Rheumatology_Joint Pain

Question 1

DDx of inflammatory arthritis.

Answer 1

Viral polyarthritis: parvovirus B19, hepatitis B, hepatitis C andmosquito-borne viruses (eg Ross River and Barmah Forest)can cause symmetrical polyarthritis that can mimic RA.

Connective tissue disease: systemic lupus erythematosus (SLE),Sjögren’s syndrome, dermatomyositis (usually have additional features such as skin rash, dry mouth and eyes, and alopecia)

Psoriatic arthritis

Reactive arthritis

Enteropathic arthritis

Crystal arthropathy

Paraneoplastic disease: rarely, polyarthritis can be associated with malignancies.7

Sarcoid arthropathy: sarcoidosis may cause an inflammatory polyarthritis with a similar pattern of joint involvement as RA.

Question 2

history of patient with joint pain?

Answer 2

Preceding URTI or GI illness?

Extra-articular features such:

• dryness symptoms, rash, mouth ulcers
• conjunctivitis
• urinary sx, urethritis
• gut sx: inflammatory bowel disease
• Raynaud’s phenomenon

Systemic symptoms weight loss, fatigue,
fever or night sweats
Functional impairment?

Family history of psoriasis, RA or other
autoimmune disease?

Smoking?

(Ref bones and joints check 2015)

Question 3

Extra articular examination features of joint pain?

Answer 3

Eye
-conjunctivitis, anterior uveitis, episcleritm corneal ulcers (e.g. in reactive arthritis)

Skin 
-keratoderma blennorrhagica
-erythema nodosum 
(both associated with reactive arthritis) 
- gouty tophi 

Enthesitis/dactylitis (suggestive of a seronegative spondyloarthropathy)

Nail changes
- nail pits, onycholysis, nail bed
hyperkeratosis (points to possible psoriatic arthritis)
points to the possibility of psoriatic arthritis

Stigmata of endocarditis

(bones and joints, 2015 - check racgp)

Question 4

DDx of monoarthritis

Answer 4

Trauma

Infection (Septic)

• Gonnococcal (features of new tenosynovitis, urethral discharge, new rash)
• Non Gonnococcal (hx of IVDU, prosthetic joint, immunosuppressed)

Inflammatory arthritis

• Gout
• RA
• SLE
• Psoriatic arthritis

Reactive Arthritis 
(ref Bones and Joints Check 2015)