mechanical vs inflammatory pain

Question 1

in terms of inflammatory joint disease, what pathologies are we talking about?

Answer 1

-RA
-inflammatory osteoarthritis
-polymyalgia rheumatica
-septic arthritis
-axial and peripheral spondyloarthropathy
-crystal arthropathies eg gout

Question 2

what is polymyalgia rheumatic?

Answer 2

inflammatory disorder that causes muscle pain and stiffness, particularly in the shoulders, neck, and hips
-often people over 50, more common in women than men

Question 3

what is septic arthritis?

Answer 3

-also known as infectious arthritis, is a joint infection caused by bacteria, viruses, or fungi.
-It typically occurs when microorganisms spread to a joint through the bloodstream
-would likely present with fever like symptoms (ie sign of infection)

Question 4

revision: what are spondyloarthpathies?

Answer 4

a group of rheumatic diseases that primarily affect the spine, but can also involve other joints

Question 5

what is axial spondyloarthropathy?

Answer 5

primarily involve inflammation in the spine and sacroiliac joints

eg AS - ankylosing spondylitis

Question 6

what are peripheral spondyloarthropathys?

Answer 6

Peripheral spondyloarthropathies affect the limbs and extremities, including joints in the arms and legs (knees, ankles, wrists, fingers, and toes).

Question 7

what are examples of peripheral spondyloarthropathies?

Answer 7

-psoriatic arthritis (in people w/ psoriasis)
-reactive arthritis - following infections etc

Question 8

what is gout?

Answer 8

Gout is a form of inflammatory arthritis caused by the buildup of uric acid crystals in the joints

Question 9

why is it important to diagnose rheumatological conditions early?

Answer 9

-early initiation of therapy after diagnosis results in better outcomes
-prevents and slows down joint damage
-achieves remission or low disease state
-maximise quality of life and function

Question 10

how do we treat inflammatory arthritis to achieve remission / low disease state (in a medical POV)?

Answer 10

-patient commences a medical therapy
-a certain set of disease markers are reviewed and the aim is to reduce / maintain at specific levels eg bloods, disease activity scores
-a patient should be reviewed and medical management changed if they show a failure to respond for 3 months

Question 11

what drugs are given for the medical management of rheumatological conditions?

Answer 11

-steroids
-non steroidal anti-inflammatory drugs
-pain killers

Question 12

what drugs are given to prevent symptoms in rheumatological conditions?

Answer 12

-disease modifying anti rheumatic drugs (DMARDs)
-biologics

Question 13

what subjective features may suggest an inflammatory pathology?

Answer 13

-reports swelling
-multi joint involvement - may be symmetrical or asymmetrical
-more than 30 min morning stiffness
-often awake in the 2nd half of night
-good response to anti-inflams
-exercise helps, rest docent
-report fatigue
-family history
-history of 6-12 weeks of symptoms

Question 14

describe the difference between RA and OA

Answer 14

RA:
-affects whole body ( not just joint pain)
-commonly starts in the hands and feet
-usually symmetrical
-AM stiffness 30 mins +
-generally pts report swelling
-younger age
-better w/ exercise, worst with rest

OA:
-generally affects just your joints
-may only affect 1 or multiple
-generally associated with age or trauma
-symptoms often worse at the end of the day or after activity
-bony swelling

Question 15

what are examples of extraarticular manifestations of RA?

Answer 15

-eyes - dry and irritated eyes
-mouth - dry mouth, ulcers
-skin - rash, reduced elasticity, raynauds
-allopecia - hair loss
-lung/ cardiac/ vascular/ renal involvement

Question 16

what does THREADS stand for?

Answer 16

-Thyroid
-Heart
-Rheumatoid Arthritis
-Epilepsy
-Diabetes
-Steroids

Question 17

on subjective exam - PMH, DH, SH what is found with RA?

Answer 17

-PMH- THREADS, red flags, fatigue and malaise
-DH- NKDA, names of meds and doses
-SH- including impact on quality of life, work, activity levels

Question 18

what are examples of questions to ask for rheumatology patients?

Answer 18

-do you have any problems with swelling in your joints?
-do you have any problems with your breathing?
-do you have any problems with your circulation?
-do you get any skin rashes/ itchiness?
-how does it impact you in daily life eg function, activity, participation etc

Question 19

what kind of things are you looking for in bloods?

Answer 19

-full blood count
-kidney/ liver/ bone function
-inflammatory markers eg erythrocyte sedimentation rate ESR
-C reactive protein CRP
-antibody screening
-rheumatoid factor, CCP Elisa, connective tissue disease

Question 20

other than bloods, what are examples of other investigations that could be used for rheumatology pts?

Answer 20

-x ray
-MRI
-US
-neurophysiology

Question 21

what would the physical exam involve with a rheumatology pt?

Answer 21

-observation for synovitis/ other joint swelling / nodules etc
ROM- limiting factors and crepitus
-muscle strength
-neurological exam if needed
-special tests if indicated

Question 22

describe and compare features of inflammatory back pain IBP and chronic mechanical back pain MBP

Answer 22

IBP
-age of onset - less than 40 yrs
-incidious onset less likely to be acute
-pain improves with exercise
-pain does not improve w/ rest
-morning stiffness - + 30 mins
-pain @ night which may cause pt to be awake for 2nd half of night

MBP
-age of onset - any age
-variable onset - may be acute
-pain may worsen with movement
-pain improves w/ rest

Question 23

what other symptoms can rheumatology pts get other than swelling pain etc

Answer 23

-psoriasis - skin condition
-enthesitis - inflammation where tendon/ ligaments insert into bone
-dactylitis - inflammation of digit
-sacrolitis - inflammation of a sacroiliac joint
-uveitis - eye swelling
-symptoms associated w/ inflammatory bowel disease

Question 24

describe gout

Answer 24

-intensely painful joint swelling, most often in the big toe or other part of the foot
-caused by a build up of sodium urate crystals in the joint
-40-50 years
-men more common than women
-sudden onset and severe pain, redness and tenderness in 1 joint associated w. swelling
-BIG TOE often

Question 25

what is pseudogout?

Answer 25

-when calcium pyrophosphate crystals built up in the cartilage of joints
-more common in older people and often women
-uric acid levels normal (incomparison to high lvls in gout)
-moderate joint pain, swelling, heat and redness
-often knee and wrist