Inflammatory joint conditions (RA) Flashcards
State 5 yellow flags for pain [5]
History of numerous episodes
Duration of symptoms
Intensity of symptoms
Anxiety / depression
Loss of control
Catastrophizing
Muscoloskeletal pain can normally be triaged into which three categories? [3]
Back pain
Myalgia: muscle pain
Arthralgia: joint pain
What are the sources of MSK pain? [4]
Soft tissue
Bone
Joint
Referred / central pain
State three categories of inflammatory joint disease [3]
- Infection: septic arthiritis or generalised arthralgia
- crystal arthropathy: gout and pseudogout
- Autoimmune disorders: RA, spondarthritis, connective tissue disease
When taking a MSK history what would you ask? [4]
History
- Episodic and / or joints additive?
- mono, oligo or poly joints?
- symmetrical?
Precipitating factors (infection, trauma, drugs)?
Responsiveness to therapy?
Systemic illness?
Many joints / polyarthralgia would be suggestive of what type of disease? [1]
Single joint / monarthralgia would be suggestive of what type of disease? [1]
polyarthralgia: autoimmune disorders
monarthralgia: inflammatory disorder
Why do you ask if joint / bone pain (e.g. polyarticular pain) has been around for 6 weeks? [1]
Viral arthritis is a cause of joint pain: if 6 weeks probably something else like RA
Draw a flow chart for diagnosis of joint pain
Describe the features of RA [3]
Symmetrical
Hands and feet in 80% of cases
Early morning stiffness
Valgus deformity
Bakers cyst: synovial fluid at popliteal area
What is this sign of RA [1]
Bakers cyst: synovial fluid at popliteal area
State three eye complications of RA [3]
Why is the eye commonly a problem? [1]
RA effects type 2 collagen; get lots of type 2 collagen in they eye
Keratoconjunctivitis sicca
Scleritis & episcleritis
Scleromalacia perforans: intraocular contents prolaspes out of the sclera
Describe three neuromuscular complications of RA [3]
Muscle wasting
Carpal tunnel syndrome
Atlanto-axial subluxation: odointal peg impinges on the spinal cord
What causes cervical myelopathy in RA patients? [1]
What are signs of cervical myelopathy? [5]
Compression of the spinal cord and brain stem is typically caused by atlantoaxial instability (AAI) or atlantoaxial subluxation (AAS)
spasticity (sustained muscle contractions)
hyperreflexia
pathologic reflexes
digit/hand clumsiness
gait disturbance
State a cardiac [1] and bone [1] complication of RA
ischaemic heart disease
osteoporosis
What are characteristics of RA in imaging? [3]
bone erosions
soft tissue swelling
periarticular osteoporosis
Early detection of RA synovitis using ultrasound would identify what? [3]
Synovial thickening
Effusion
Power doppler signal
Describe the symptoms of SLE
90% of patients have arthritis:
* symmetrical small joint polyarticular arthiritis (most common)
* jaccoud arthropathy (rare)
* avascular necrosis
Fatigue
Weight loss
arthralgia
myalgia
fever
butterfly rash: gets worse with sunlight
shortness of breath
hair loss
