Joint Pain Flashcards
Type of collagen that is used to build bone (primarily)
Collagen 1
Bones that form via membranous ossification?
Skull, mandible, clavicle
What forms the urate crystals?
Breakdown of pyramidines - can see after heavy drinking, consuming lots of fats, can also see in chemotherapy patients
Can form tophi, first episode usually mono-articular, then can reoccur in a chronic form, distal great toe - big joint far from heart - drink lots of water
Pathogen spread via bacteraemia to cause a septic joints?
Gonorrhoea- can see skin lesions, as well as joint inflammation, and poly-articular, general malaise
What is rheumatic fever? Sx?
Group A strep (S. pyogenes) + autoimmune response - can lead to mitral valve stenosis/ myocarditis
Jones criteria - joints -migratory poly arthritis, heart, subcutaneous nodules, erythema marginatum, Sydenham chorea
What toxin is produced by group A strep?
M-protein
Risk factors for Ankylosing Spondylitis
Males, younger, autoimmune type 1 (bone) and 2 (cartilage) collagen, related to HLA- B27, but is RF negative
Insidious onset, better with exercise, presents with iritis, crohn’s often
Start with osteophytes, progresses to syndoesophytes
Psoriatic arthritis sx?
RH negative, can also be associated with HLA-B27, may or may not have the rash, joint erosion and deformity (pencil and cup)
Rheumatoid Arthritis Pathophysiology ?
Autoimmune, HLA associated, smoking, can be related to pathogen
Collagen structure change and attack, RF factor positive
Forms a pannus in the joint which leads to inflammation and synovial thickening
Sx of RA?
Can have extra-articular
Pleural effusions, liver - less iron absorption, pericarditis, nodules, plaques in blood vessels, fever, loss of muscle mass
Symmetrical multiple joints, common in hands
Flares - chronic, stiff after inactivity (AM stiffness), hand deformity EROSIVE
Red flags for limb pain?
POOP,»_space;»>
Polymyositis vs dermatomyositis
Both have proximal, bilateral, symmetrical weakness
But dermatomyositis has skin symptoms.
OA Sx?
Inflammation + wear and tear, osteophytes, narrowing of the joint spaces, BUT not erosive, chronic and progressive, hx of fracture, obesity
T-spine sparing
Fibromyalgia sx?
Multiple MSK pain, ++fatigue and sleep disturbance, somatic, multiple cognitive disturbances, psychiatric sx, women young to middle aged the most common. Central sensitization. Past trauma, genetic or family factors.
FOR 3 MONTHS
Polymyalgia Rheumatica sx?
Increased inflammation ESR/CRP, aching shoulders hips and neck - morning stiffness - articular structures, abrupt onset, Bsx.
Watch out for Giant Cell Arteritis. Give them steroids low dose
Compartment syndrome sx?
POOP (pain out of proportion), think trauma or vascular disorders/ inflammation, loss of pulses below the site of the compartment
Tx for RA
DMARDS, biologics, analgesia, can use hydroxychloroquine, methotrexate
Classically it is a combo of methotrexate and NSAIDS
Gout Tx?
Allopurinol, stops the production of uric acid - preventative ONLY NOT DURING ATTACK
Colchicine - reduces inflammation, diarrhea - TI
Indomethicin
Prednisone
Sx of septic arthritis?
Mono-articular, pre-existing infection, most often due to S.Aureus or Streptococcus,
Look for single swollen joint (usually knee) with warmth restricted motion and fever. Collect fluid/ x-ray start on 7-14 Abx
Sx of gout flare after initial mono-articular presentation?
12 years after, can have tophi, kidney (colicky flank pain, stones, decreased urine output) complications, can reoccur in other joints.
Urate crystals under polarized light microscope?
Negatively birefringent
STI which can lead to polyarticular joint pain?
Disseminated gonococcoemia - triad of tenosynovitis, polyarthralgias and dermatitis
Usually distal joints are effected.
Scarlet fever sx?
Post strep infection - blanching sandpaper like body rash, strawberry tongue, circumoral pallor.
