MSK symptoms and signs Flashcards
Name three examples of autoimmune inflammatory MSK diseases
Rheumatoid arthritis
Spondyloarthropathies
Vasculitis
Describe inflammatory conditions
Eases with use more than 60 mins stiffness Stiff in the evening Hot and Red Young, FHx Hands and feet Responds to NSAIDs
What is expected for MSK examinations
Arthritis research UK
Describe degenerative conditions
Increases with use Stiffness <30mins Older, prior occupation/sport 1st CMCJ, DIPJ, knees Less convincing response to NSAIDs
Questions to ask in MSK history
Where is the pain? Nature of it? Stiffness? Swelling? History of symptoms? Has it affected function?
Where does RA affect
PIPJ Elbows, shoulders Knee DCMCJ (peripheral)
Where does OA affect
Spine
Hips
1st CMCJ, DIPJ, knees
(central)
What three places does psoriatic arthritis affect
Enthesitis
Dactylitis
Joints
How would describe the history of RA
Once onset it will continue, fluctuate slightly.
What can start RA
Sudden stress
Which type of arthritis, can come and go completely
Palindromic rheumatoid arthritis
Describe the history of gout
Acute phase:
Self limiting, short
Chronic phase:
Constant
what is pondagra
Gout of the big toe
When after infection does reactive arthritis occur
2-3 weeks
Common associated symptoms with joint pain
Rash (photosensitive) Raynauds Mouth ulcers Sicca symptoms Diarrhoea Preceding factors (infection)
What are sicca symptoms
Dry eyes and mouth
Which kind of infection most commonly causes arthritis
Bowel
STI
Autoimmunity family history diseases
Thryoid Vitiligo T1DM Pernicious anaemia RA/CTD/MS
HLA B27 spectrum family history
Psoriasis
Crohns/UC
Ankylosing Spondylitis
Reactive (reiters)
Lifestyle factors in genetically susceptible individuals
Smoking
Occupation
Alcohol
Describe the classic RA presentation and first investigation outcome
Symmetrical, deforming polyarthritis
Erosion on XRay
Describe the hand signs in RA
Ulnar deviation of fingers Radial deviation of wrist Swan neck deformity Boutonniere deformity Digital vasculitis Z thumb
Describe the hand signs in OA
Heberdens nodes
Bouchards nodes
Where are heberdens nodes
Distal DIPJ
Where are bouchards nodes
Proximal DIPJ
What are the classic changes in RA
Swan neck deformity and boutonniere
Name four spondyloarthropathies
Ankylosing spondylitis
Reactive arthritis
Psoariatic arthritis
Enteropathic arthritis
What is enteropathic arthritis associated with
Crohns/UC
Why do AnkSpond get inflammatory spinal pain
In reaction to previous bony inflammation, new bone forms and calcifies. Causing severe limitation of movement.
Where are the two places commonly affected by AnkSpond
Sacro-iliitis
Spine
Where is often firstly involved in AnkSpond
Sacroiliitis
Where can be affected by Enthesitis
Tennis elbow
Golfers elbow
Anterior knee
Achilles
What inflammatory eye disease do spondyloarthropathies
Anterior uveitis aka iritis
Where is commonly affected by spondyloarthropathies
Large joint oligoarthritis
Features of psoaritic arthritis of the hand
Psoarisis of the nails (nail pitting)
Dactylitis
Inflammation of DIPJ
DIPJ arthritis must be
OA
Psoriatic
Which places of skin are often affected by psoarisis
Scalp Behind ears Umbilicus Nails Hands and feet
Hidden places for psoriasis
Natal cleft
Umbilicus
Genitals
3 examples of connective tissue disease
SLE
Scleroderma
Polymyositis/dermatomyocits
Signs of SLE
Non erosive arthritis
Butterfly rash
Photosensitivity
Mouth ulcers
Describe raynuads
Circulatory changes in the fingers, responding to changes in temperature
Which phases of raynauds are painful
White! and red
When does raynuads often start
Menarche
Who with raynauds has a good prognosis
Started at menarche, no ANA
