mechanical vs inflammatory pain Flashcards
in terms of inflammatory joint disease, what pathologies are we talking about?
-RA
-inflammatory osteoarthritis
-polymyalgia rheumatica
-septic arthritis
-axial and peripheral spondyloarthropathy
-crystal arthropathies eg gout
what is polymyalgia rheumatic?
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
what is septic arthritis?
-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)
revision: what are spondyloarthpathies?
a group of rheumatic diseases that primarily affect the spine, but can also involve other joints
what is axial spondyloarthropathy?
primarily involve inflammation in the spine and sacroiliac joints
eg AS - ankylosing spondylitis
what are peripheral spondyloarthropathys?
Peripheral spondyloarthropathies affect the limbs and extremities, including joints in the arms and legs (knees, ankles, wrists, fingers, and toes).
what are examples of peripheral spondyloarthropathies?
-psoriatic arthritis (in people w/ psoriasis)
-reactive arthritis - following infections etc
what is gout?
Gout is a form of inflammatory arthritis caused by the buildup of uric acid crystals in the joints
why is it important to diagnose rheumatological conditions early?
-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
how do we treat inflammatory arthritis to achieve remission / low disease state (in a medical POV)?
-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
what drugs are given for the medical management of rheumatological conditions?
-steroids
-non steroidal anti-inflammatory drugs
-pain killers
what drugs are given to prevent symptoms in rheumatological conditions?
-disease modifying anti rheumatic drugs (DMARDs)
-biologics
what subjective features may suggest an inflammatory pathology?
-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
describe the difference between RA and OA
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
what are examples of extraarticular manifestations of RA?
-eyes - dry and irritated eyes
-mouth - dry mouth, ulcers
-skin - rash, reduced elasticity, raynauds
-allopecia - hair loss
-lung/ cardiac/ vascular/ renal involvement
what does THREADS stand for?
-Thyroid
-Heart
-Rheumatoid Arthritis
-Epilepsy
-Diabetes
-Steroids
on subjective exam - PMH, DH, SH what is found with RA?
-PMH- THREADS, red flags, fatigue and malaise
-DH- NKDA, names of meds and doses
-SH- including impact on quality of life, work, activity levels
what are examples of questions to ask for rheumatology patients?
-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
what kind of things are you looking for in bloods?
-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
other than bloods, what are examples of other investigations that could be used for rheumatology pts?
-x ray
-MRI
-US
-neurophysiology
what would the physical exam involve with a rheumatology pt?
-observation for synovitis/ other joint swelling / nodules etc
ROM- limiting factors and crepitus
-muscle strength
-neurological exam if needed
-special tests if indicated
describe and compare features of inflammatory back pain IBP and chronic mechanical back pain MBP
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
what other symptoms can rheumatology pts get other than swelling pain etc
-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
describe gout
-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
what is pseudogout?
-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
