Introduction to Arthritis Exam 1 Flashcards
Components of a patient evaluation for joint pain
- History
- Physical examination
- Laboratory tests
- Imaging
- Synovial fluid analysis
What are elements in patient history?
- Pain
- Stiffness
- Deformity
- Loss of function
- Systemic illness
- Extra-articular involvement
- Other medical conditions that predispose to or affect expression of arthritis
- Family history of arthritis or associated conditions
- Activities that predispose to arthritis
- Joint injury
What are elements in physical examination?
- Synovial inflammation
- Instability
- Deformity
- Crepitus
- Distribution will help tell us which type of arthritis is involved
- Skin
- Eyes
- Oropharynx
- Lungs, heart, abdomen, nervous system
What is there to look for in synovial inflammation?
- Redness (rubor)
- Swelling (effusion or soft tissue swelling)
- Heat (calor)
- Pain (tenderness)
- Loss of function (movement)
What is crepitus?
sounds or crackling that can be heard as the joint is being felt or being put through its range of motion
How can instability and deformity happen?
when join exposed to inflammation over a long period of time
What are you looking for when evaluating the skin?
- rash
- nodules
- texture
- tophi (urate deposits)
What are you looking for when evaluating the eyes?
- dryness
- corneal disease
- episcleritis / scleritis
- uveitis
What are the lab tests conducted when differentiating between the forms of arthritis?
- CBC
- Chemistry
- Uric acid, creatine kinase (CK)
- Urinalysis
- Inflammatory markers
- Autoantibodies
- Complement
- Synovial fluid analysis
What is included in the chemistry lab test?
- albumin
- creatinine
- liver function tests
What are the inflammatory markers?
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
What are the autoantibodies?
- ANA (Anti-nuclear antibodies) and other lupus-related autoantibodies
- RF (rheumatoid factor) and anti-CCP (cyclic citrullinated peptide) antibodies
What is included in the synovial fluid analysis?
- appearance
- cell count
- gram stain
- crystal analysis
- special studies
What are the imaging studies conducted when differentiating between the forms of arthritis?
- Xray
- CT scan
- MRI
- Ultrasound
Xray
- In inflammatory arthritis, can see: Soft tissue swelling, Peri-articular demineralization, Articular erosions, Characteristic distribution
- In degenerative arthritis, can see: Reactive bone formation (osteophytes on edges of the joints), Joint space narrowing (loss of cartilage), Joint deformity
