Diagnosis and Investigations Flashcards
Questions to ask re swollen and painful hands?
When did your symptoms start and have they built up gradually?
Do they vary throughout the day?
When are at they at their worst and how do they respond to activity and time of day?
Do your joints ever feel stiff, for example in the morning?
Any constitutional symptoms i.e. fever, night sweats or weight loss?
Any skin rashes, change in bowel habit or dry or watery eyes?
Do joint problems run in your family?
Types of Inflammatory Arthritis
CTD
Vasculitis
Seropositive Spondlyoarthritis
Seronegative Spondlyoarthritis
How does IA present?
Insidiously
<30 mins morning stiffness
Improves with exercise and as the day goes on
If multisystem or constitutional sx, expect CTD
If other symptoms such as bowel habit or eye involvement consider Seronegative
How does RA present?
As with IA but expect strong family hx
Symmetrical small joint polyarthritis
What is non inflammatory arthritis?
Osteoarthritis
How does OA present?
No morning stiffness, or morning stiffness lasting <30 mins
Worse with exercise and better with rest
Ageing pt
How does Septic Arthritis present?
Asymmetrical monoarthritis
Associated fever and infective sx
Acute hx over hours or days
Pt feels generally unwell
What are the types of crystal arthritis?
Gout
Pseudogout
How can you differentiate between gout and pseudogout?
Gout: Negatively bifringent needles
Pseudogout: Positively bifringent rhomboids
Gout more likely in pattern - MTP - Ankle - Knee
Pseudogout more likely in larger joint and in patient with underlying OA
What are the risk factors for gout?
Male Age >45 Taking thiazide diuretics Consume large amount of alcohol Diet high in purines i.e. meat, oily fish, marmite High BMI Family Hx
How does crystal arthritis present?
Acute onset
acutely painful and unable to weight bear on affected joint
What is Sjogren’s Syndrome?
Goes often alongside CTD/RA
Dry eyes and mouth
What is reactive arthritis?
Presents after an infection such as food poisoning or STI
Affects younger patients
Asymmetric oligoarthritis
What do you do if you suspect someone has RA?
Provide simple analgesia for pain relief
Refer urgently to Rheumatology
What investigations would you do in someone who has RA?
Baseline FBC, LFT, U&E
ESR/CRP - markers of inflammation
TFT - if abnormal can present with joint pain
Rheumatoid Factor and anti-CCP - suggest RA
ANA - suggest CTD
X-Rays of hands and feet - may see RA changes
What would you see on an X-Ray of a patient with RA?
Soft tissue swelling
Loss of joint space
Intra-articular erosions
Periarticular osteopenia
How do you diagnose RA?
Using the American College of Rheumatologist guidelines
Which areas are looked at in the diagnosis of RA?
Number of joints involved - at least 1 must be a small joint
Serology - RF or anti-CCP
Acute phase reactants - CRP or ESR
Duration of symptoms >6 weeks
How do we monitor disease activity in RA?
Disease Activity Score - DAS
Calculated after looking at number of tender joints, number of swollen joints, global assessment of disease activity from 0-100, and ESR/CRP measurement.
When would you use USS in a patient with joint swelling?
If there is clinical suspicion about whether or not swelling is present. USS can identify synovitis and joint effusion as well as bone erosions very sensitively.
