Clinical aspects of arthritis Flashcards
What are the two proformas for joint examination?
GALS - gait, arms, legs and spine
REMS - regional examination of the musculoskeletal system
What is osteoarthritis?
Disease of the synovial joints whereby there is slowly progressive destruction of the articular cartilage that affects the weight bearing joints and digits
What are the components of a typical synovial joint?
Joint capsule
Synovial membrane
Synovial fluid
Hyaline (articular) cartilage
What is the joint capsule?
The joint enclosure, reinforced by and strengthened with ligaments
What is the synovial membrane?
A continuous sheet of connective tissue lining the capsule; its cells produce synovial fluid that lubricates the joint and prevents the two cartilage caps on the bones from rubbing together
What is synovial fluid?
Produced by the synovial membrane, the fluid lubricates the joint. In the normal joint, very little fluid (less than 5cc) exists in the cavity.
What is hyaline cartilage?
Where the bones actually “meet”
What is primary osteoarthritis?
Prevalence increases with age
18-24: 4% affected
75-79: 85% affected
Before the age of 45, disease mainly affects males. After 55 more common in females
Also called wear and tear arthritis and degenerative joint disease
No obvious predisposing event
A familial pattern is apparent in some cases – in some, mutation of type II collagen gene is found
What is secondary osteoarthritis?
Clear association with some predisposing condition
- Congenital abnormal joint (slipped femoral epiphysis)
- Trauma to a joint
- Abnormal stresses on a joint (e.g. weight bearing demands of obesity, association with particular sports, occupations)
- Previous inflammation
- Neuropathic joints e.g. diabetes mellitus
What hand deformities may be present in osteoarthritis?
Bouchards nodes - PIPs
Heberden’s nodes - DIPs
What hand deformities may be present in rheumatoid arthritis?
Swan neck deformity - DIP flexion with PIP hyperextension
Inflammation and swelling of MCP joints
What hand deformities may be present in psoriatic arthritis?
Sausage digit - diffusely swollen digit, especially at PIP
Deformity of DIP
Red, scaly skin and crumbly nails
In which disease is the prayer sign seen and why?
Type 1 diabetes
- hand stiffness resulting from flexion contractures of the fingers and thickened, tight, waxy skin
What is dermatomyositis?
a rare neuromuscular disease related to polymyositis (PM) that is characterized by inflammation of the muscles and the skin.
Heliotrope rash and Gottron’s sign
What is the cause of pseudogout?
Calcium pyrophosphate
