Clinical Classification of Rheumatic Diseases

Study Notes

Clinical Classification of the Rheumatic Diseases

Clinical classification categorizes rheumatic diseases for effective diagnosis and management.

Joint Involvement Characterization

Monoarthritis: involvement of one joint; often hot and inflamed, may indicate crystal or infectious etiology.
Oligoarthritis: involves 2-4 joints; commonly asymptomatic.
Polyarticular: affects five or more joints.

Types of Oligoarthritis

Reactive arthritis: characterized by the classic triad "can't pee, can't see, can't climb a tree."
Psoriatic arthritis: associated with psoriasis skin condition.
Enteropathic arthritis: linked to inflammatory bowel diseases like Crohn’s and ulcerative colitis.

Degenerative Arthritis Types

Osteoarthritis: the most common form of arthritis overall.
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Aseptic Necrosis and Charcot's joint disease are also recognized forms.

Non-Articular Arthritis

Conditions include fibromyalgia, bursitis, tendinitis, Reflex Sympathetic Dystrophy (RSD), and Polymyalgia Rheumatica (PMR).

Patient Assessment for Joint Pain

Comprehensive approach includes patient history, physical examination, laboratory tests, X-ray imaging, and potential tissue diagnosis.

Differentiating RA from OA

Morning stiffness—prolonged stiffness lasting more than an hour is indicative of rheumatoid arthritis (RA).
In contrast, osteoarthritis (OA) typically does not present systemic symptoms and affects joints asymmetrically.

Most Common Inflammatory Arthritis

Gout has surpassed rheumatoid arthritis as the most prevalent inflammatory polyarthritis.

Relevant History in Rheumatic Disease

Important factors include age, sex, history of morning stiffness, joint involvement pattern, extra-articular symptoms, and family history.

Patterns of Joint Involvement

Three patterns: monoarticular, oligoarticular, and polyarticular with attention to symmetry and distribution.

Revised Criteria for Systemic Lupus Erythematosus (SLE)

Diagnosis includes criteria such as malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, and various organ involvements including neurological and hematologic disorders.

Gout Management Focus

Protect kidneys during treatment as gout can lead to renal failure.

Distinction in Joint Pain

Essential to differentiate between arthralgia (pain without inflammation) and arthritis (inflammation).

Laboratory Screening Tests for Connective Tissue Disease (CTD)

Tests include Complete Blood Count (CBC), Antinuclear Antibody (ANA), urinalysis, Rheumatoid Arthritis latex test, Comprehensive Metabolic Panel (CMP), and Erythrocyte Sedimentation Rate (ESR).

Synovial Fluid Analysis

Analysis includes white blood cell differential, Gram stain, glucose levels, crystal analysis, protein levels, complement, and mucin clot formation.

Symptoms in Rheumatoid Arthritis

Typically affects MCP joints and wrists, with symmetrical involvement and sparing of the distal interphalangeal (DIP) joints.

Symptoms in Osteoarthritis

Primarily spares MCP and wrist joints; characterized as a disease of cartilage.

Leading Cause of Septic Arthritis

Staphylococcus is currently recognized as the leading cause; historically, gonococci (GC) was more common.

Crystal-Induced Arthritis Features

Marked by acutely painful episodes, typically monoarticular, and may remit spontaneously.

Infectious Arthritis Characteristics

Usually monoarticular but may involve multiple joints with signs of concurrent infection elsewhere.

Most Common Forms of Monoarticular Arthritis

Includes gout, pseudogout, septic arthritis, traumatic arthritis, mechanical derangement, and bursitis/tendinitis.

Seronegative Spondyloarthropathies

Includes ankylosing spondylitis, Reiter's syndrome (reactive), psoriatic arthritis, enteropathic arthritis, and Yersinia enterocolitis.

Early Non-Vertebral Signs and Symptoms of Spondyloarthropathies

Symptoms include asymmetric leg arthritis, first MTP joint involvement, heel pain from Achilles tenosynovitis, and evidence of heel spurs on radiographs.

Distinct Features of Seronegative Spondyloarthropathies

Typically oligarticular, asymmetric, with lower extremity involvement, lower back stiffness, heel pain, and positive HLA-B27 marker.

Characteristic Features of Connective Tissue Disease (CTD)

Defined by a triad of polyarthritis, systemic disease signs, and multiple autoantibody presence.

Types of Connective Tissue Diseases (CTD)

Includes rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis, polymyositis/dermatomyositis, vasculitis, Sjogren's syndrome, overlapping connective tissue diseases (MCTD), and undifferentiated CTD.

Causes of Chronic Polyarthritis

Commonly involves rheumatoid arthritis, juvenile chronic arthritis, connective tissue diseases, spondyloarthropathies, chronic crystal arthritis, and may be exacerbated by hypothyroidism or metabolic bone diseases.

Description

Explore the clinical classification of rheumatic diseases through these flashcards. Learn about types of arthritis, key characteristics, and classifications based on joint involvement. This quiz will enhance your understanding of rheumatic conditions and their clinical presentation.

Clinical Classification of Rheumatic Diseases

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Questions and Answers

What is the first way to characterize rheumatic disease?

What is oligoarthritis?

What is the most common form of inflammatory arthritis?

List three important aspects of history in rheumatic disease.

What are the revised criteria for SLE?

RA shows constitutional symptoms.

Which of the following is a laboratory screening test for connective tissue disease (CTD)?

What is synovial fluid analysis used for?

What is the number one cause of septic arthritis?

Define seronegative spondyloarthropathies.

The triad characteristic features of connective tissue disease (CTD) are ______, systemic signs of disease, and multiple autoantibodies.