| Polyarthritis | Monoarthritis | Investigations | Treatment | Systemic Disorders |
|---|---|---|---|---|
|
Reactive arthritis/Reiter’s disease.
Name the condition with the following clinical triad: nongonoccocal urethritis, conjunctivitis, arthritis.
|
Articular: ROM restricted symmetrically, active=passive, pain in all ROM, tender along joint line, diffuse swelling
Non-Articular: restricted asymmetrically, asymmetry in active & passive ROM, pain only on certain movements, periarticular joint pain, loca
Name 3 features that distinguish articular from non-articular pain.
|
Anti-CCP antibodies
You have a patient with a positive rheumatoid factor. What other test should you order to help support your diagnosis of Rheumatoid Arthritis?
|
NSAIDS
What analgesic should you avoid giving to patients with renal failure and peptic ulcer disease?
|
1. Serositis
2. Oral ulcers 3. Arthritis 4. Photosensitivity 5. Blood disorders 6. Renal involvement 7. ANA 8. Immune phenomena (dsDNA, anti-Sm ab) 9. Neurologic disorder 10. Malar rash 11. Discoid rash
The American College of Rheumatologists requires 4 of 11 criteria to diagnosis lupus. Name at least 5.
|
|
Genetics, advanced age, obesity, female, history of trauma.
Name 4 risk factors for OA.
|
Trauma, surgery, EtOH, purine rich foods, drugs that raise urate concentrations (diuretics, ASA), starvation, lactic acidosis.
Name 5 causes/precipitants of gout.
|
Gonorrhea
Your patient has migratory arthritis, a painful swollen finger, and a few lesions on his hands. What should you test him for?
|
Heat/cold, PT, joint protection, rest, aids, splints, orthotics, self-management skills, social supports, massage
Name 3 non-pharmacologic treatments for joint pain.
|
1. Hematologic (ACD, IDA, thrombocytosis, lymphadenopathy)
2. Cardiac (pericarditis/pericardial effusions) 3. Respiratory (pleurisy, pleural effusions, nodules, interstitial pulmonary fibrosis) 4. Ocular (dry eyes, episcleritis, scleritis, scleromalacia
Name 5 extra-articular manifestations of rheumatoid arthritis?
|
|
Fibromyalgia.
Your patient has widespread joint pain, fatigue, with mood disturbances. Most likely diagnosis?
|
Prosthetic joints, underlying inflammatory joint disease, elderly, diabetics, IVDU, immunosuppression, recent joint surgery, skin infection.
Name 5 patients at risk of non-gonoccoccal septic arthritis.
|
Squaring of vertebral edges, bridging syndesmophytes, bamboo spine.
Describe the Xray findings in Ankylosing Spondylitis.
|
Cloxacillin 2gIV q4h
Ancef 2g IV q8h Gentamicin 7mg/kg IV q24h Vancomycin 15mg/kg IV q8-12h Clindamycin 600 mg IV q8h
Name the empiric treatment of non-gonoccoccal septic arthritis.
|
Cancer, ruptured AAA, cardiac ischemia, appendicitis
Name 3 common non-MSK diagnoses that can present as joint pain.
|
|
1. Morning stiffness >1h
2. Arthritis in 3 or more areas (MCP, PIP, wrist, elbow, knee, ankle, MTP) 3. Arthritis in hand joints (wrist, MCP, PIP) 4. Symmetric arthritis (same joint area both sides) 5. Rheumatoid nodules (subcutaneous) 6. Serum RF positive
Name 4 criteria for the diagnosis of Rheumatoid Arthritis.
|
1. 3 or more attacks/year
2. Uric acid nephrolithiasis 3. Uric acid nephropathy 4. Tophi
List 2 indications for gout prophylaxis.
|
1. Elevated uric acid
2. Urate crystals in aspirated synovial fluid
Name 2 of the common laboratory findings in gout.
|
Infection, osteoporosis, AVN, cataracts, HTN, easy bruising, mood changes, truncal obesity, adrenal insufficiency, hyperglycemia, myopathy, acne, impaired wound healing, ulcer perforation.
Name 5 adverse effects of corticosteroids?
|
Nonerosive, asymmetric, affects large joints, parallels activity of intestinal involvement
Describe the joint manifestations in IBD.
|
|
1. Peripheral arthritis (lrg joints → hips, knees, ankles, MTP)
2. Back pain (insidious, dec ROM, kyphosis) 3. Buttock pain (sacroilitis) 4. Enthesitis (most commonly Achilles tendon, plantar fascia) 5. Uveitis (associated w/pain, redness, photophobia) 6.
Name 4 clinical features of Ankylosing Spondylitis.
|
Inflammatory: morning stiffness >1h, better w/activity, worse w/rest, systemic sx, extraarticular features, good response to NSAIDS
Non-inflammatory: morning stiffness lasts minutes, worse w/activity, better w/rest, no systemic or extraarticular sx, some
List 5 features that distinguish inflammatory from noninflammatory arthritis.
|
1. Opaque transparency
2. Yellow-green in colour 3. Variable viscosity 4. >100 WBC 5. 75% PMNS 6. Culture positive
Describe 3 features of a septic joint aspirate.
|
MTX, Hydroxychloroquine, Sulfasalazine, Azathioprine, Cyclosporine, Leflunomide.
Give examples of three disease-modifying agents used in rheumatic diseases.
|
Granulomatosis with polyangiitis (Wegener’s) OR Microscopic Polyangiitis
A patient has joint pain, chronic sinusitis with bloody nasal discharge, pulmonary nodules on CXR and microscopic hematuria. Name the most likely diagnosis.
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