Rheumatic Conditions - Lecture 6 Flashcards
Musculoskeletal Red flags
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 Drug abuse, immunosuppression, HIV Systematically unwell Unexplained weight loss Widespread neurology (including cauda equina syndrome) Structural deformity Fever
Joint pain - red flags
Erythema, warmth, effusion, and decreased range of motion
Fever with acute joint pain
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
Systemic or extra-articular symptoms
5 common presenting complaints
pain - think of symmetry/asymmetry, local or generalised stiffness joint swelling impaired function constitutional symptoms
What joints are commonly involved in RA?
metacarpal-phalangeal (MCP)
proximal interphalangeal (PIP)
(symmetrically involved)
Asymmetrical involvement of the PIP & DIP are common with what three conditions
OA
gout
psoriatic arthritis
What is the main disease affecting the sacro-iliac joint?
ankylosing spondylitis
When chronic widespread pain has been present for more than 3 months what may it be?
3 conditions & one general
multiple joint probs or myopathy
fibromyalgia with many muscle tenderpoints
joint hypermobility syndrome
polymyalgia rheumatica - with pain in hips or shoulder girdles
Mechanical disorders are aggravated by?
tend to worsen with activity, though sometimes may get disturbed sleep
no night pain
no systemic signs
chronic symptoms
Inflammatory diseases - characteristics?
painful at rest & activity - associated stiffness (needs to last longer than an hour to be considered inflamm. ) can be relieved with movement
night time pain - also think cancer etc
systemic systems present - also think cancer etc
acute or sub acute presentation
Patterns of stiffness in Rheumatic disease, joint inflamm., OA, spondy…….
rheumatic disease - discomfort when moving after a rest period
joint inflamm. - stiffness is more severe & increases as inflamm. does
OA - theatre sign - short lived stiffness upin standing after hours of being still
spondylitis - stiffness in low back in morning lasting over an hour
Joint swelling - what does it indicate & what is happening (physiologically) in joint?
indicates - an inflamm. condition, infection or trauma
Due to - soft tissue inflamm, thickening of synovial membrane, excessive synovial fluid causing effusion
Septic arthritis will show by……..think pain & inflamm.
very rapid onset of swelling and pain
Constitutional symptoms - one of the five common presenting complaints relate to auto immune diseases - name some signs & what they might be from
dry eyes skin - nodules or vasculitis renal - glomerulonephritis lung - fibrosing alveolitis CDV - ischemia, thrombosis, pulmonary hypertension neural - cerebral vasculitis blood - lymphoma
Name 3 seronegative arthropathies and some signs
ankylosing spondylitis: eye - uveitits, lung - fibrosis, CDV - aortic valve disease
psoriatic arthritis - skin rashes, nail pitting/ridging
reactive arthritis - GU infection
Discuss diffuse idiopathic skeletal hyperostosis
ossification of ligaments that mainly affects the spine (longitudinal ligs)
motion is possible - z joints & SI spared, IVD too
more men than women affected & over 50 years often in conjunction with arthritis, bursitis, tendinitis
