Joint pain

Question 1

What is arthritis and how is it classified?

Answer 1

Inflammation of the joint.
Inflammatory: seronegative, seropositive, infectious or crystal induced, e.g. rheumatoid, SLE, psoriatic.
Non-inflammatory (degenerative): e.g. osteoarthritis.

Question 2

What are the seropositive inflammatory arthritis?

Answer 2

Rheumatoid arthritis.
Lupus.
Scleroderma.
Vasculitis.
Sjogren's.

Question 3

What are the seronegative inflammatory arthritis?

Answer 3

Ankylosing spondylitis.
Psoriatic arthritis.
Reactive arthritis.
IBD arthritis.

Question 4

Give an example of infectious inflammatory arthritis.

Answer 4

Septic arthritis.

Question 5

What are the crystal-induced inflammatory arthritis?

Answer 5

Gout.

Pseudogout.

Question 6

Give an example of non-inflammatory (degenerative) arthritis.

Answer 6

Osteoarthritis.

Question 7

Screening questions for joint pain?

Answer 7

Do you suffer from any pain or stiffness in your arms, legs, neck or back?
Do you have any difficulty with stairs or steps?
Do you have any difficulty with washing or dressing?

Question 8

Joint pain: history of presenting complaint

Answer 8

SOCRATES.
Chronology, sudden onset/gradual, recurrent?
Relationship to trauma/exercise?
Joint pain, stiffness, swelling, bone pain, muscle weakness?
Knee- locking, giving way, grinding, clicking?
Morning stiffness: OA <1hr, RA hrs.
Associated symptoms: rash, red eye (iritis), urethritis?- reactive arthritis.

Question 9

What are the clinical features of osteoarthritis?

Answer 9

Degenerative process.
Mainly large, weight bearing joints (back, knee, hip, ankle, hands) and DIP.
Asymmetrical.
Usually less deformity.
Morning stiffness <1hr.

Question 10

What are the clinical features of rheumatoid arthritis?

Answer 10

Autoimmune process.
Mainly small joints of hand.
PIP (not DIP), MCP, wrists, elbows, neck.
Also hips, knees, ankles.
Symmetrical.
Gross deformity.
Tendon rupture.
Morning stiffness >1hr.

Question 11

What are the clinical features of psoriatic arthropathy?

Answer 11

Seronegative inflammatory arthritis (RhF and ACCP -ve).
Personal or FHx of psoriasis.
Similar to RA in distribution, except: initial oligoarticular involvement, DIP joints, marked dactylitis, sacroiliitis.

Question 12

GALS screen: arms

Answer 12

Hands behind head with elbows back.
Supination and pronation of elbow.
'Squeeze my fingers'.
Opposition of thumb and fingers.
Squeeze metacarpal joints.

Question 13

GALS screen: legs

Answer 13

Hand over the knee to feel for crepitus.
Internal rotation of hip (foot moves externally).
Ankle flex/extend- tibiotalar joint affected in OA.
Supination of foot- subtalar joint affected in RA.

Question 14

GALS screen: spine

Answer 14

Lateral flexion of cervical spine (mid-cervical region, 1st movement affected in OA cervical spondylosis).
Bending forward- need to ensure the movement does not come from the hips.

Question 15

What are the clinical features of rheumatoid arthritis in the hands?

Answer 15

Ulnar deviation.
Subluxation at MCP joints.
Rheumatoid nodules.

Question 16

What are the clinical features of osteoarthritis in the hands?

Answer 16

Heberden’s nodes.

Bouchard’s nodes.