week 4 Flashcards
arthritis vs arthralgia
Arthritis: Joint pain with inflammation
Arthralgia: Joint pain
articular pain vs periarticular pain vs referred pain
Articular pain: Pain from the joint
Periarticular pain: Pain from soft tissue surrounding joint
Referred pain: Pain from proximal or distal structures to the joint or neurogenic
mono vs oligo vs poly articular
Monoarticular: Involving a single joint
Oligoarticular: Involving 2-4 joints
Polyarticular: Involving ≥ 5 joints
inflammatory arthritis vs septic joint vs migratory arthritis
Inflammatory arthritis: Combination of redness, swelling, warmth, and/or tenderness
Septic joint: Generally refers to bacterial infection of the joint
Migratory arthritis: Development of new joint symptoms with improvement of previously affected joints
symmetrical vs asymmetrical arthritis
Symmetrical arthritis
Affecting both sides of the body
Asymmetrical arthritis
Spotty distribution of affected joints
inflammatory vs non inflammatory joints pain
which is worse with inactivity and better with activity and what are causes
non inflam: worse with exercise i.e. OA, trauma
inflam: worsen with inactivity and joint stiff/ gelling in morning i.e.infection, gout, RA, all other arthritis…
what is typically mono or oligoarticular vs polyarticular
mono or oligo: septic arthritis, spondyloarthritides, gout, OA
poly: RA, lupus
to consider in joint pain
Previous medical history
* Previous gastrointestinal or sexually transmitted disease
* Obesity,hypertension,diabetes,kidneystones
* Immunocompromised
* Prior joint surgery, prosthetic joints
- Medications
- Thiazidediuretics,cyclosporine,procainamide,hydralazine
Previous medical history
* Previous gastrointestinal or sexually transmitted disease
* Obesity,hypertension,diabetes,kidneystones
* Immunocompromised
* Prior joint surgery, prosthetic joints
* Medications
* Thiazidediuretics,cyclosporine,procainamide,hydralazine
- Social history
- Drug and alcohol use, travel, tick bites, risky sexual behaviour
how to know its interarticular pain (in the joint) and not periarticular (soft tissue around joint)
Signs of true intraarticular disorder:
* Effusion, redness, swelling
* Restricted AROM and PROM
* Maximum pain at end range
* Pain with motion in multiple directions
*** Periarticular problems may restrict only AROM
** * Pain on RROM suggest tendonitis or bursitis
Extraaritcular manifestations
skin, eyes, oral cavity, lungs, heart
WBC and ESR and CRP in inflammatory vs non inflam
all elevated in inflame
septic arthritis cause
Nongonococcal bacteria
staphylococcus aureus
Via hematogenous spread of bacteremia (from blood to joint)
septic arthritis
gout
pseudogout
RA
OA
–>mono or poly articular?
inflammatory?
which joint?
SA
inflam
mono
large joints
G
inflam
mono
1st MTP (podagra)
PG
RA
inflam
poly, symmetrical
wrists, PIP, MCP, MTP
OA
non inflam
asymmetrical
hands, knees, hips, feet, spine
septic arthritis
gout
pseudogout
RA
OA
morning stiffness?
no
yes
yes
yes > 1 hours
yes < 1 hr
RA genes and causes
women, smokers, family history
-genes: HLA-DR1, HLA-DR4
-autoimmune
-chronic/relapsing destructive synovitis (cyotkines TNFa, IL1, IL6)
RA blood work
-ESR, CRP, RF (rheumatoid factor), ACPA (anti cirtilluline antibodies)
-**ACPA highest LR+
gout vs psuedogout crystal type?
gout; monosodium urate
pseudo; Calcium pyrophosphate dihydrate
