Arthritis Diagnosis and History Taking

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Questions and Answers

What symptom is typically associated with rheumatoid arthritis (RA)?

Chronic back pain

Morning stiffness lasting over 30 minutes (correct)

Asymmetric joint involvement

Swelling only in large joints

Which of the following features can help differentiate types of arthritis during patient evaluation?

Number of affected joints (correct)

Family history of trauma

Age of the patient

Presence of fever

What is a critical step in the physical examination of an arthritis patient?

Measuring blood pressure

Only inspecting the joints visually

Confirming past medical history

Assessing range of motion actively and passively (correct)

Which laboratory test is specific for diagnosing rheumatoid arthritis?

Anti-CCP antibody test Signup and view all the answers

In assessing a patient for systemic conditions associated with arthritis, which symptom would raise suspicion?

Weight loss and fatigue Signup and view all the answers

What type of joint involvement suggests osteoarthritis rather than rheumatoid arthritis?

Asymmetric joint involvement Signup and view all the answers

Which of the following findings on examination indicates possible synovitis?

Palpable warmth and tenderness Signup and view all the answers

Which of these is NOT a typical feature of rheumatoid arthritis?

Localized swelling in a single joint Signup and view all the answers

What is a potential finding in imaging studies for osteoarthritis?

Joint space narrowing Signup and view all the answers

Which of the following conditions is HLA-B27 commonly associated with?

Ankylosing spondylitis Signup and view all the answers

Which treatment is considered first-line for managing most forms of arthritis?

Non-steroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

Which joint aspiration finding would indicate septic arthritis?

Presence of inflammatory cells Signup and view all the answers

What is the main characteristic of psoriatic arthritis?

Asymmetric arthritis with skin psoriasis Signup and view all the answers

Which statement is true regarding uric acid levels in gout?

May remain normal during acute attacks Signup and view all the answers

What type of early imaging is preferred for assessing cartilage and ligaments in rheumatoid arthritis?

MRI Signup and view all the answers

Which treatment is used specifically for acute flares of gout and pseudogout?

Colchicine Signup and view all the answers

Study Notes

Arthritis Approach

Arthritis refers to a group of conditions affecting joints
Causes pain, swelling, stiffness, and decreased range of motion
Diagnostic approach includes history, physical examination, laboratory testing, and imaging
Aims to determine the specific cause and guide treatment

History Taking

Distinguishes types of arthritis
Onset and duration: sudden vs gradual onset
- Acute (less than 6 weeks)
Pattern of joint involvement:
- Monoarthritis - one joint
- Oligoarthritis - 2-4 joints
- Polyarthritis - more than 5 joints
- Symmetry of joint involvement is important: Symmetric polyarthritis typical of rheumatoid arthritis (RA), whereas asymmetric involvement suggests osteoarthritis (OA) or psoriatic arthritis.
Associated symptoms:
- Morning stiffness - greater than 30 minutes may suggest RA
- Systemic symptoms like fever, weight loss, or fatigue may suggest systemic disease like RA, lupus, or systemic vasculitis.
Past medical history: trauma, infection, or autoimmune conditions
Family history: rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis may suggest genetic predisposition.

Physical Examination

Inspection: swelling, erythema (redness), deformities
Palpation: tenderness, warmth, effusion (fluid buildup), synovitis (inflammation of the lining of the joint).
Range of Motion: passive and active motion assessment
- Decreased range suggests joint effusion or structural damage
Joint-specific exam:
- Small joints (hands, feet) commonly involved in RA
- Knee or hip osteoarthritis is common
Systemic findings:
- Skin changes (rash in lupus, psoriasis), eye involvement (uveitis in ankylosing spondylitis), and oral ulcers (SLE).

Laboratory Investigations

Tests depend on the suspected diagnosis:
- CBC (complete blood count): anemia of chronic disease, leukocytosis (increased white blood cell count), or thrombocytosis (increased platelet count) in inflammatory arthritis.
- Acute Phase Reactants: ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein): elevated in inflammatory arthritis (e.g., RA, SLE, or systemic infection).
- Rheumatoid Factor (RF) and Anti-CCP: specific markers for rheumatoid arthritis (RA)
- Antinuclear Antibodies (ANA): positive in SLE, but can also be present in other connective tissue diseases.
- HLA-B27: associated with ankylosing spondylitis, reactive arthritis, and other spondyloarthropathies.
- Uric Acid: elevated in gout, but can be normal during acute attacks.
- Joint Aspiration and Synovial Fluid Analysis: evaluates for septic arthritis, crystals (gout or pseudogout), and inflammatory cells.

Imaging Studies

X-ray: joint space narrowing, osteophytes in osteoarthritis, erosions in rheumatoid arthritis, or soft tissue swelling.
Ultrasound: synovitis, effusion, and erosions not visible on X-ray.
MRI: cartilage, ligaments, and early erosions in rheumatoid arthritis.
CT Scan: detailed bone evaluation (e.g., in the spine or pelvis for ankylosing spondylitis).

Differential Diagnosis of Arthritis

Inflammatory arthritis
- **Rheumatoid arthritis (RA): **chronic, symmetric polyarthritis affecting small joints
- Ankylosing spondylitis: involves the spine and sacroiliac joints, often in young males
- Psoriatic arthritis: asymmetric arthritis with skin psoriasis
- Gout: acute, monoarticular arthritis, commonly in the big toe
- Systemic Lupus Erythematosus (SLE): arthritis with multi-organ involvement
- Septic arthritis: monoarthritis caused by infection - requires urgent treatment
Non-inflammatory arthritis
- Osteoarthritis (OA): common, degenerative changes in weight-bearing joints
Crystal-induced arthritis
- Gout: uric acid crystal deposition
- Pseudogout: calcium pyrophosphate deposition
Reactive arthritis: follows infections (gastrointestinal or genitourinary).

Treatment Approach

Non-pharmacologic Measures
- Physical therapy, joint protection strategies, and weight loss (osteoarthritis).
- Exercise programs and occupational therapy to maintain function.
Pharmacologic Therapy
- Non-steroidal anti-inflammatory drugs (NSAIDs): first-line for most forms of arthritis.
- Corticosteroids: acute flares in RA, lupus, or gout.
- Disease-modifying anti-rheumatic drugs (DMARDs):
  - Methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide are used in RA
- Biologic agents like TNF inhibitors: RA, ankylosing spondylitis, and psoriatic arthritis.
- Colchicine: gout and pseudogout flares.

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Description

This quiz delves into the diagnostic approach for arthritis, focusing on the importance of history taking. It covers the types of arthritis, patterns of joint involvement, symptom duration, and associated symptoms to help distinguish between different types. Understanding these elements is crucial for effective treatment planning.