Joint Paint Flashcards
Sequence of events
Open question
Timeline- did trauma precipitate it?
Symptom analysis
SOCRATES
E- what painkillers have you tried, are you sleeping
Systems review
MSK- Stiffness in joints, how long does it last, swelling (red, swollen), infections eg. UTI, STI, painful red eyes, back pain/stiffness, Rashes, mouth ulcers, dry eyes or mouth, painful cold hands that change colour, nodules, back pain, breathing difficulties, psoriasis, DVT, PE, miscarriages
IBD Sx- could be an IBD arthritis first presentation
Constitutional- FWARJNLT
Trauma
Patients perspective
Feelings and impact
ICE
Background
PMH- psoriasis, STI, eye disorders, past joint problems
DH- thiazides
FH- arthritis, psoriasis, IBD
SH
RA
Symmetrical polyarthritis that causes synovitis in small joints, particularly hands and feet, although large joints can be affected
Morning stiffness longer than 1 hour, pain that improves with exercise
Seronegative spondyloarthritis (HLA B27 associated)
PA, AS, enteropathic arthritis, reactive arthritis
Asymmetrical oligoarthritis affecting large joints, spine frequently involved, and sacroilitis and enthesitis
Morning stiffness lasting longer than 1 hour, pain improves on exercise
Consider if they have a history of psoriasis, bowel disorder, recent infection
SLE
Arthralgia and or symmetrical small joint polyarthritis
Non Caucasian females in early adulthood
Oral ulcers, Raynauds, dry eyes, mouth, photosensitivity, malar rash, discoid rash, fever, general malaise
OA
Pain in older patients worse with exercise and partially relieved by rest
Symmetrical oligo or polyarthritis that most frequently affects hips, knees, and hands
History of previous injury to joint and or obesity (esp. knee OA)
Gout
Joint pain, oedema, erythema that develops acutely (classically overnight)
Usually it is a large joint mono arthritis typically affecting the first MTPJ, but it can affect any joint and be polyarticular
History- excessive alcohol, red meat consumption, HTN, renal failure, diuretics, being male
Fibromyalgia
Myalgia that can be reproduced over specific trigger points without joint involvement
Patient may complain of swelling despite objectively no swelling being present
Associated with depression, IBS
Septic arthritis
An acutely hot, very painful, tender and swollen joint in an unwell patient with fever
Limited range of movement
May be history of immunosuppression or trauma
Investigations
Observations, MSK exam
Bloods- FBC UE LFT CRP ESR, rheumatoid factor, anti CCP, autoimmune screen for connective tissue disorders, 2x blood cultures from 2 sites, serum urate level (can be low in acute gout attack however)
I&S- joint aspirate, microscopy and culture and sensitivities, X rays of affected joints
Causes of hip pain in a child
Transient synovitis Perthe's disease SUFE Septic arthritis Juvenile idiopathic arthritis DDH
Rarer;
Haematological malignancy
Fracture
Bone tumour
Causes of hip pain in an adult
OA Inflammatory arthritis Referred lumbar spine pain Greater trochanteric pain syndrome (Trochanteric bursitis) Meralgia paraesthetica Avascular necrosis of the hip Pubic symphysis dysfunction (esp. pregnant women) Fractured NOF Hip dislocation
Rarer;
Haematological malignancy (MYELOMA)
Fracture
Bone tumour
