History and Examination in Inflammatory Joint Disease

Question 1

Inflammatory type of arthritis?

Answer 1

Rheumatoid arthritis

Question 2

Non-inflammatory type of arthritis?

Answer 2

Osteoarthritis

Question 3

What lines joints?

Answer 3

Synovium

->lubrication, control of synovial fluid, articulation

Question 4

Which investigation shows ongoing inflammation?

Answer 4

Doppler ultrasound

Question 5

Which condition has early morning stiffness which gets better as day goes on?

Answer 5

Rheumatoid arthritis

Question 6

In which type of arthritis are constitutional symptoms more common e.g. malaise, fatigue, weight loss…

Answer 6

Inflammatory arthritis e.g. rheumatoid

Question 7

When does inflammatory pain tend to be best and worst?

Answer 7

Best on movement
Worst on rest

Question 8

When does mechanical pain tend to be best and worst?

Answer 8

Best on rest
Worst on movement

Question 9

What are some of the questions to ask if suspecting connective tissue disease?

Answer 9

Raynaud’s
Photosensitivity
Mouth ulcers
Genital ulcers
Hair loss
Miscarriages
Thromboembolic events (FH too)

Question 10

Rashes are important in inflammatory joint disease.
Which rashes should be asked and looked for?

Answer 10

Psoriasis (inc FH)
Erythema nodosum
Photosensitive rashes

Question 11

What is nail pitting associated with?

Answer 11

Psoriatic arthritis

Question 12

What does swelling of joints fell like in inflammatory arthritis?

Answer 12

Hard and boney

Question 13

What does swelling of joints fell like in synovitis?

Answer 13

Soft and spongy

Question 14

Dactylisis?

Answer 14

Sausage shaped fingers or toes

Question 15

What is dactylisis associated with?

Answer 15

Spondylyoarthritis

Question 16

Do you just check joints for inflammatory joint disease?

Answer 16

No- often affects systemically too e.g. lungs, gut, bone, eyes, heart

Question 17

Investigations for connective tissue disease?

Answer 17

Urinalysis and BP

Question 18

Investigations for gout?

Answer 18

Urate- but can be low/normal/high in an acute flare-up

Question 19

If there is joint swelling, what investigation can be done?

Answer 19

If you can collect a sample, send for microbiology!!

Question 20

Random but parts of this lecture gives an overview of a lot of conditions we’ve covered so would be a good revision lecture!

Answer 20

Well…gonna watch it?

Question 21

Firbomyalgia?

Answer 21

Widespread pain in multiple regions of body for >3months
Increased fatigue, emotion, sensitivity to sound, light

Question 22

Who can prescribe biologics?

Answer 22

Secondary care, cannot prescribe in primary care