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DPD Stuff > Joint Pain > Flashcards

Joint Pain Flashcards

1
Q

What percentage of cases presenting to the GP is musculoskeletal?

A

25%

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2
Q

What are the classes of arthritis?

A
  • Inflammatory (RA/ SLE/ psoriatic)

- Non-inflammatory (OA)

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3
Q

What is the incidence and prevalence of RA?

A

Prevalence- 400,000
Incidence- 5 per 10,000 per year
women>men
peak age 40’s

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4
Q

What is the incidence and prevalence of OA?

A

Prevalence- 8.5 mil
Elderly
women>men

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5
Q

What questions should you take in arthritis screening?

A

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?

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6
Q

What is reactive arthritis associated with?

A

Inflammatory processes like IBD

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7
Q

What are you looking for in a HPC of arthritis?

A

Pain
Chronology, sudden onset / gradual, recurrent?
Relationship to trauma / exercise?

Ask specifically about…
Joint pain, stiffness, swelling, bone pain, muscle weakness
Knee – locking, giving way, grinding, clicking
Morning stiffness – (OA <1 hour, RA hours)
Associated symptoms (rash, red eye (iritis), urethritis – reactive arthritis)

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8
Q

What other parts of the history is relevant to arthritis?

A

Family history
PMH (other autoimmune diseases, psoriasis, other infections)
DH - what have they tried so far
SH – impact on life, describe a typical day, what have they had to give up?

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9
Q

What is OA like?

A
  • Degenerative process
  • Mainly large weight bearing joints (back, knee, hip, ankle, hands) and DIP
  • Asymmetrical
  • Usually less deformity
  • Morning stiffness < 1 hour of discomfort
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10
Q

What is RA like?

A
  • Autoimmune process
  • Mainly small joints of hand
    PIP (not DIP), MCP, wrists, elbows, neck (But also hips and knees and ankles)
  • Symmetrical
  • Gross deformity
  • Tendon rupture
  • Morning stiffness > 1 hour of discomfort
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11
Q

What is psoriatic arthropathy?

A

Seronegative inflammatory arthritis (RhF and ACCP –ve)
Personal or family history of psoriasis
Similar to RA in distribution – EXCEPT

Initial oligoarticular involvement
DIP joints
Marked dactylitis
sacroiliitis

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12
Q

What is the GALS screen?

A
  • Designed as a quick screening tool to discover any joint problems
  • Mainly testing the joint where the capsule is tightest and symptoms are more likely to occur
  • Can help to differentiate between OA and RA
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13
Q

How do you test arms in GALS?

A
  1. Hands behind head with elbows back
  2. Supination and pronation of elbow
  3. ‘Squeeze my fingers’
  4. Opposition of thumb and fingers
  5. Squeeze metacarpal joints
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14
Q

How do you test opposition of thumb?

A

Tip of thumb to tip of other fingers

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15
Q

How do you test legs in GALS?

A
  1. Hand over the knee to feel for crepitus
  2. Internal rotation of hip (foot moves externally)
  3. Ankle flex / extend - tibiotalar joint affected in OA
  4. Supination of foot – subtalar joint affected in RA
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16
Q

How do you test gait in GALS?

A
  1. Antalgic gait
  2. Spastic gait (circumduction)
  3. Foot drop gait (high stepping)
  4. Parkinsonian gait
  5. Trendelenburg gait
17
Q

How do you test spine in GALS?

A

Lateral flexion of cervical spine (mid cervical region, first movement affected in OA cervical spondylosis)

Bending forward - need to ensure the movement does not come from the hips

18
Q

What are the clinical features of RA hands?

A 
Ulnar deviation
Subluxation at MCP joints
Rheumatoid nodules
Boutonnieres/ swan neck deformity
Bony erosions (XRAY)
19
Q

What are the clinical features of OA hands?

A

1 – Heberden’s nodes (DIP)
2 – Bouchard’s nodes (PIP)
HDBP

20
Q

What is boutonnieres deformity?

A

Hyperextension at DIP

Flexion deformity at PIP

21
Q

What is a swan neck deformity?

A

Flexion deformity of DIP

Hyperextension of PIP

22
Q

What are Z shaped thumbs?

A
  • Hyperextension of the interphalangeal joint

- Fixed flexion and subluxation of the metacarpophalangeal joint.

23
Q

What is genu varum and valgus?

A

Genu varum- bowlegs (out)

Genu valgus- knock knees (in)

24
Q

Which gait is more likely in OA?

A

Genu varum

25
Q

How do you investigate joint pain?

A

Bloods (FBC [anaemia, inc. WBC, uric acid], CRP, ESR, rheumatoid factor, anti CCP)

Imaging (MRI knees and back)

Synovial fluid (septic, gout)

Athroscopy

26
Q

What is the management of OA?

A
  • Exercise
  • Physical therapy
  • Weight loss
  • TENS
  • Orthotics and walking aids
  • Analgesia (simple analgesia and topical NSAIDs before oral NSAIDs and opioids)
  • Consider surgical referral
27
Q

How do you manage RA?

A

Pharmacological treatment

  • Analgesia (as in OA, simple analgesia first)
  • Steroids
  • DMARDS (disease modifying anti-rheumatic drugs e.g. methotrexate, sulphasalazine, hydroxychloroquine)
  • Biological agents (Tumour necrosis factor inhibitors e.g. etanercept, infliximab)
Supportive treatment (involving MDT)
- Physio
- OT
- Orthotics
PLUS all the HOLISTIC care
28
Q

When do you refer RA?

A

Refer early if inflammatory arthritis is suspected

Especially small joints hand and feet
More than one joint
Three months from onset of symptoms

Even if inflammatory markers and rheumatoid factor are negative

29
Q

How do you manage pain?

A

WHO pain ladder

  • Non opioid (paracetamol, NSAIDS)
  • Weaker opioids (Codeine, tramadol)
  • Stronger opioid (morphine, fentanyl)

Adjuvants

  • Gabapentin
  • Pregabalin
  • Amitryptilline
  • TENS

DPD Stuff (23 decks)

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