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

Week 3 : Rheumatological Conditions Flashcards by Matthew Russell

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

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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

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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?

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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

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Red Flag conditions include

fracture
infection
organ involvement

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Articular vs periarticular

articular

pain - diffuse, deep tenderness
ROM pain - active +passive in all planes
Swelling - Common

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Articular vs periarticular

periarticular

pain = point

ROM pain = active motion in few planes

Swelling = uncommon

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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

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inflammatory vs non-inflam

Pain (when)

Yes (AM)

Yes (PM)

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inflammatory vs non-inflam

swelling

soft tissue

bony

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inflammatory vs non-inflam

Erythema

Sometimes

absent

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inflammatory vs non-inflam

Warmth

sometimes

absent

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inflammatory vs non-inflam

AM stiffness

prominant

Minor (<30(

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inflammatory vs non-inflam

Systemic features

sometimes

absent

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inflammatory vs non-inflam

Increased erythrocyte sedimentation rate, c-reactive protein

Frequent

uncommon

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inflammatory vs non-inflam

Synovial Fluid WBC

WBC >2000

WBC <2000

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inflammatory vs non-inflam

examples

septic, RA, SLE, Gout

OA, AVN

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Inflammatory articular conditions

septic gout
RA
Psoriatic arthritis

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Inflammatory non-articular conditions

bursitis
enthesitis
PMR
Polymyositis

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Noninflammatory articular condition

OA
charcot joint
fracture

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Noninflammatory nonarticular conditions

fibromyalgia
CPS
CRPS

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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

affects distal interphalangeal joints | may or may not be symmetrical

symmetrical both sides | affects proximal interphalangeal joints and metacarpal phalangeal joints

Bouchard's nodes at PIP joints herbenden's nodes at DIP indicate

Synovitis and volar subluxation at the MCP synovitis at the wrists indicates

Jaccoud's deformity | indicates

SLE

Butterfly/malar rash that spares nasolabial fold | indicates

systemic lupus erythematosus SLE