Rheumatology (approach to arthralgia ) Flashcards
what percentage of patients exprience pain in the joint but not coming from the joint itself ?
50%
what does non-articular conditions /disoders mean?
conditions where the pain might be in the joint but not coming from the joint
what are the 4 broad areas that one must ask during history taking regarding the joint pain
- How long ?
- to determine whether the pain is acute or chronic - Ask about the describution
- Which joints are sore?
3.Symptoms: inflammatory vs mechanical
4.ask about extra-articular features such as skin ,eyes ,constitutional symptoms and family history
what do you want to elicit by asking the duration ?
whether the joint pain is acute( up to 6w) or chronic (>6w)
what are the causes of acute of polyarthitis ?
- Infection—viral, bacterial
Onset of chronic polyarthritis - tauma
what can causes chronic polyarthritis ?
- Rheumatoid arthritis
- Seronegative spondyloarthritis
- Osteoarthritis
- Gout, pseudogout or hydroxyapatite arthritis
5.Connective tissue disease (e.g. systemic lupus
erythematosus) - Infection
* TB—infectious monoarthritis->Inflammatory (Ponceta
disease): large and
small joints
* Hepatitis C
when asking about the describution of the joint what are you trying to elicit ?
to elicit whether the joint affected is :
* peripheral vs axial
* large vs small
* symmetrical vs asymmetrical
* mono/ oligo/polyarthritis
Which joints are axial ?
which joints are peripheral ?
which conditions affect small joints
which condition affect large joints ?
In which condtions is the joint pain symmetrical ?
In which condtions is the joint pain asymmetrical ?
what are the causes of acute MONOARTHRITIS?
- Septic arthritis
* Haematogenous (e.g. staphylococcal or
gonococcal—latter may be polyarticular)
* Secondary to penetrating injury - Traumatic
- Gout, pseudogout or hydroxyapatite arthritis
- Haemarthrosis
- Seronegative spondyloarthritis (occasionally)
what could be the cause of a single painful joint but not inflamed joint
Osteoarthritis
what are the causes of chronic
monoarthritis (A single chronic inflamed joint )?
- Chronic infection (e.g. atypical mycobacterial
infection) - Seronegative spondyloarthritis
- Synovial (osteo)chondromatosis
what is the difference betweeb mono, oligo and poly arthritis
- monoarthritis =1
oligoarthritis - (2–5 joints)
- polyarthritis (>5 joints).
what is the main aim of asking about the symptoms of the pain ?
to determine whether it is inflammatory or non-inflammatory( mechanical)
How do you differentiate between inflammatory or non-inflammatory( mechanical) joint pain ?
ask whether the pain is better or worse with activity
in patients with inflammatory conditions how do you expect the pain to be throughout the day ?
improves with activity
in patients with mechanical joint pain how do you expect the pain to be throughout the day ?
worsen with activity
Does early morning stiffness happen in inflammatory or mechanical joint pain ?
both