Pathophysiology of ankylosing spondylitis
Autoimmune response destroys the fibroblasts and replaces them with fibrin which makes a band around the joints and limits ROM - osteoblasts will then ossify the fibrin.
Sx of ankylosing spondylitis
Back pain, before 40, insidous, improved with exercise, not with rest, pain at night, responsive to NSAIDS
Look for hx - IBD, psoriasis, iritis
Investigate - ESR/CRP, X-ray
Pathophysiology of psoriatic arthritis
inflammatory response in the body leads to T-cells can get into the joints and activate osteoblasts and clasts which will erode the joint
Should be RH and CYP negative (to differentiate from RA)
Pathophysiology of RA?
Inflammation (smoking, pathogen, genetic) causes changes in collagen and immune system attacks with adaptive immune system leads to proliferation of synovial cells - makes a pannus = damage and erosion.
Classic presentation of dermatomyositis?
Heliotrope rash, mechanics hands, gottron’s sign
Tx for fibromyalgia?
Exercise and education, help with comorbidities, start on an SNRI - classically duloxetine
What do you need to keep in mind with PMR?
Increased risk of Giant Cell Arteritis - be sure to screen regularly for SX
- Tx for GCA is high dose steroids, PMR is low dose steroids
Compartment syndrome causes?
Trauma, infection, burn, most common in leg, can also happen with massive fluid resuscitation
Sx of compartment syndrome?
Loss of pulses distally, tense compartment, pain with passive stretch, loss of sensation and weakness, can measure pressure with manometer
Tx of compartment syndrome
Fascitomy
Things you can test in synovial fluid?
Culture and gram stains
Cell count and differential
Crystal examination
Sx of septic arthritis?
Mono-articular, pre-existing infection, most often due to S.Aureus or Streptococcus,
Look for single swollen joint (usually knee) with warmth restricted motion and fever. Collect fluid/ x-ray start on 7-14 Abx
Sx of gout flare after initial mono-articular presentation?
12 years after, can have tophi, kidney (colicky flank pain, stones, decreased urine output) complications, can reoccur in other joints.
Urate crystals under polarized light microscope?
Negatively birefringent
STI which can lead to polyarticular joint pain?
Disseminated gonococcoemia - triad of tenosynovitis, polyarthralgias and dermatitis
Usually distal joints are effected.
Scarlet fever sx?
Post strep infection - blanching sandpaper like body rash, strawberry tongue, circumoral pallor.
Pathophysiology of ankylosing spondylitis
Autoimmune response destroys the fibroblasts and replaces them with fibrin which makes a band around the joints and limits ROM - osteoblasts will then ossify the fibrin.
Sx of ankylosing spondylitis
Back pain, before 40, insidous, improved with exercise, not with rest, pain at night, responsive to NSAIDS
Look for hx - IBD, psoriasis, iritis
Investigate - ESR/CRP, X-ray
Pathophysiology of psoriatic arthritis
inflammatory response in the body leads to T-cells can get into the joints and activate osteoblasts and clasts which will erode the joint
Should be RH and CYP negative (to differentiate from RA)
Pathophysiology of RA?
Inflammation (smoking, pathogen, genetic) causes changes in collagen and immune system attacks with adaptive immune system leads to proliferation of synovial cells - makes a pannus = damage and erosion.
Classic presentation of dermatomyositis?
Heliotrope rash, mechanics hands, gottron’s sign
Tx for fibromyalgia?
Exercise and education, help with comorbidities, start on an SNRI - classically duloxetine
What do you need to keep in mind with PMR?
Increased risk of Giant Cell Arteritis - be sure to screen regularly for SX
- Tx for GCA is high dose steroids, PMR is low dose steroids
Compartment syndrome causes?
Trauma, infection, burn, most common in leg, can also happen with massive fluid resuscitation
Sx of compartment syndrome?
Loss of pulses distally, tense compartment, pain with passive stretch, loss of sensation and weakness, can measure pressure with manometer
Tx of compartment syndrome
Fascitomy
Things you can test in synovial fluid?
Culture and gram stains
Cell count and differential
Crystal examination
