Rheumatic Conditions Lecture Flashcards
What are some Musculoskeletal Red Flags that increase the risk of systemic disease?
Age of onset 55yr Violent trauma Constant progressive, non mechanical pain (no relief with bed rest) Past medical history of malignant tumour Prolonged use of corticosteroids Malaise Fever Weight Loss
What are some Joint Pain Red Flags ?
Erythema,effusion, and decreased range of motion
Fever
Acute joint pain in a sexually active young adult
Skin breaks with signs of cellulitis adjacent to the affected joint
Underlying bleeding disorder or use of anticoagulants
What are some Common Presenting Complaints of people with rheumatic conditions?
Pain Stiffness Joint Swelling Impaired Function Constitutional Symptoms
In patients with rheumatic conditions what should we consider when asking about their pain?
Number of joints involved
Symmetry vs. asymmetry
Localised or general pain
Briefly compare and contrast the pain patterns of RA and other conditions
In RA
The MCP, PIP joints are symmetrically involved, sparing the distal interphalangeal (DIP) joints
Gout and psoriatic arthritis;
PIP and DIP joints are often involved
In OA
Asymmetrical issues
Ankylosing Spondylitis
Sacroiliac joints are affected
What could Chronic Widespread Pain (>3 months duration) indicate?
Fibromyalgia; with many muscular tenderpoints
PMR: with pain in the hips or shoulder girdles
Multiple joint problems or myopathy
Joint hypermobility syndrome
Compare and contrast characteristics of mechanical and inflammatory disorders.
Inflammatory:
Painful at rest and with activity
Stiffness with prolonged rest – this can be relieved with movement
Pain is worse with passive as well as active joint motion on examination, and restricts joint motion,
Mechanical:
Worsen with activity and improve with rest
Both:
Excessive movement can increase pain
How would you know whether stiffness of a joint is because of an inflammatory disease?
Stiffness lasts for more than an hour
Eases with heat and movement
What is the “theatre sign” and who is it commonly seen in?
Stiffness that is relieved upon standing and walking around after sitting for several hours.
It is common in OA
What would morning stiffness that lasts > 1 h In the low back reflect?
Spondylitis.
Why could a person have swelling?
Due to: An inflammatory condition Infection Trauma Soft-tissue inflammation Thickening of synovial membrane Excessive synovial fluid causing effusion
What is the Modified Schober test and what is it used for?
Increase in distance should be ≥6cm. Less than this shows significant restriction, such as may arise due to ankylosing spondylitis
