Rheumatology History Flashcards
Approach to the Rheumatology History
What are the ddxs for a single, hot, red swollen joint
Septic arthritis, Traumatic, goutpesusodgout and seronegative spondyloarthritis
What is a ddx or a sgbnle painful but not inflamed joint
Osteoarthrritis
What are the ddx for a single chronic inflamed joint (mono arthritis?)
Chronic infect, seronegative spondyloarthritis, pigmented villonodular synovitis
First 4 questions for a presentation of joint pain
- Which joints are sore?
- Is it 1 joint of multiple joints?
- Are the joints swollen or red?
- Are they getting better or worse?
What ar 4 other key questions for a joint pain history
5 .Is the pain worshippers int he morning?
- Have you injured the joint?
- Is the back pain worse ti night?
- Did the back pain start suddenly?
What are 3 questions to ask in a sudden onset of joint pain?
- Is it an injury?
- Have you recently consumed alcohol? (gout)
- Is therre any signs of infecitons
What are 2 ddx for acute polyarthriis?
Infection (viral/bacterial)
Onset of chronic polyarthritis
What are ddx for chronic polyarthritis?
RA, Seronegative spondyloarthritis, OA, Gout, conceive tissue disorder and infection
Where infections can cause chronic polyarthritis?
Tb (infectious mono arthritis), Hep C
What is the significance of morning stiffness/pai?
Suggests Rheumatoid Arthritis, duration suggests severity
what is stiffness after sitting suggestive of?
Osteoarthritis
Describe the pattern of OA
Symmetrical and affects many joints
Pain/stiffness that is worse on movement and better with rest
Describe the pattern RA
Symmetrical polyarthritis of the PIPs, metacaophalanegeal and wrist joints
Describe the pattern of Ankylosing Spondylitis
Sacroiliac joints and spine
Describe the pattern of psoriatic arthritis
Asymmetrical oligoarthritis with sausage digits and athritismutilans
Look for other signs of psoriasis (plaques + nail chanes0
What is the difference between Heberden’s and Bouchard’s nodes
Heberden’s nodes of those of the DIPs, Bouchard’s are those of the PIPs
What are the clinical features of Sjogren’s Sydnreom
Dry eyes, Dry mouth, chest infections, vaginitis
Why do you get chest infections with SJS?
Dryness of the much-ciliary tract leads to reduced innate immune response
What aspects of the treatment history is key in this history?
Past history of NSAIDs, sulfasalazine, methotrexate, steroids, TNF-inhibitor, biologics
Document side effects of these
What aspects of the past history of key in this presentation?
Trauma, surgery
Infection
What infections are important to screen for in rheumatoid histroies
Hepatitis, strep pharyngitis, rubella, Tb, gonorrhoea
What family conditions should be screened for?
RA, OA, Gout, haemochomratosis, psoriasis and IBD
