Rheumatology (approach to arthralgia )

Question 1

what percentage of patients exprience pain in the joint but not coming from the joint itself ?

Answer 1

50%

Question 2

what does non-articular conditions /disoders mean?

Answer 2

conditions where the pain might be in the joint but not coming from the joint

Question 3

what are the 4 broad areas that one must ask during history taking regarding the joint pain

Answer 3

1. How long ?
   - to determine whether the pain is acute or chronic
2. 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

Question 4

what do you want to elicit by asking the duration ?

Answer 4

whether the joint pain is acute( up to 6w) or chronic (>6w)

Question 5

what are the causes of acute of polyarthitis ?

Answer 5

• Infection—viral, bacterial
  Onset of chronic polyarthritis
• tauma

Question 6

what can causes chronic polyarthritis ?

Answer 6

1. Rheumatoid arthritis
2. Seronegative spondyloarthritis
3. Osteoarthritis
4. Gout, pseudogout or hydroxyapatite arthritis
   5.Connective tissue disease (e.g. systemic lupus
   erythematosus)
5. Infection
   * TB—infectious monoarthritis->Inflammatory (Ponceta
   disease): large and
   small joints
   * Hepatitis C

Question 7

when asking about the describution of the joint what are you trying to elicit ?

Answer 7

to elicit whether the joint affected is :
* peripheral vs axial
* large vs small
* symmetrical vs asymmetrical
* mono/ oligo/polyarthritis

Question 8

Which joints are axial ?

Question 9

which joints are peripheral ?

Question 10

which conditions affect small joints

Question 11

which condition affect large joints ?

Question 12

In which condtions is the joint pain symmetrical ?

Question 13

In which condtions is the joint pain asymmetrical ?

Question 14

what are the causes of acute MONOARTHRITIS?

Answer 14

1. Septic arthritis
   * Haematogenous (e.g. staphylococcal or
   gonococcal—latter may be polyarticular)
   * Secondary to penetrating injury
2. Traumatic
3. Gout, pseudogout or hydroxyapatite arthritis
4. Haemarthrosis
5. Seronegative spondyloarthritis (occasionally)

Question 15

what could be the cause of a single painful joint but not inflamed joint

Answer 15

Osteoarthritis

Question 16

what are the causes of chronic
monoarthritis (A single chronic inflamed joint )?

Answer 16

• Chronic infection (e.g. atypical mycobacterial
  infection)
• Seronegative spondyloarthritis
• Synovial (osteo)chondromatosis

Question 17

what is the difference betweeb mono, oligo and poly arthritis

Answer 17

• monoarthritis =1
  oligoarthritis
• (2–5 joints)
• polyarthritis (>5 joints).

Question 18

what is the main aim of asking about the symptoms of the pain ?

Answer 18

to determine whether it is inflammatory or non-inflammatory( mechanical)

Question 19

How do you differentiate between inflammatory or non-inflammatory( mechanical) joint pain ?

Answer 19

ask whether the pain is better or worse with activity

Question 20

in patients with inflammatory conditions how do you expect the pain to be throughout the day ?

Answer 20

improves with activity

Question 21

in patients with mechanical joint pain how do you expect the pain to be throughout the day ?

Answer 21

worsen with activity

Question 22

Does early morning stiffness happen in inflammatory or mechanical joint pain ?

Answer 22

both