Rheumatology - Clinical Evaluation Of Arthritis

Front 1

Sites of nonarticular rheumatism

Back 1

Joint capsule
Tendon
Muscle

Front 2

Site of inflammatory arthritis

Back 2

Synovium

Front 3

Site of degenerative arthritis

Back 3

Articular cartilage

Front 4

Classification of arthritis

Back 4

Inflammatory: seropositive, seronegative, crystal, infectious
Degenerative: primary (old age), secondary (trauma, disease, etc)
Non-articular: localized, generalized

Front 5

Types of seropositive arthropathies

Back 5

RA
SLE
Scleroderma
Dermatomyositis/polymyositis
Sjogren's syndrome

Front 6

Characteristics of Seropositive arthropathies (3)

Back 6

Symmetrical (esp. mcp and mtp joints)
Morning stiffness >1hr
Autoantibodies (ANA, RF, ACCP)

Front 7

Classification of seronegative arthropathies

Back 7

Symmetrical: ankylosing spondylitis, IBD
Asymmetrical: psoriatic arthritis, reactive arthritis

Front 8

Characteristics of seronegative arthropathies

Back 8

Spondylitis (back pain in am >1hr)
HLA B27 positive
No autoantibodies
Sacroiliitis (bilateral or unilateral)
Symmetric: large joints, oligoarticular
Asymmetric: DIP, dacylitis

Front 9

Characteristics of ankylosing spondylitis

Back 9

Symmetrical spine and large joint involvement

Front 10

Characterisitcs of psoriatic arthritis

Back 10

Asymmetrical spine and smaller joint involvement

Front 11

Classification of crystal arthropathies

Back 11

Gout: uric acid
Pseudogout: calcium pyrophosphate
Calcific periarthritis: hydroxyapatite

Front 12

Characteristics of crystal induced arthropathes

Back 12

Monoarticular
Abrupt onset (pain at rest)
Complete remissions
Urate, calcium crystals and WBC in synovial fluid

Front 13

Classification of infectious arthritis

Back 13

Gonoccocal
Non-gonoccal (bacterial, fungal, TB)

Front 14

Characteristics of infectious arthritis

Back 14

Monoarticular
Abrupt or insidious onset
Predisposed host or joint
Pain at rest, severe with movement
Purulent synovial fluid

Front 15

Classificaion of degenerative arthritis

Back 15

Primary (OA, familial Heberden's nodes, regional hip or knee)
Secondary (Traumatic (most), metabolic, hemophiliac, neropathic, etc)

Front 16

Characteristics of degenerative arthritis

Back 16

Distribution: DIP, PIP, Thumb, 1st MTP, knee, hip, spine
No inflammation: morning stiffness <30min, bland effusions
Structural changes: crepitus, enlargement, malalignment, decreased ROM

Front 17

Classification of non-articular rheumatism

Back 17

Localized: bursitis, tendonitis, capsulitis
Generalized: fibromyalgia, polymyalgia rheumatica

Front 18

Signs/symptoms of inflammatory arthritis

Back 18

am stiffness >1hr
worse after rest/better with activity
night time pain that wakes
+/- warmth
+/- erythema

Front 19

Patterns of joint involvement in arthritis

Back 19

Symmetrical small joint polyarthritis: wrists, hands, knees, ankles feet (RA)
Asymmetrical oligoarthropathy: finger, knee (psoriatic, reactive)
Symmetrical large joint polyarthritis: shoulders, hips, knees (ankylosing spondylitis, enteric arthritis)
Monoarthritis: knee (infectious, crystal)
Degenerative:fingers, thumb, hips, knees, spine (C4-T1, L3-S1)

Front 20

Things to evaluate on history and physical

Back 20

Onset (acute, subacute, insidious)
Characteristics
Pattern
Course
Therapy (drug, dose, duration, response, reason for discontinuation)
Extra-articular features
Effect on activities of daily living

Front 21

Signs/symptoms of degenerative arthritis

Back 21

am stiffness<30min
better with rest/worse with activity
evening pain that wakes
+/- crepitus

Front 22

Classification based on onset

Back 22

Insidious: inflammatory or degenerative
Subacute: CPPD, infection
Acute: Gout, infection

Front 23

Classification based on course

Back 23

Gout - acute flares with complete remission in between
RA - flares with incomplete and decreasing remission
Osteoarthritis - steady worsening with slight flares
CPPD - steady worsening with spikes of flares

Front 24

Classification based on extra-articular manifestations

Back 24

Seropositive: multisystemic
Seronegative: psoriasis, iritis, urethritis, mucosal ulcers
Crystal: tophi
Infectious: primary source, skin pustules/lesions, tenosynovitis
Non-articular rheumatism: tender points, dermatographism

Front 25

Classification of funcional capacity

Back 25

Class I: able to perform usual activities
Class II: limitation of vocational activities
Clas III: limitation of vocational and avocational activities (ex-work)
Class IV: limited self-care

Front 26

Role of xray in diagnosis of arthropathies

Back 26

Confirm suspected diagnosis

Front 27

Blood tests for Seropositive arthritis

Back 27

RF, anti-ccp, ANA, CBC, urinalysis

Front 28

Blood tests for Seronegative arthritis

Back 28

HLA B27

Front 29

Blood tests for crystal arthritis

Back 29

serum urate, calcium, 24hr urine urate

Front 30

Blood tests for infectious arthritis

Back 30

Tissue cultures
CBC

Front 31

Blood tests for degenerative and non-articular rheumatism

Back 31

ESR
CRP

Front 32

Approach to evaluation of arthritis

Back 32

1. Articular vs. non-articular
2. Degenerative or inflammatory
3. Extra-articular features guide diagnosis
4. Lab tests confirm diagnosis

Front 33

Synovial fluid characteristics: inflammatory arthritis

Back 33

Appearance: turbid
String Sign: poor
WBC: >2000
Crystal: positive in gout, CPPD
Gram stain: positive in septic
Glucose: decreased in septic and RA

Front 34

Synovial fluid characteristics: degenerative arthritis

Back 34

Appearance: clear
String Sign: good
WBC: <2000
Crystal: negative
Gram stain: negative
Glucose: normal

Front 35

Xray findings: inflammatory arthritis

Back 35

Diffuse cartilage loss (symmetric joint space narrowing)
Erosions
Periarticular osteopenia

Front 36

Xray findings: degenerative arthritis

Back 36

Local cartilage loss (assymetric joint space narrowing)
Bone overgrowth (osteophytes)
Eburnation (sclerosis)