Tutorial 1 Flashcards
Arthralgia vs arthritis
Arthralgia = pain in the absence of swelling
Arthritis - swelling
Four pain differentials
Osteoarthritis - middle aged
RA - can present at any time, F
Spondyloarthritis - younger males, hx of psoriasis
Crystal arthritis - gout - mono sodium urate crystals in middle aged men, CPPD - no longer called pseudogout - calcium pyrophosphate crystals
Hx taking for joint problems
Affected joints - small vs large, axial vs peripheral
Symptoms
Severity of pain
Preceding infection or event
Exacerbating and relieving factors
Response to analgesics or NSAIDs
Constitutional symptoms
FH for HLA B27 disease
SH - occupation, smoking, alcohol
Sexual history - reactive arthritis
Travel hx - Lyme disease or TB
DRUGS
Inflammatory vs mechanical cause - how would you differentiate with symptoms
Inflammatory:
Worse in morning
Better with activity
Mechanical:
Opposite to above
Systems review questions
Systems symptoms - fever or sweats
Malaise and fatigue
B symptoms and weight loss
Symptoms suggestive of connective tissue disease
Key PMH
Psoriasis, iritis, IBD - HLA 27
Other autoimmune or auto inflammatory diseases - DM, thyroid
Hep c - poly arthritis nodosa
HIV - Arthralgias
Which drugs could impact rheum conditions
Diuretics - risk of gout
Anticoagulation - risk of haemarthrosis
Immunosuppression - septic arthritis
Steroids - risk of septic arthritis
Statins - myalgias
Anti-oestrogen treatment
Vasculitis
Takayasu arteritis - younger women - hands above head, pain
Lupus - younger women
Systemic sclerosis - middle aged women
Sjogren’s - middle aged women
GCA - over 50s
Send for immunofluoresence
Lupus symptoms
Joint symptoms
Photosensitive rash - a rash on sun exposed areas
Raynauds
Hair fall - when you wake up in the morning and the pillow has had a hair transplant
Mouth ulcers and genital ulcers
Behçet’s disease
Perianal ulcers
Crest - anti-centromere
Systemic - anti-scl70
Limited
Diffuse
Limited - raynaulds for a long time
Systemic sclerosis
Skin features - tightening, telangiectasia, calcinosis, reduced mouth opening
Raynaulds, finger
Sjogren’s
Dry eyes
Dry mouth
Overwhelming fatigue
Gum disease
Poor dentition
Swelling of glands
Joint symptoms
Anti-Ro, anti-La
If Sjogren’s serology is negative, what is the most likely condition for these symptoms
Keratoconjunctival sicca
Idiopathic immune myosotis
Weakness rather than pain - different from PMR
Muscle pain and weakness, proximal > distal,
Myositis
Muscle
Lung
Skin
Dermatomyositis -
Inclusion body myositis - cancer
GCA - large vessel arthritis
Temporal headache
Jaw claudication - pain after chewing
Pain during chewing = tMJ dysfunction
Visual symptoms
Polymyalgic features
Polymyalgia rheumatic a
Stiffness and pain more than weakness
Shoulder and hip pain and stiffness
Difficulty dressing
Small vessel vasculitis
Purpuric rash
Upper airway involvement - see below
Respiratory symptoms
Haemturia/frothy urine
Ankle swelling
Mononeuritis multiplex
Granulomatosis - upper airway, epistaxis, sinusitis
EGPA - lower resp - untreatable asthma
Same risk of renal disease
Key question for connective tissue disease
Multiple pregnancy losses
RA
Thyroid disease
IBD
T1DM
Endocrine disorders
SpA
Gynaecology questions for osteoporosis
Menarche - over 16 years
Menopause - under 48
Periods of amenorrhoea - pregnancy or anorexia
Drugs predisposing for osteoporosis
Steroids
Antidepressants
Anticonvulsants
ARTs
Gonadotropin therapy - men, prostate cancer
Anti oestrogens
FH questions for osteoporosis
Parental hip feature
Any FH
Osteoporosis life style questions
Calcium intake
Vit D
Exercise - weight bearing, high impact fast walking
Smoking
Alcohol
Key drugs to ask about in osteoporosis
Any swallowing problems or any GI problems - not good for alendronic acid as it can erode through the oesophagus if not swallowed properly
Renal problems
Antibodies
Super high RA - Sjogren’s
Hx of lupus, high crp and low esr - infection
Low crp high esr - lupus flare
