SM_220a: Approach to Joint Pain Flashcards Preview

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Flashcards in SM_220a: Approach to Joint Pain Deck (23)
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1

The approach to joint pain in rheumatology involves _____, _____, _____, _____, and _____

The approach to joint pain in rheumatology involves history, physical exam, laboratory assessment, arthrocentesis/synovial fluid analysis, imaging

2

_______ has polyarticular inflammatory joint pain

Rheumatoid arthritis has polyarticular inflammatory joint pain

3

In assessing joint pain, history involves asking about _____, _____, _____, and _____

In assessing joint pain, history involves asking about location and symmetry, onset and chronology, inflammatory vs other joint pain, and systemic and extra-articular features

4

______, ______, and ______ have asymmetric oligarticular inflammatory joint pain

Psoriatic arthritis, crystalline arthritis (gout), and gonorrhea/chlamydia related arthritis have asymmetric oligarticular inflammatory joint pain

5

Describe inflammatory joint pain

Inflammatory joint pain

  • Stiffness lasting > 1 hour in the morning or after period immobility
  • Symptoms can improve with activity
  • Symptoms worse with rest
  • Symptoms respond to steroid

(rheumatoid arthritis, spondyloarthropathies such as ankylosing spondylitis, inflammatory arthritis in connective tissue disease)

6

_____ joint pain improves with activity

Inflammatory joint pain improves with activity

7

_____ joint pain responds to steroids

Inflammatory joint pain responds to steroids

8

Describe systemic and extra-articular features someone with joint pain might have

Systemic and extra-articular features associated with joint pain

  • Constitutional symptoms: fever, weight loss, anorexia, fatigue
  • Rash
  • Inflammatory eye disease
  • Raynaud's
  • Enthesitis
  • Dactylitis
  • IBD

9

Relevant family history for joint pain includes _____, _____, and _____

Relevant family history for joint pain includes HLA B27 associated conditions, rheumatoid arthritis, systemic autoimmune disease

 

(IBD, ankylosing spondylitis, psoriatic arthritis are HLA B27 associated)

10

Physical exam for joint pain includes _____, _____, _____, and _____

Physical exam for joint pain includes inspection, palpation, range of motion, and strength

11

Lab assessment of joint pain includes _____, _____, and _____

Lab assessment of joint pain includes erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor / anti-cyclic citrullinated peptide / ANA / ANCA

12

Describe erythrocyte sedimentation rate

Erythrocyte sedimentation: non-specific marker of inflammation

  • Increases with age
  • Can be higher in women
  • Increased in diabetes, ESRD, and pregnancy
  • Lowered by CHF, and sickled erythrocytes

13

Describe C-reactive protein

C-reactive protein: non-specific marker of inflammation

  • Levels change more quickly than ESR: more sensitive
  • Less variable than ESR
  • Affected by age and gender
  • Can be increased by heart disease, infection, malignancy, obesity, diabetes, and smoking

14

Rheumatoid factor is _____ but often associated with _____

Rheumatoid factor is non-specific but often associated with rheumatoid arthritis

15

Anti-cyclic citrullinated peptide is associated with _____

Anti-cyclic citrullinated peptide is associated with rheumatoid arthritis

16

ANA is associated with _____ but can occur in _____

ANA is associated with autoimmune disease but can occur in the healthy population

17

ANCA is associated with _____

ANCA is associated with systemic vasculitis

18

In arthrocentesis / synovial fluid analysis, as the WBC count increases, fluid becomes ______

In arthrocentesis / synovial fluid analysis, as the WBC count increases, fluid becomes less clear (more turbid)

19

Cell count of 30,000 on arthrocentesis / synovial fluid analysis indicates _____

Cell count of 30,000 on arthrocentesis / synovial fluid analysis indicates inflammatory arthritis

20

Turbidity and cell count over 50,000 on arthrocentesis / synovial fluid analysis indicates ______

Turbidity and cell count over 50,000 on arthrocentesis / synovial fluid analysis indicates infection

21

Crystals on arthrocentesis / synovial fluid analysis indicate _____ or _____

Crystals on arthrocentesis / synovial fluid analysis indicate gout or pseudogout

22

Plain radiograph is used to assess _____

Plain radiograph is used to assess progression of rheumatoid arthritis

23

In terms of joint pain, MRI is best at looking at _____ and assessing _____

In terms of joint pain, MRI is best at looking at soft tissue and assessing torn rotator cuffs

 

(also looking for inflammatory arthritis not seen on x-ray)

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