Polyarthritis Flashcards
articular diseases cause ____ for active ROM and ____ for passive ROM
pain, pain
non- articular diseases cause ____ for active ROM and ____ for passive ROM
pain, no pain
non-MSK related diseases cause ____ for active ROM and ____ for passive ROM
no pain, painful
psychological (?)
features (stiffness, systemic symptoms, joint pattern, etc.) for inflammatory diseases
stiffness: morning, last >30 min
systemic symptoms (B symptoms): present
joint pattern: RA or PsA or other
other: nodules, rashes, other organ involvement
not confined to joints
features (stiffness, systemic symptoms, joint pattern, etc.) for non-inflammatory diseases
stiffness: after inactivity, lasts few min
systemic: no
joint pattern: OA
other: no
what is the number one route of infection for adult septic arthritis?
hematogenous
what is a common route of infection for paediatric septic arthritis
contiguous spread from osteomyelitis
what are some medical conditions that predispose to MSK infections
compromised host defence (hematological & metabolic disorders, immunosuppressive drugs direct penetration of joint joint damage (rheumatic, prosthetic joints)
septic arthritis organism for neonates
staph
strep
coliform bacteria
septic arthritis organism for children
staph
septic arthritis organism for young adults
staph
neisseria gonorrhoeae
septic arthritis organism for adult
staph
septic arthritis organism for immunocompromised patients
gram negatives
investigations for septic arthritis
aspirate, send for:
cell count and differential
crystal analysis
culture and sensitivity, including gram stain
joint aspirate feature for OA
clear
1-10mL (slightly higher than normal)
high viscosity,
200-10,000 WBC/cubic mm (higher than normal)
<50 polymorphonuclear cells (slightly higher than normal)
joint aspirate feature for inflammatory arthritis
opaque (abnormal) 5-50mL (higher than normal) low viscosity (abnormal) 500-75,000 cell count (higher than normal) >50 (higher than normal)
joint aspirate feature for septic arthritis
opaque (abnormal) 5-50mL (higher than normal) low viscosity (abnormal) >50,000 cell count (much higher than normal) >75 (much higher than normal)
higher the white count, higher the % of PMN’s, higher the chance of septic arthritis
what is gout and describe the epidemiology?
buildup of uric acid crystals in joints
most common cause of inflammatory arthritis in men over 40yr old
does not occur in premenopausal females
what are risk factors for gout
alcohol - purines obesity diabetes medication use renal insufficiency concurrent illness past kidney stones FHx myeloproliferative disorders
what is pseudogout?
deposit of calcium pyrophosphate crystals
set off inflammatory response
episodic mono-arthritis
knee & wrist
how to Dx pseudogout?
synovial fluid
birefringence
XR showing chondrocalcinosis
what is rheumatoid arthritis and its epidemiology?
autoimmune
prevalence of 1%
3:1 (F:M)
onset 20’s - 40’s
clinical presentation of rheumatoid arthritis
fluctuating joint pain and swelling morning stiffness > 1 hour alleviated by moving and heat systemic symptoms MCP + wrist > PIP + MTP > knees and shoulders and ankles > elbows and hips
what is the pattern of joint involvement in RA?
small joint, symmetrical, polyarthritis
may start as monoarthritis
what are extra-articular diseases of RA?
subcutaenous nodules pulmonary & cardiac involvement eye involvement neurologic renal muscular atrophy rheumatoid vasculitis
epidemiology of SLE
9 females : 1 male
African and Asian more common/severe presentation
common features of lupus
(SOAP BRAIN MD) serositis (lining of heart/lungs) oral ulcers arthritis photosensitivity cytopenias renal problems ANA positive antiDNA antibodies neurologic malar rash discoid rash
what are seronegative arthritis diseases
rheumatoid factor negative
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis
epidemiology of ankylosing spondylitis
males > females
late teens/early 20s
rare in black populations
high prevalence in Native Americans (HLA B27)
Clinical presentation of ankylosing spondylitis
alternating butt pain (SI joints)
inflammatory back pain worse with rest, improve with exercise
morning stiffness > 60 min
q/3 get peripheral joint disease
describe enteropathic arthritis
~5% of patients with IBD
often indistinguishable from primary AS
affects M/F equally
usually follows onset of bowel disease
describe psoriatic arthritis
M=F
7-15% with curaneous psoriasis
psoriasis precedes arthritis in 2/3
nail changes
describe reactive arthritis
mostly M
follows infectious diarrhea
(salmonella, yersinia, shigella, campylobacter, chlamydia)
clinical presentation of reactive arthritis
Sx appear 1-4 weeks post-infection TRIAD: arthritis, conjunctivitis, urethritis systemic features acute, asymmetric, additive oligoarthritis lower > upper limbs oral ulcers penile rash (circinate balanitis) keratoderma blenorrhagicum
describe scleroderma
skin thickening, calcinosis, fingertip ulcertation Raynaud's (fingers turning white) GI reflux symptoms, hypomotility renal insufficiency, malignant HTN pulmonary fibroisis
what are the 2 forms of scleroderma?
limited and diffuse
describe limited scleroderma
CREST
calcinosis raynauds esophageal dysmotility sclerodactyly telangiectasia
anti-centromere +
skin thickening doesn’t go above elbows or knees
describe diffuse scleroderma
spread above elbows and knees
internal organ involvement early and severe
scl-70 topoisomerase positive
what is inflammatory muscle disease
progressive symmetrical proximal muscle weakness
pulmonary disease
GI symptoms
rash over eyelids, hands and neck, chest, shoulders
labs for inflammatory muscle disease
high creatine autoantibodies- anti-Jo-1 or anti-tRNA synthetase CXR: interstitial lung disease EMG: myopathic features muscle biopsy
describe granulomatous polyangiitis (wegener’s) vasculitis
inflammation of blood vessels systemic features ENT lung skin neuro renal MSK
describe polymyalgia rheumatica
proximal muscle pain, weakness and stiffness
difficulty rising from seated position
reduced ROM in shoulders
describe temporal arteritis/giant cell arteritis
blockage of large blood vessels of the scalp, neck and arms due to inflammation
severe headache, fatigue, scalp tenderness
visual disturbance (double vision, blindness)
describe fibromyalgia
F>M
common in those w chronic inflammatory conditions
widespread msk pain, fatigue, headache, forgetfulness (fibro fog)
Dx using symptom severity score
