Joint Pain

Question 1

Pnemonic for joint pain:

Answer 1

L: location, articular or periarticular
I: inflamm present or absent
M: mono, oligo, or polyarticular
D: Duration
A; associated symptoms and signs;

LIMDA!!

Question 2

Acute inflamm monoarthritis is; septic arthritis can

Answer 2

acute and urgent;

INDICATED FOR ARTHROCENTESIS and synovial fluid analysis; destroy the joints within a few days

Question 3

What can synovial fluid analysis tell you?

Answer 3

1. Lose viscosity: inflamed or infected
2. Less than 200 WBCs is normal, greater than 100000 is septic, and 200-10000 could be noninflamm or inflamm
3. Culture and gram stain (gram stain is an immediate test)

Question 4

Similarities and differences b/w gout and septic arthritis:

Answer 4

Both with 25 cc of turbid yellow fluid with low viscosity, cell count at 45000, PMN at 90%;
septic arthritis gram stains gram pos cocci with NEGATIVE crystal analysis

Question 5

Characteristics of psoriatic arthritis:

Answer 5

1. Chronic inflamm seronegative arthritis: neg RF and anti CCP!!!
2. mono or assymetric oligoatricular; polyarticular symmetrical like RA but also with DIP involvement; dactylitis or sausage fingers; axial (spinal); arthritis mutilans (rare);

In China, get through MAO’s PAAS

Question 6

Differentiate b/w osteoarthritis and anserine bursitis:

Answer 6

Former with tenderness at medial articular line, occurs chronically with no redness or swelling; latter is periarticular

Question 7

Polyarticular arthritis causes:

Answer 7

1. Inflamm (RA, SLE, psoriatic, chronic gout, chronic CPPD)
2. Infectious: viral with HCV, HBV, HIV more chronic, parvovirus, rubella, chikungunya more acute; bacterial is tertiary lyme and endocarditis; RA patient could present as HCV
3. Post infectious (Reactive arthritis with enteric or urogenital; rheumatic fever)
4. Noninflamm

Question 8

For parvovirus, think

Answer 8

kids with slapped cheek disease; fever before arthritis; low titer ANA, IGM parvovirus high;
disease should resolve within few weeks to 6 months

Question 9

For RA, look for

Answer 9

initial treatment with ibuprofen, and month(s) later you have worse swelling and severe am stiffness;
RF mildly up, antiCCP very high, ANA mildly high;
Hep B and C are negative;

it is a disease of SMALL JOINTS (won’t involve DIP) and spine at C1-C2 junction, leads to deformities and erosions if not treated, and should be there for 6 weeks for accurate diagnosis and DMARD starting;

RF sens but not very specific (could be seen in inflamm diseases, viral illnesses, maybe periodontal disease and endocarditis); CCP less sens, more specific!!!

VIPE R

Question 10

For reactive arthritis, think:

Answer 10

1. Think shigellosis (campylobacter, yersinia, C diff; urogenital is chlamydia)
2. HLA-B27 positive
3. Think urethritis, conjunctivitis, skin rash
4. Knees, ankles, back involved more so than small joints in hands (BAK)

Question 11

For OA, think:

Answer 11

1. better with rest, worse with prolonged activity
2. common in hands and cervical/lumbar spine, weight-bearing joints like hips and knees (CHHK)
3. rarely ankles, wrists
4. Bony sclerosis and osteophytes; NO EROSIONS
5. Normal ESR and CRP; negative autoimmune labs

Question 12

Seronegative spondylarthropathies:

Answer 12

1. inflamm arthritis of spine, hips, SI joints, tendons, ankles, knees; less of the small joints (SHITAKi mushrooms)
2. HLA B27 pos
3. Give NSAIDs and exercise
4. Psoriatic arthritis, reactive arthritis, IBD arthritis, pure ankylosing spondylitis

Question 13

Active and passive range of motion are

Answer 13

limited in arthritis, but passive range of motion is usually normal in tendinitis (rotator cuff disease eg)

Question 14

Lyme disease associated with; what can help with crystalline-induced arthropathies?

Answer 14

isolated knee arthritis;

arthrocentesis, lab work for uric acid, Ca, and xrays show typical changes (CAUX)