The normal joint and MSK symptoms Flashcards
How common are MSK presentations in primary care?
About 1 in 5 consultations in primary care are about MSK problems
What are the most common presenting symptoms of joint disease?
Pain, stiffness and swelling - either localised to one joint or affecting multiple joints
How many types of joint are there?
Three
Fibrous, fibrocartilaginous and synovial
What are examples of fibrous and fibrocartilaginous joints?
The intervertebral discs, the SIJs, the pubic symphysis and the costochondral joints
There is little movement in these joints
What are examples of synovial joints?
Joints where there is a ball and socket e.g. hip
and hinge joints e.g. interphalangeal
In synovial joints, the opposed cartilaginous articular surfaces move painlessly over each other
Stability is maintained during use and the load is distributed across the surface of the joint
What is arthralgia?
Pain in joints when the joint appears normal on examination
In a patient presenting with joint pains, what is important to ask & do?
History:
Ask about joints affected - symmetrical, axial or peripheral?
Presence of morning stiffness - >30minutes in inflammatory arthropathies
Aggravating and relieving factors
PMHx
and FHx
What can be causes of joint pain?
Articular - pain from joint itself
Periarticular pain - from enthesitis, bursitis and tendinitis
What is enthesitis?
Inflammation at the site of attachment of ligaments, tendons and joint capsules
What are the causes of large joint monoarthritis?
Osteoarthritis Gout Pseudogout Septic arthritis Trauma
What could be a cause of acute non-traumatic monoarthritis or oligoarthritis in young people?
Reactive arthritis
Caused by disseminated gonococcal infection
Why does acute monoarthritis warrant urgent investigation and treatment?
To rule out septic arthritis
What is the key investigation in acute monoarthritis?
Synovial fluid aspiration with Gram stain and culture
& analysis for crystals in polarised light (in gout & pseudogout)
What is important to establish if the patient presents with stiffness?
Is it localised or generalised?
Does it affect limb girdles or periphery?
Is it worse in the morning or after activity?
What is the joint capsule?
It protects the joint - connects to the periosteum and is lined by synovium
What is synovial fluid?
viscous fluid that lubricates the joint secreted by synovial cells into the synovial cavity
What is articular cartilage?
Cartilage on the faces of articulating surfaces
Hyaline cartilage - made up of water, type II collagen and proteoglycans
What is the enthesis?
The point at which ligaments and tendons (both of which stabilise the joint) insert into bone
What is the purpose of the anatomy and physiology of a synovial joint?
It creates a smooth, highly compressible structure which acts as a shock absorber and distributes load over the joint surface
What is arthritis?
The term used when there is objective evidence of joint inflammation - swelling, deformity or an effusion
What are less common causes of acute non-traumatic monoarthritis or oligoarthritis in young adults?
Rheumatoid arthritis
Spondyloarthropathies
TB infection and
Haemoarthrosis (in haemophilia or on warfarin)
What are the most common causes of polyarticular arthritis in young males in the UK?
Reactive arthritis
Ankylosing spondylitis
What are the most common causes of polyarticular arthritis in young adults in the UK?
Psoriatic arthropathy
Enteropathic arthropathy
Reactive arthritis
What are the most common causes of polyarticular arthritis in young women in the UK
Systemic lupus erythematous
Rheumatoid arthritis
Sjogren’s syndrome
What is the most common cause of polyarticular arthritis in middle-aged men in the UK?
Gout
What is the most common cause of polyarticular arthritis in middle-aged women in the UK?
Rheumatoid arthritis
What is the most common cause of polyarticular arthritis in middle-aged men and women in the UK?
Osteoarthritis
What are the most common causes of polyarticular arthritis in the elderly in the UK?
Osteoarthritis
Polymyalgia rheumatica
Pseudogout
What are causes of polyarticular arthritis in any age?
Lyme disease Endocarditis Acute hepatitis B infection HIV infection Parovirus
What are uncommon arthropathies?
Malignancy (hypertrophic pulmonary osteoarthropathy)
Rheumatic fever
Henoch-Schonlein purpura
Behcet’s syndrome
