Overview of Rheumatologic Conditions & Management Flashcards
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
Arthritis in Canada
Does Ankylosing Spondylitis affect Men or Women more?
Men
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
Rheumatologic Ax
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)
Key Questions
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
1) Identify Red Flag Conditions
- Nature of pain:
Key question
Diffuse, deep (in joint)
- Pain on mvmt: Active & passive in all planes
Effusion/Swelling: Common
2) Articular
Key question
- Nature of pain: Localized tenderness (bursitis, tendinopathy)
- Pain on mvmt: Active in a few planes
- Effusion/swelling: Uncommon
2) Periarticular
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
3) Inflammatory Condition
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
3) Non-inflammatory Condition
Articular:
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
Periarticular:
- Bursitis
- Enthesitis
- Polymyositis
Inflammatory
Articular: Osteoarthritis
Periarticular:
- Fibromyalgia
- Carpal Tunnel Syndrome
Non-Inflammatory
Key question
≤ 3 joints
- Osteoarthritis
- Osteonecrosis
- Gout
4) Monoarticular/Oligoarticular (focal)
Key question
> 3 joints
- Rheumatoid Arthritis
- Lupus
- Osteoarthritis (rare)
4) Polyarticular (widespread)
Key question
≤ 6 weeks
≤ 3 joints/ > 3 joints
“Early Inflammatory Arthritis”
5) Acute
Key question
> 6 weeks
≤ 3 weeks
- Reactive arthritis
- Gout
> 3 joints
- RA
- Lupus
5) Chronic
- 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
Juvenile Idiopathic Arthritis (JIA)
- Joint synovium
- Tendon sheath synovium
- Enthesis
JIA Affected Structures
- Oligoarticular
- Polyarticular
- Systemic
- Psoriatic
- Enthesitis- Related Arthritis
JIA Subtypes
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%
Uveitis
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
JIA Oligoarticular
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
JIA Polyarticualr
Peak age onset: Any age
Gender ratio: female = male
joints: variable
Uveitis: Asymptomatic rare
Systemic signs: always positive
Extra-articular involvement: generalized growth retardation
JIA Systemic
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
Psoriatic
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
JIA Enthesitis
- Pain
- Restricted function
- Morning stiffness
- Fatigue
- Restricted ROM
- Restricted muscle strength and length
- Growth abnormalities
- Asymmetric posture and movement patterns
Disease Signs & Symptoms
