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PHTH 565 - Rheumatology > Overview of Rheumatologic Conditions & Management > Flashcards

Overview of Rheumatologic Conditions & Management Flashcards

1
Q

1 in 6 Canadians (>15yo)

> 100 types of rheumatologic conditions

2/3 women

19% of Indigenous people (27% after adjusting for age)

Leads to Pain, Activity restriction & Long-Term Disability

80% of costs related to long-term disability

A

Arthritis in Canada

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2
Q

Does Ankylosing Spondylitis affect Men or Women more?

A

Men

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3
Q

Dx by good medical history and physical ax.

  • Age, sex, race/ethnic background, family history
  • Type of presentation: febrile, acute, chronic, widespread pain
  • # of joint

Labs do NOT make a dx. (blood tests) - only confirm the suspicions

A

Rheumatologic Ax

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4
Q

1) Are there RED FLAGS
2) Within the joint (articular) vs. around the joint (periarticular)
3) Inflammatory vs Non-Inflammatory (7 S/S)
4) Focal (< 3 joints) vs Widespread (> 3 joints)
5) Acute (< 6 weeks) vs. Chronic (> 6 weeks)

A

Key Questions

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5
Q

Key question

Conditions w/ sufficient morbidity/mortality to warrant an expedited dx

Fracture

Septic arthritis (rapid onset - over hours or days)

  • Commonly caused by staph/strep bacteria
  • Severe pain, swelling, redness & heat

Malignancy; neurological s/s

  • Focal/diffused muscle weakness
  • Burning, numbness, paraesthesia
A

1) Identify Red Flag Conditions

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6
Q
  • Nature of pain:
    Key question

Diffuse, deep (in joint)

  • Pain on mvmt: Active & passive in all planes

Effusion/Swelling: Common

A

2) Articular

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7
Q

Key question

  • Nature of pain: Localized tenderness (bursitis, tendinopathy)
  • Pain on mvmt: Active in a few planes
  • Effusion/swelling: Uncommon
A

2) Periarticular

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8
Q

Key question

Heat: Sometimes present

Redness: Sometimes present

Swelling: Moderate to severe

Pain (worse when?): Yes (morning)

Loss of function: Yes (quite common, use SF36 as objective measure)

Morning stiffness: > 1 hr

Systemic features: Sometimes present

↑ESR: Frequent

Ex: Rheumatoid Arthritis

A

3) Inflammatory Condition

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9
Q

Key question

Heat: Absent

Redness: Absent

Swelling: Mild

Pain (worse when?): Yes (after used)

Loss of function: Sometimes

Morning Stiffness: <30mins

Systemic Festures: Absent

↑ESR: Uncommon

Ex: Osteoarthritis

A

3) Non-inflammatory Condition

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10
Q

Articular:

  • Rheumatoid Arthritis
  • Systemic Lupus Erythematosus

Periarticular:

  • Bursitis
  • Enthesitis
  • Polymyositis
A

Inflammatory

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11
Q

Articular: Osteoarthritis

Periarticular:

  • Fibromyalgia
  • Carpal Tunnel Syndrome
A

Non-Inflammatory

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12
Q

Key question

≤ 3 joints

  • Osteoarthritis
  • Osteonecrosis
  • Gout
A

4) Monoarticular/Oligoarticular (focal)

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13
Q

Key question

> 3 joints

  • Rheumatoid Arthritis
  • Lupus
  • Osteoarthritis (rare)
A

4) Polyarticular (widespread)

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14
Q

Key question

≤ 6 weeks

≤ 3 joints/ > 3 joints

“Early Inflammatory Arthritis”

A

5) Acute

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15
Q

Key question

> 6 weeks

≤ 3 weeks

  • Reactive arthritis
  • Gout

> 3 joints

  • RA
  • Lupus
A

5) Chronic

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16
Q
  • S/S must be present for 6 weeks to make a diagnosis
  • Subtype is determined by disease presentation in the first 6 months
  • Dx made before the age of 16. Not uncommon for disease to be active for a lifetime w/ varying intensity
A

Juvenile Idiopathic Arthritis (JIA)

17
Q
  • Joint synovium
  • Tendon sheath synovium
  • Enthesis
A

JIA Affected Structures

18
Q
  • Oligoarticular
  • Polyarticular
  • Systemic
  • Psoriatic
  • Enthesitis- Related Arthritis
A

JIA Subtypes

19
Q

Can cause blindness if not screened/picked up early

Oligoarticular
- Asymptomatic Chronic 20-30%

Polyarticular
- Asymptomatic Chronic 5%

Systemic
- Asymptomatic Rare

Psoriatic
- Asymptomatic Chronic

Enthesitis-Related Arthritis
- Symptomatic Acute 10-20%

A

Uveitis

20
Q

Peak age onset: 1-3 years

Gender ratio: female>male

joints: 4 or less

Pattern of inflammation: Asymmetrical large joints

Uveitis: Asymptomatic chronic 20-30%

Systemic signs: None

Extra-articular involvement: Tendonitis, bony over/under growth

A

JIA Oligoarticular

21
Q

Peak age onset: 1-3 years & 9-12 years

Gender ration: female>male

joints: 5 or more

Pattern of inflammation: Symmetrical large & small joints

Uveitis: Asymptomatic chronic 5%

Systemic signs: Possible

Extra-articular involvement: Rheumatoid factor +ve tendon nodules

A

JIA Polyarticualr

22
Q

Peak age onset: Any age

Gender ratio: female = male

joints: variable

Uveitis: Asymptomatic rare

Systemic signs: always positive

Extra-articular involvement: generalized growth retardation

A

JIA Systemic

23
Q

Peak age onset: 0-5 years

Gender ratio: female>male

joints: many

Pattern of inflammation: Asymmetrical small joints

Uveitis: Asymptomatic Chronic

Systemic signs: Possible

Extra articular: Psoriasis, nail pitting

A

Psoriatic

24
Q

Peak age onset: 9-16 years

Gender ratio: male>female

joints: few

Pattern of inflammation: Asymmetrical large joints

Uveitis: Symptomatic acute 10-20%

Systemic signs: possible

Extra articular involvement: Enthesitis, aortic valve inflammation

A

JIA Enthesitis

25
Q
  • Pain
  • Restricted function
  • Morning stiffness
  • Fatigue
  • Restricted ROM
  • Restricted muscle strength and length
  • Growth abnormalities
  • Asymmetric posture and movement patterns
A

Disease Signs & Symptoms

PHTH 565 - Rheumatology (9 decks)

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