SM 220a - Approach to Joint Pain Flashcards
What finding is present in this ultrasound of a patient’s foot?
Which joint condition does it indicate?
Double-contour sign
Indicative of gout
Which autoantibodies are likely to be elevated in rheumatic disease?
- Rheumatoid factor
- Anti-Cyclic Citrullinated Peptide (Anti-CCP)
Neither is specific for rheumatic disease, but both are sensitive
If a patient has both autoantibodies + clinical suspicion for rheumatic disease, then the diagnosis is very likely
Which autoanitbody is most likely present in a patinet with lupus?
ANA
Sensitive, but not specific for Lupus
(30% of the healthy population is positive for ANA)
Someone with infectious joint pain will usually have ______ WBCs in their synovial fluid
Someone with infectious joint pain will usually have
50,000 - 100,000 WBCs in their synovial fluid
Will be turbid to very turbid
Send this patient to the ER!
What factors can increase a patient’s CRP?
- Obesity
- Heart disease
- Infection
- Malignancy
- Diabetes
- Smoking
This double-contour sign on ultrasoudn is indicative of which joint condition?
Gout
Which autoantibody is most likely present in a patient with systemic or drug-induced vasculitis?
ANCA
May also be present in IBD, SLE, and AIH
Someone with non-inflammatory joint pain will usually have ______ WBCs in their synovial fluid
Someone with non-inflammaory joint pain will usually have
200-2,000 WBCs in their synovial fluid
Will be clear to slightly turbid
What factors can increase a patient’s Erthroycyte Sedimentation Rate? (ESR)
- Age
- Diabetes
- ESRD
- Pregnancy
- Females tend to have higher ESR
Someone with inflammatory joint pain will usually have ______ WBCs in their synovial fluid
Someone with inflammaory joint pain will usually have
2,000 - 50,000 WBCs in their synovial fluid
Will be slightly turbid
What factors can decrease a patient’s Erthroycyte Sedimentation Rate? (ESR)
- CHF
- Sickled RBCs
What information can you learn from an Erthroycyte Sedimentation Rate? (ESR)
Inflammatory state of the patient
- Higher ESR implies more inflammation
- Factors that can increase ESR
- Age
- Diabetes
- ESRD
- Pregnancy
- Females tend to have higher ESR
- Factors that can decrease ESR
- CHF
- Sickled RBCs
What information can you learn from an C-Reactive Protein (CRP) test?
A patient’s inflammatory state
Higher CRP implies more inflammation
- Levels change more quickly than ESR = more sensitive
- Less variable than ESR
- Can be affected by age and gender
- Factors that increase CRP
- Obesity
- Heart disease
- Infection
- Malignancy
- Diabetes
- Smoking
Which labs are most useful in measuring control/determining prognosis for rheumatic disease?
CRP and ESR
Note: Anti-CCP and ANA are useful for diagnosis, but nor monitoring
What is the Schober test?
In which patients is it useful?
Useful in patients with estabilished inflammatory back pain - used to monitor management/progression
- Mark lumbosacral junction
- Mark 10 cm above (measure w/tape measure)
- Ask the patient to bend forward
- Normal = Space between marks will expand to 15 cm
- Less expansion = evidence of lost range of motion. May indicate progression of inflammation or possible fusion
- Normal = Space between marks will expand to 15 cm
What features of a patient’s history are consistent with an inflammatory joint condition?
- Symmetric pain
- Pain in multiple joints
- Improvement with activity
- Response to steroids
- Systemic and extra-aricular features
- Rash (lupus)
- IBD
- Raynauds (color changes to hands/extremeties in different temperature)
- Inflammatory eye disease
- Enthesitis
- Dactylitis
What pathology can be revealed using the straight leg test?
Useful when a patient presents wtih lumbar radiculopathy (back pain that radiates down the leg)
- Straight leg test puts traction on lumbar spinal roots and causes pain
- This provides evidence of radiculopathy
- Due to compression of the nerve
- Helps to diagnose the problem
A normal synovial fluid will have ________ WBCs
A normal synovial fluid will have 0-200 WBCs
Will be clear, pale yellow
What distinguishing features can separate inflammatory joint pain from other joint pain?
-
Stiffness
- Inflammatory: stiffness lasts >1 hour in the morning
- Other: May be stiff, but usually <30 minutes
-
Response to activity
- Inflammatory: symptoms improve with activity
- Other: symptoms are worse with activity
-
Response to rest
- Inflammatory: symptoms are worse with rest
- Other: Symptoms are better with rest
-
Response to steroids
- Inflammatory = yes
- Other = no
