Joints and bone

Question 1

Characteristics of inflammatory joint pain

-Differential diagnosis of inflammatory joint pain

Answer 1

-AM stiffness >1hr
-Worse after rest
-Ease with activity
-Night time pain
+/- warmth
+/- Erythema
1. Seropositive
2. Seronegative
3. Crystal
4. Septic

Question 2

Seropositive (examples) Characteristics

Answer 2

Autoantibodies present (anti-nuclear antibody, rheumatoid factor)
i.e. rheumatoid arthritis, SLE, scleroderma, dermatomyositis, Sjorjen’s.
Symmetrical small jt involvement (polyarthritis, esp MCP & MTP)

Question 3

Seronegative

Answer 3

No autoantibodies present
1st determine if symmetrical or asymmetrical
Symmetrical (i.e. ankylosing spondylitis, IBD)
Characteristics: sacroilitis on x-ray. Often DIPs involved or dactylitis.

Question 4

Crystal

Answer 4

Uric acid –> gout, calcium pyrophosphate –> pseudogout

Characteristics: monoarticular, abrupt onset, complete remissions, diagnosis (fluid sample of jt)

Question 5

Septic/Infectious jt

Answer 5

Classification: Gonococcal or non-gonococcal (bacterial, tuberculous, fungal)
Characteristics: monoarticular, abrupt or insidious onset, often predisposed host/joint (i.e. joint damaged to begin with), pain at rest, severe to movements, purulent synovial fluid.