Rheumatism History Taking

Question 1

Rheumatoid arthritis is often associated with morning stiffness lasting for what length of time?

Answer 1

> 30mins

Question 2

Which other conditons can be related to rheumatoid arthritis?

Answer 2

• Psoriasis
• Inflammatory bowel disease

Question 3

What is reactive arthritis?

Answer 3

A reaction to a previous infection

(normally STIs e.g. chlamydia or gonorrhoea or bacterial gastoenteritis e.g. campylobacter or salmonella)

Joint aspirate is clear

Question 4

Which conditions can be associated with polyarthritis?

Answer 4

• Rheumatoid arthritis
• Lupus
• Psoriatic arthritis (can also be monarthritic)

Question 5

What is the term given to arthritis which comes on, completely recovers and comes on again?

Answer 5

Palindromic arthritis

Question 6

What are the main risk factors for gout?

Answer 6

• Alcohol (especially beer)
• Being male
• High protein intake
• Hyperuraemia
• Diuretic use (loop diuretics are worse)

Question 7

Septic arthritis is most often caused by what?

Answer 7

Gram +ve bacteria due to a skin break

Question 8

How may rheumatoid arthritis affect the respiratory system?

Answer 8

• Pneumonitis (methotrexate use)
• Pulmonary fibrosis
• Pleural effusions (associated cough and SOB)

Question 9

How can rheumatoid arthritis affect the eyes?

Answer 9

• Scleritis
• Anterior uveitis
• Dry eyes

Question 10

How can rheumatoid arthritis affect the renal system?

Answer 10

Glomerulonephritis

(Often presents with no symptoms)

Question 11

How can rheumatoid arthritis affect the mucocutaneous system?

Answer 11

• Alopecia
• Oral/nasal ulceration
• Malar rash
• Photosensitive rash
• Systemic sclerosis (includes thickening and tightening of skin of fingers)

Question 12

How can rheumatoid arthritis affect the cardiovascular system?

Answer 12

1. Vasoconstriction of arteries e.g. Secondary Raynaud’s
2. Increased risk of atherosclerosis, MI and stroke
3. Valvulitis
4. Endocarditis
5. Pericarditis
6. LVF

Question 13

Which conditions may be associated with monoarthritis?

Answer 13

• Traumatic
• Gout
• Palindromic rheumatism
• Reactive arthritis
• Osteoarthritis
• Septic arthritis

Question 14

Which two nail changes are a good indication of psoriatic arthritis?

Answer 14

1. Onycholysis
2. Nail pitting

Question 15

What are “tophi”

Answer 15

Urate crystal deposition in the skin

Question 16

How could the crystals deposited in gout be described?

Answer 16

Needle-shaped birefringent crystals

Question 17

What is usually the first line pain management for gout?

Answer 17

NSAIDs

(colchicine can also be used bu can cause diarrhoea)

Question 18

Why is allopurinol given 2 weeks after a gout attack?

Answer 18

It can provoke a flare