Week 3 : Rheumatological Conditions Flashcards
What is rheumatology
diagnosis and therapy of rheumatic diseases
rheumatologists specialise
rheumatologists deal mainly with clinical problems involving joints, soft tissues, autoimmune disease, vasculitis, and heritable connective tissue disorders
What do rheumatologists do
treat arthritis, autoimmune diseases, pain disorders affecting joints, and osteoporosis
> 200 disease, inc rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis and tendinitis
MSK complaint - joint pain, joint swelling, diffuse/systemic Sxs -> initial rheumatic Hx and P/E to determine
is it articular is it acute or chronic is inflammation present how many/which joints are involved are there red flags?
Goals of assessment
identify red flag conditions
- conditions with sufficient morbidity/mortality to warrant an expedited diagnosis
make a timely diagnosis
- common condition occur commonly
- many MSK conditions are self limiting
- some conditions require serial evaluation over time to make a Dx
Provide relief, reassurance and plan for evaluation and treatment
Red Flag conditions include
fracture
infection
organ involvement
Articular vs periarticular
articular
pain - diffuse, deep tenderness
ROM pain - active +passive in all planes
Swelling - Common
Articular vs periarticular
periarticular
pain = point
ROM pain = active motion in few planes
Swelling = uncommon
Peri-/non-articular pain
Fibromyalgia Fracture Bursitis, tendinitis, enthesitis, periostitis CTS Polymyalgia rheumatica Sickle cell crisis Raynaud's phenomenon Complex regional pain disorder (RSD) Myxedema
inflammatory vs non-inflam
Pain (when)
Yes (AM)
Yes (PM)
inflammatory vs non-inflam
swelling
soft tissue
bony
inflammatory vs non-inflam
Erythema
Sometimes
absent
inflammatory vs non-inflam
Warmth
sometimes
absent
inflammatory vs non-inflam
AM stiffness
prominant
Minor (<30(
inflammatory vs non-inflam
Systemic features
sometimes
absent
inflammatory vs non-inflam
Increased erythrocyte sedimentation rate, c-reactive protein
Frequent
uncommon
inflammatory vs non-inflam
Synovial Fluid WBC
WBC >2000
WBC <2000
inflammatory vs non-inflam
examples
septic, RA, SLE, Gout
OA, AVN
Inflammatory articular conditions
septic gout
RA
Psoriatic arthritis
Inflammatory non-articular conditions
bursitis
enthesitis
PMR
Polymyositis
Noninflammatory articular condition
OA
charcot joint
fracture
Noninflammatory nonarticular conditions
fibromyalgia
CPS
CRPS
What is monoarticular
affecting one joint
inflammatory, trauma, hemarthrosis
spondyloarthropathy
septic arthritis, crystal induced
What is oligoarticular
affects a few joints
spondyloarthropathy, crystal induced, infection related
Polyarticular
affects multiple joints
RA, SLE
Crystal induced
infectious
Conditions that affect less than 4 joints
OA Fracture Osteonecrosis gout or pseudogout septic arthritis lyme disease reactive arthritis TB sarcoidosis
Conditions that affect 4 or more joints
OA RA PA Viral arthritis serum sickness Juvenile arthritis SLE/PSS/MCTD
conditions that affect the young
JRA, SLE, Reiter’s, GC arthritis
Conditions that affect the middle aged
fibromyalgia, tendinitis, bursitis, LBP, RA
conditions that affect the elderly
OA, crystal , PMR, Septic, osteoporosis
conditions that affect males
gout, AS, reiter’s
conditions that affect females
fibrositis, RA, SLE, OA
conditions that affects whites
PMR< GCA and wegener’s
Conditions that affect black
SLE, sarcoidosis
Conditions that affect asians
RA< SLE, takayasu’s arteritis, Behcet’s
constitutional conditions
fever, wt loss, fatigue
conditions that affect ocular senses
blurred vision, diplopia, conjunctivitis, dry eyes
oral conditions
dental caries, ulcers, dysphagia, dry mouth
GI conditions
Hx ulcers, abd pain, change in BM, melena, jaundice
Pulmonary conditions
SOB, DOE, hemoptysis, wheezing
Skin conditions
photosensitivity
alopecia, nails, rash
CNS conditions
HA, weakness, paraesthesia
Reproductive conditions
sexual dysfunction, promiscuity, genital lesions, miscarriages, impotence
MSK conditions
joint pain/swelling, stiffness, ROM/function, nodules
Acute conditions
fracture, septic arthritis, gout, rheumatic fever, Reiter’s syndrome
Chronic conditions
OA, RA, SLE, Psoriatic arthritis, fibromyalgia
Intermittent conditions
gout, pseudogout, lyme, palindromic, rheumatism, behcet’s
Addictive conditions
OA, RA, Reiter’s syndrome, psoriatic
Migratory conditions
viral arthritis (Hep B) Rheumatic fever, GC arthritis, SLE
OA
affects distal interphalangeal joints
may or may not be symmetrical
RA
symmetrical both sides
affects proximal interphalangeal joints and metacarpal phalangeal joints
Bouchard’s nodes at PIP joints
herbenden’s nodes at DIP
indicate
OA
Synovitis and volar subluxation at the MCP
synovitis at the wrists
indicates
RA
Jaccoud’s deformity
indicates
SLE
Butterfly/malar rash that spares nasolabial fold
indicates
systemic lupus erythematosus SLE
