Common orthopaedic/rheumatological histories - Joint pain/stiffness/swelling Flashcards
What would you want to ask about jointpain/stiffness/swelling?
- SOCRATES
- Worse in the morning
- Worse/better after exerciser
- Sleep disturbance
- Loss of function
What rheuamtological features would you want to ask about joint pain/stiffness/swelling?
- Joints - pain, stiffness, swelling
- Skin- rashes, ulcers, raynaud’s
- Hair loss
- Eyes - redness, dryness
- Dry mouth
- Chest - breathlessness
- GI - IBD symptoms
- Genitourinary - discharge
- Fever
- Weight loss
What features assocaited with joint pain/stiffness/swelling would suggest RA?
- Slowly progressive symmetrical polyarthropathy
- Small joints
- Deforming
- Early morning stiffness
What features of joint pain/swelling/stiffness suggest gout as the cause?
- First MTP joint
- Isolated, swollen joint - hot
- Hyperuricaemia risk factors - diuretics, alcohol excess, renal disease
What features assocaited with joint pain/stiffness/swelling would suggest PSoriatic arthritis as the cause?
- Skin plaques and nail changes
- Early monring stiffness
- Many patterns of joint involvement
What features assocaited with joint pain/stiffness/swelling would suggest SLE as a cause?
- Systemic illness with intermittent fevers
- Photosensitive rash
- Generalised myalgia/arthralgia
- Other systemic symptoms - psychosis, pleurisy, ukcers
What features assocaited with joint pain/swelling/stiffness suggest enteropathic arthritis as a cause?
- Symmetrical large joint arthritis of lower limb joints/SI joints
- Early morning stiffness
- Symptoms/diagnosis of Crohn’s/UC
What features assocaited with joint pain/stiffness/swelling would suggest reactive arthritis?
- Urethrtis - dysuria, discharge
- Conjunctivitis - red eye, gritty feeling
- History of diarrhoea
- Polyarthritis
- Iritis, kertaoconjunctiva blenorrhagica
What features of joint pain/stiffness/swelling would suggest Sjogrens syndrome?
- Severe acutely inflammed artitis
- Dry eyes
- Dry mouth
- Enlarged salivary glands
What features assocaited with joint pain/stiffness/swelling would suggest osteoarthritis?
- Elderly
- Worse on movement - relived by rest
- End of day/night pain common
What features assocaited with joint pain/stiffness/swelling would suggest septic arthritis?
- Isolated hot, red, swollen joint
- Agonizingly painful
- Systemically unwell with high fever
- WCC ↑↑
What are causes of monoarthritis?
- Acute septic arthritis
- Gout/pseudogout
- Trauma
- Haemarthrosis
- Adhesive capsulitis
- Transient synovitis
- Bursitis
- Reactive arthritis
- RA
What are causes of polyarthritis?
- RA
- Psoriatic arthritis
- SLE
- Enteropathic arthritis
- Sjogrens
- Rheumatic fever
- Viral polyarthropathies
- Polymysotis
- Spondyloarthropathies
What features assocaited with joint pain/stiffness/swelling suggest traumatic haemarthrosis?
Acute inflammation following trauma
What features of joint pain/swelling/stiffness would suggest pseudo gout?
- On painful joint - usually knee
- Elderly
- History of condition
