joint pain

Question 1

how do we assess joint pain on history?

Answer 1

LIMDA
(location/articular/periarticular, inflammation present or absent, mono/oligo/polyarticular, duration, associated signs and symptoms)

Question 2

inflammatory monoarthritis Dx

Answer 2

infectious (septic arthritis, gonococcal/lyme), crystal induced (gout), rheumatological (RA (although usually polyarthritis small joints), psoriatic arthritis, reactive arthritis, SLE).

Question 3

noninflammatory monoarthritis DX

Answer 3

osteoarthritis which is occasionally swollen, trauma, bleeding and avascular necrosis.

Question 4

is acute inflammatory mono arthritis serious?

Answer 4

yes. this is a medical emergency and indicates arthrocentesis and analysis of the synovial fluid. this can destroy joints within a few days.

Question 5

gout analysis

Answer 5

turbid yellow fluid with low viscosity. cell count is high. PMN 90%. gram stain is negative. there will be a positive crystal analysis.

Question 6

septic arthritis analysis

Answer 6

turbid yellow fluid with low viscosity. cell count will be high, 90% PMN, gram stain typically positive. crystal analysis negative.

Question 7

psoriatic arthritis characteristics

Answer 7

chronic inflammatory seronegative arthritis negative RF and anti CCP. it is typically mono or asymmetric oligoarticular polyarticular symmetrical like RA but with DIP involvement.

Question 8

other common associations with psoriatic arthritis

Answer 8

dactylitis or sausage finger, axial spinal, arthritis mutilans.

Question 9

what is a specific test for RA?

Answer 9

cyclic citrullanated protein antibody. this is less sensitive and more specific that RF. there is a high-risk of RA if both are positive

Question 10

reactive arthritis or reiter syndrome

Answer 10

urethritis, conjunctivitis, skin rash. can’t pee, can’t see, can’t climb a tree. knees, ankles, and back involved more than small joints and hand. post infectious

Question 11

what HLA is associated with reiter syndrome

Answer 11

B27

Question 12

what infections commonly cause reiters?

Answer 12

enterics such as shigella, campylobacter, yersinia, C. diff. chlamydia.

Question 13

rheumatic fever characteristics

Answer 13

recurrent strep throat. fever, pinking skin. severe pain in ankle with small effusion present. high ESR, high ASO titer.

Question 14

osteoarthritis

Answer 14

noninflammatory degenerative joint disease can be deforming. this is the most common type of arthritis with genetic or environmental factors.

Question 15

presentation of osteoarthritis

Answer 15

AM stiffness about 10-15 min. better with rest, worse with prolonged activity. common in the hands and cervical and lumbar spine. it will occur in the weight-baring joints like hips and ankles.

Question 16

where does osteoarthritis normally not occur?

Answer 16

rare in the ankles, wrist, metacarpalphalageal joints and glenohumeral joints.

Question 17

what is the lab work for osteoarthritis

Answer 17

normal ESR and CRP, negative autoimmune. radiological findings include bony sclerosis and osteophyte.

Question 18

what is normally not found in osteoarthritis?

Answer 18

there are usually no erosions.

Question 19

serum negative spondylarthropathy

Answer 19

inflammatory arthritis of the spine, hips, sacroiliac, tendons, ankles, knees. less small joints involved. there is usually pain at night that is relieved by exercise or NSAID.

Question 20

what HLA is involved in spondyloarthritis?

Answer 20

B27

Question 21

serum negative spondylarthropathy DX

Answer 21

psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease. and pure ankylosing spondylitis

Question 22

which range of motion is limited in arthritis?

Answer 22

active and passive

Question 23

which range of motion is limited in tendonitis or bursitis

Answer 23

usually active. passive is usually okay.

Question 24

AM stiffness in osteoarthritis

Answer 24

less than 15 min

Question 25

AM stiffness in inflammatory disease

Answer 25

is at least 30 min

Question 26

rheumatoid arthritis

Answer 26

symmetrical inflammatory arthritis mostly of the small joints of the hands present for 6 weeks.

Question 27

which joints are never involved in RA

Answer 27

DIP and does not involve spine except for C1-C2 junction

Question 28

psoriatic arthritis

Answer 28

affects all joints and comes in different scenarios such as mono and oligoarthritis dactylitis. symmetrical small joints like RA and spinal.