The GALS Screen Flashcards
Define the following terms:
a. Arthritis
b. Arthralgia
c. Subluxation
d. Synovitis
e. Dislocation
Arthritis: definite inflammation of a joint
Arthralgia: Pain within a joint without demonstrable inflammation
Subluxation: Partial dislocation of a joint
Synovitis: Inflammation of the synovium
Dislocation: Articulating surfaces are displaced + no longer in contact
What does GALS stand for?
Gait
Arms
Legs
Spine
What is gout caused by?
Deposition of monosodium urate (MSU) crystals as a result of hyperuricaemia
What are the key clinical features of gout?
Gouty arthritis
Tophi: aggregated deposits of MSU in tissue
Which joint is commonly affected by gouty arthritis?
1st Metatarsophalangeal joint
List 3 signs of irreversible joint damage.
Joint deformity
Crepitus
Loss of joint range or abnormal movement
List 2 signs of a mechanical defect in the joint.
Painful restriction of motion in the absence of features of inflammation e.g. knee locking
Instability
Distinguish between monoarthritis, oligoarthritis and polyarthritis
Monoarthritis: Single joint affected
Oligoarthritis: 2-4 joints involved
Polyarthritis: >4 joints involved
Describe the pattern of arthritis in the following diseases including the joints that are commonly affected:
a. Rheumatoid arthritis
b. Reactive arthritis
c. Gout
Rheumatoid: Bilateral + symmetrical polyarthritis involving large + small joints
Reactive: Lower limb asymmetrical oligoarthritis + axial involvement
Gout: exclusive 1st metatarsophalangeal joint
What is the main extra-articular feature of gout?
Tophi: subcutaneous deposits of uric acid
What are the two types of synovial lining cell?
Type 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 syonovial effusion and describe the synovial fluid composition in each of them.
Abnormal mechanical stimulation: can stimulate fibroblasts to produce more hyaluronic acid
Increases oncotic pressure + synovial volume= normal composition
In synovitis due to inflammation, effusion is inflammatory exudate= Abnormal composition with inflammatory cells + reduced hyaluronic acid
What features of the synovial fluid are examined to determine the cause of the synovial effusion?
How turbid it is
Presence + quantity of inflammatory cells (WCC + neutrophils)
When is synovial fluid examination performed?
When joint infection is suspected
Useful for confirming diagnosis of crystal arthritis
What are some contraindications for arthrocentesis?
Conditions that increase risk of bleeding e.g. anti-coagulant drugs
Overlying skin infection
List 3 possible complications of arthrocentesis
Risk of introducing infection
Bleeding into the joint
Damage to structures of the joint
What technique is used to detect crystals in the synovial fluid?
Polarising light microscopy
What is a common feature of most connective tissue diseases?
Raynaud’s phenomenon (intermittent vasospasm of digits on exposure cold)
What is Sjogren’s syndrome and what are its symptoms?
AI exocrinopathy (destruction of lacrimal + salivary glands) Symptoms: Dry eyes Dry mouth Parotid gland enlargement Non-erosive arthritis + Raynaud’s
Which antibodies are associated with Sjogren’s syndrome?
ANA
Rheumatoid factor
What is inflammatory muscle disease and what are the two types?
Proximal muscle weakness due to AI-mediated inflammation either with (dermatomyositis) or without a rash (polymyositis)
Describe the skin changes that take place in dermatomyositis.
Lilac rash on eyelid, malar region + naso-labial folds
Red/ purple lesions on knuckles (Gottron’s papules)
Subcutaneous calcinosis
Mechanic’s hands (fissuring + cracking of the skin over finger pads)
What is systemic sclerosis?
Thickened skin with Raynaud’s phenomenon
Dermal fibrosis
Cutaneous calcinosis
Telangiectasia
What are the two types of systemic sclerosis and what are the differences between them?
Diffused systemic sclerosis Proximal to elbows or knees Pulmonary fibrosis + renal involvement SHORT history of Raynaud’s Limited systemic sclerosis Hands, forearms, feet, neck + face Pulmonary hypertension LONG history of Raynaud’s
What is overlap syndrome?
When features of >1 connective tissue disease are present
List 5 clinical manifestations of SLE
Malar rash (nasolabial fold sparing) Photosensitive rash Mouth ulcers Hair loss Raynaud's phenomenon
What are the signs of inflammation?
Swelling tenderness Redness Warmth Loss of function
What lifestyle choice predisposes one to gout?
Purine rich diet (e.g. red meat)
Give 4 characteristics of gout
Abrupt onset
Extremely painful
Joint swollen, tender, red + warm
Resolves spontaneously with 10 days
Give 2 examples of enthesopathies other than ankylosing spondylitis
Achilles tendinitis
Plantar fasciitis
What is an enthesopathy?
Pathology at the enthesis (where ligament or tendon inserts into bone)
Give an example of a chronic condition in which joint deformity may occur
Ankylosing spondylitis
Which joints are spared in Rheumatoid arthritis?
DIP
Thoracic spine
Lumbar spine
Which joints are spared in Osteoarthritis?
MCP Wrist Elbow Shoulder Ankle Tarsal joints
Which joints are spared in polyarticular gout?
Axial
What are the main extra-articular feature of rheumatoid arthritis?
Subcutaneous nodules
What is the main extra-articular feature of SLE?
Malar rash (spares nasolabial folds)
What is synovial fluid, and what increases it’s viscosity?
Viscous fluid in joint space of synovial joints
Hyaluronic acid increases viscosity
What type of crystal is present in pseudogout?
CPPD
