November 18, 2015 - Approach to Polyarthritis

Question 1

Polyarthritis

Answer 1

Inflammation of 4 or more joints.

(Oligoarthritis is 2 or 3)

Question 2

Stiff in the Morning for >45 minutes

Answer 2

Signs of Inflammation

Question 3

Schober Test

Answer 3

Used to help determine Akylosing Spodylitis.

You measure 10cm above L5 and then hold the tape measure there and have the patient bend over as far as they can. The distance should increase by a minimum of 5cm. Anything less is a positive sign.

Question 4

Ankylosing Spondylitis

Answer 4

A chronic inflammatory disease of the axial skeleton. Seronegative spondyloarthropathy.

Mainly affects joints in the spine and the sacroiliac joint in the pelvis. In severe cases, complete fusion of the spine can occur.

Affects males 5:1. Usually the onset is in the late teens or early 20s.

Question 5

Psoriasis

Answer 5

A long-lasting autoimmune disease characterized by patches of abnormal skin. The skin patches are typically red, itchy, and scaly. They may vary in severity from small and localized to complete body coverage.

May be “hidden” in areas such as the belly button, armpit, hairline, or nails.

At risk for getting psoriatic arthritis.

Question 6

Psoriatic Arthritis

Answer 6

A type of inflammatory arthritis that develops in up to 30% of people who have the skin condition psoriasis.

Can cause dactylitis.

Question 7

Dactylitis

Answer 7

Inflammation of an entire digit. Looks like a sausage.

Causes are usually psoriatic arthritis, reactive arthritis, or gout.

Question 8

Differentiating Psoriatic vs Rheumatoid Arthritis

Answer 8

• Psoriatic skin and nail changes
• RF negative (seronegative)
• No rheumatoid nodules
• Pattern of joint involvement is usually less symmetrical
• Dactylitis
• XRay shows erosion without osteopenia

Question 9

Reactive Arthritis

Answer 9

Sterile arthritis that appears 1-4 weeks after infection

Typically follows infectious diarrhea (Salmonella, Yersina, Shigella, Campylobacter)

Classic triad is urethritis, conjunctivitis, and arthritis.

Question 10

Enthesitis

Answer 10

Inflammation of the entheses (the sites where tendons orNext ligaments insert into the bone).

Common in ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and inflammatory bowel disease.