Rheumatology - Introduction Flashcards
What are the main rheumatological symptoms?
- pain
- swelling
- stiffness
- fatigue
- weakness
Systemic symptoms may also be a feature
How do patients usually describe neuralgic pain?
‘Burning’ or ‘pins and needles’
Note the description of pain is highly variable and not always useful in terms of making a diagnosis.
What are the features of inflammatory pain?
- nocturnal pain
- aggravated by rest
- better with NSAIDs / steroids
How many joints are affected in:
a) monoarticular pathology
b) oligoarticular pathology
c) polyarticular pathology
a) 1 joint
b) 2-4 joints
c) >4 joints
Give some causes of acute monoarthritis.
This is septic arthritis until proven otherwise.
Other differentials:
- gout
- pseudogout
- haemarthrosis
Give some causes of chronic monoarthritis.
- tuberculosis
- psosriatic arthritis (PsA)
- reactive arthritis
- osteoarthritis (OA)
- tumours (rare)
Give some causes of acute polyarthritis.
- reactive arthritis
- rheumatoid arthritis
- psoriatic arthritis
- systemic lupus erythematous
- vasculitis
- HIV
- uncontrolled gout
Give some causes of chronic polyarthritis.
- reactive arthritis
- psoriatic arthritis
- rheumatoid arthritis
- systemic lupus erythematous
- vasculitis
- uncontrolled gout
What is stiffness?
Difficulty moving a joint.
Stiffness worse in the morning and lasting longer than 30 minutes is suggestive of inflammatory arthritis (e.g. RA or PsA).
What are the causes of weakness in rheumatological disease?
- joint pain on movement causing restriction of movement
- neurogenic (e.g. foot drop in S1 root compression)
- muscular (e.g. proximal weakness in polymyositis)
What are the features of inflammatory disease?
a) morning stiffness
b) effect of activity
c) effect of resting
d) fatigue
e) systemic involvement
a) >1 hour
b) better
c) worse
d) significant
e) yes
What are the features of mechanical disease?
a) morning stiffness
b) effect of activity
c) effect of resting
d) fatigue
e) systemic involvement
a) <30 minutes
b) worse
c) better
d) minimal
e) no
How is a rheumatological patient examined?
GALS screen, followed by regional examination of the MSK system.
What is the GALS screen?
Gait, arms, legs and spine assessment to detect most MSK abnormalities, which will then prompt further examination in more detail.
Outline how to assess
gait
in the GALS screening assessment.
Observe and interpret gait
Outline how to assess
arms
in the GALS screening assessment.
- inspect hands
- assess pincer grip / power grip
- squeezes MCPJ for tenderness
- active elbow flexion / extension / supination / pronation
- active shoulder external rotation
Outline how to assess
legs
in the GALS screening assessment.
- inspects legs
- examine for knee joint effusion
- passive knee flexion / extension
- hip flexion / internal rotation
- inspect feet
- perform MTPJ squeeze test for tenderness
Outline how to assess
spine
in the GALS screening assessment.
- inspects spine
- palpates over supraspinatus
- tests cervical spine lateral flexion
- tests hip and lumbar spine flexion
How can you test the motor function of
a) radial nerve?
b) ulnar nerve?
c) median nerve?
a) wrist / finger extension against resistance
b) index finger abduction against resistance
c) thumb abduction against resistance
What is the significance of Hb interpretation in rheumatological disease?
- anaemia of chronic disease in RA
- NSAIDs can cause Fe deficiency
What is the significance of platelet interpretation in rheumatological disease?
- rises with inflammation or bleeding
- falls in SLE
What is the significance of neutrophil interpretation in rheumatological disease?
- rises with inflammation, sepsis and prednisolone usage
- falls with SLE and DMARD toxicity
What is the significance of lymphocyte interpretation in rheumatological disease?
- falls in SLE and DMARD toxicity
What is the significance of U&Es interpretation in rheumatological disease?
- rise due to NSAIDs and renal disease
What is the significance of uric acid interpretation in rheumatological disease?
- elevated in gout
- falls in inflammation
What is the significance of LFTs interpretation in rheumatological disease?
- hepatitic rise due to DMARD toxicity
What is the significance of CK, ALT and LDH interpretation in rheumatological disease?
Rise in myositis
