focused clinical history taking and examination - rheumatology Flashcards
What is the function of synovium
Maintenence of intact tissue
lubrication of cartilage
control of synovial volume
Nutrition of the chondrocytes within the joints
What happens to the joints in osteoarthritis
the cartilage surface becomes rough
synovium is mildly thicker then usual
bone deformities can occur
What happens to the joint in rheumatoid arthritis
The synovial lining becomes thickened due to inflammation
The cartilage becomes thinner
More synovial fluid production due to the thickened synovium
What age group is osteoarthritis more common in
over 50 years old
What is a likely cause of mechanical pain at a joint in a younger person
hypermobility
Which joints does osteoarthritis most commonly affect
1st carpo-metacarpal/ distal interphalangeal and proximal interphalangeal (thumb side)
which joints does rhematoid arthritis more commonly occur
MCPs/ PIPs
Where does pseudogout most commonly occur
Wrist or knee in the elderly
Where does spondyloarthritis more commonly occur
Monoarthritis in the young
Where does gout most commonly occur
1st MTP/ankle/knee/elbow
What is early morning stiffness over 30 minutes a sign of
Inflammatory arthritis
what is characteristic of inflammatory pain
Worse on rest but better with movement
What characterises mechanical pain
Worse on movement, better on rest
Which diseases are constitutional symptoms more common in - malaise, fatigue and weight loss
Inflammatory arthritis and rare rheumatic diseases such as lupus
What rashes should be looked for in MSK exam
psoriasis
erythema nodosum
photosensitive
vasculitic
Where are the common enthesitic points
Epicondylitis/achilles and heel
If the joint is bony or hard, what is the suggestive diagnosis
osteoarthritis
If the joint is soft and spongy, what is the suggestive diagnosis
synovitis or inflammatory arthritis
What is dactylitis suggestive of - swollen digits that look like sausages
spondyloarthritis
What is the correlation with urate level and gout
chronic gout is associated with high urate
acute gout can have high, normal or low urate
What is the investigation for a connective tissue disease patient who is unwell
urinalysis and blood pressure measurement
Who is gout rare in
premenopausal women
What are the joint fluid analysis which are done
separate samples for microbiology and cytology for polarising microscopy
What are the parameters that are looked for in diagnosing spondyloarthritis
Inflammatory back pain with a good response to NSAIDs
Family history of spondyloarthritis
HLA-B27 positive can aid in diagnosis
Elevated CRP and ESR - inflammatory markers
sacroiliitis on MRI
What is systemic vasculitis
group of rare autoimmune conditions that cause inflammation of the blood vessels
What is fibromyalgia
Centralised widespread pain disorder that is characterised by severe pain and other somatic symptoms - more than 3 months
What are the symptoms of fibromyalgia
widespread pain longer than 3 months
fatigue - physical, cognitive and emotional
Photosensitivity
