arthritis (classic)
E.g. patch of psoriasis on right knee and left knee
has psoriatic arthritis cuz its swollen
Reactive Arthritis (formerly Reiter’s)
Microcrystalline (e.g. gout)
Juvenile Idiopathic Arthritis
Lyme disease
ASAS criteria for inflammatory back pain
Improvement with exercise
Pain at night (with improvement upon arising)
Insidious onset
Age of onset less than 40 years
No improvement with rest (and may get worse)
Presence of 4 of 5 features is 79.6% sensitive and 72.4% specific in a validation cohort of 648 patient with back pain
what does periungual talengectasias suggest
connective tissue diseases!
malar rash, photosensitivity…
SLE
palpable purpura…
vasculitis
pyoderma gangrenosum is associated with…and what is the description
IBD, RA, SLE
thick bordered ulcerative lesion with over hanging borders
sicca complex
dry eyes and mouth
