session 7- MSK

Question 1

Important things to get from a history of joint pain?

Answer 1

how long the stiffness lasts for in the morning can help tell if its inflammatory or non inflammatory- so if its gone within 1 hour, likely non inflammatory, if takes over 1 hour to get going likely inflammatory.

does activity make it better or worse? better= inflammatory

symmetry of joints- OA not symmetrical, RA symmetrical

involvement of the spine?

Question 2

whats the differential diagnosis of joint pain or swelling?

Answer 2

SEPTIC JOINT/ARTHRITIS
OA 
RA
Psoriatic arthritis 
Gout
Ank Spond
Dislocation, fracture, tendon tear
SLE

Question 3

What investigations are done on someone with joint swelling?

Answer 3

Blood tests
ESR, CRP, 
ACCP and RF antibodies (RA)
Uric acid levels  (gout) 
X ray- LOSS (loss of joint space, osteophyte formation, subchondrial cysts, subchondrial sclerosis- in OA)

Question 4

What must you ensure you do with a patient on methotrexate? and why?

Answer 4

monitor them: regularly when they first go on it, then once have been on it for a while, reduce the frequency of monitoring but only to 3 months max.

Nephrotoxicity U+E
Hepatotoxicity LFT
Lung- CXR

supplement folic acid! as methotrexate inhibits the synthesis of folic acid

Question 5

What hand deformities might you expect to see in someone with advanced RA?

Answer 5

Ulnar deviation
Z thumb
Swan neck deformity
Boutonniere deformity