The GALS Screen Flashcards
Define the following terms:
a. Arthritis
b. Arthralgia
c. Subluxation
d. Synovitis
e. Dislocation
a. Arthritis
Refers to definite inflammation of a joint
b. Arthralgia
Refers to pain within a joint without demonstrable inflammation by physical examination
c. Subluxation
Partial dislocation of a joint
d. Synovitis
Inflammation of the synovium
e. Dislocation
Articulating surfaces are displaced and are no longer in contac
What does GALS stand for?
Gait
Arms
Legs
Spine
What is gout caused by?
It is caused by deposition of monosodium urate (MSU) crystals as a result of hyperuricaemia
What are the key clinical features of gout?
Tophi – subcutaneous depositions of aggregated monosodium urate crystals
Gouty arthritis
Which joint is commonly affected by gouty arthritis?
1st Metatarsophalangeal joint – this is called podagra
List some signs of irreversible joint damage.
Joint deformity
Crepitus
Loss of joint range or abnormal movement
List some signs of a mechanical defect in the joint.
Painful restriction of movement in the absence of features of inflammation
Instability
How many joints have to be involved for arthritis to be classifiedas ‘oligoarthritis’?
2-4
Describe the pattern of arthritis in the following diseases including the joints that are commonly affected and spared:
a. Rheumatoid arthritis
b. Reactive arthritis
c. Gout
a. Rheumatoid arthritis
Symmetrical polyarthritis involving large and small joints
Joints spared: DIP, lumbar spine, thoracic spine
Joints involved: most others
b. Reactive arthritis
Lower limb asymmetrical oligoarthritis and axial involvement
c. Gout
Exclusive inflammation of the 1st metatarsophalangeal joint
Joints commonly spared: axial
What is the main extra-articular feature of gout?
Tophi – subcutaneous deposits of uric acid
What are the two types of synovial lining cell?
Typa A – macrophage-like
Type B – fibroblast-like (secrete hyaluronic acid)
What is a synovial effusion?
Abnormal increase in synovial fluid volume
State two causes of spinal effusion and describe the synovial fluid composition in each of them.
Abnormal mechanical stimulation – can stimulate the fibroblasts to produce more hyaluronic acid – normal composition
Inflammation – inflammatory exudate – abnormal composition with inflammatory mediators and reduced hyaluronic acid
What features of the synovial fluid are examined to determine the cause of the synovial effusion?
How turbid it is
The presence and quantity of inflammatory cells (neutrophils in particular)
Non-inflammatory – slightly turbid – osteoarthritis or mechanical defects
Inflammatory – turbid – reactive arthritis or gout
Infection – very turbid – bacterial infection
When is synovial fluid examination performed?
When joint infection is suspected
Useful for confirming diagnosis of crystal arthritis