CMS150 Clinical Medicine Week 4: Joint Pain Diagnosis

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Questions and Answers

What is the term for joint pain with inflammation?

Periarticular pain

Articular pain

Arthritis (correct)

Arthralgia

Which type of joint pain involves 2-4 joints?

Polyarticular

Asymmetrical

Monoarticular

Oligoarticular (correct)

What is the term for pain from soft tissue surrounding the joint?

Articular pain

Referred pain

Periarticular pain (correct)

Inflammatory pain

Which type of arthritis is characterized by a combination of redness, swelling, warmth, and/or tenderness?

Inflammatory arthritis Signup and view all the answers

What is the typical presentation of tophi in gout?

Mottled hypopigmentation on the dorsa Signup and view all the answers

What is the term for a bacterial infection of the joint?

Septic joint Signup and view all the answers

What is the term for a type of joint pain that affects both sides of the body?

Symmetrical arthritis Signup and view all the answers

What is the purpose of the 2015 ACR-EULAR Gout Classification Criteria?

To identify subjects for clinical studies Signup and view all the answers

What is the gold standard for diagnosing gout?

Joint aspiration and microscopy analysis Signup and view all the answers

What is the characteristic appearance of monosodium urate crystals under microscopy?

Needle-like appearance with strong negative birefringence Signup and view all the answers

What is the primary role of serum uric acid levels in gout diagnosis?

To identify hyperuricaemia Signup and view all the answers

What is shown in the dual-energy CT image of the feet in a patient with tophaceous gout?

Monosodium urate crystal deposition (green) Signup and view all the answers

What is the main purpose of measuring serum uric acid in a patient with suspected septic arthritis?

To rule out gout Signup and view all the answers

What is the significance of a positive PCR test in a patient with suspected septic arthritis?

It is an indication of Borrelia burgdorferi infection Signup and view all the answers

What is the significance of a WBC count of > 50,000 WBC/mm3 in synovial fluid analysis?

It is a characteristic of septic arthritis Signup and view all the answers

What is the purpose of performing arthrocentesis in a patient with suspected septic arthritis?

To collect synovial fluid for analysis Signup and view all the answers

What is the significance of an elevated ESR and CRP in a patient with suspected septic arthritis?

They are used to monitor therapeutic response Signup and view all the answers

What is the significance of a medical emergency in septic arthritis?

It requires immediate diagnosis and referral for treatment Signup and view all the answers

What is a complication of Rheumatoid Arthritis?

Pleuritis Signup and view all the answers

What is the goal of early diagnosis and early initiation of treatment in Rheumatoid Arthritis?

To prevent irreversible joint damage Signup and view all the answers

What is a characteristic of Rheumatoid Arthritis?

Non-traumatic, chronic, and progressive symmetric oligoarthritis Signup and view all the answers

What is a consequence of a 12-week delay in treatment of Rheumatoid Arthritis?

Reduced chance of drug-free remission Signup and view all the answers

What is another possible diagnosis besides Rheumatoid Arthritis in Zain Mara's case?

Osteoarthritis Signup and view all the answers

What is a common extra-articular complication of Rheumatoid Arthritis?

Vasculitis Signup and view all the answers

What percentage of people aged 65 and older have osteoarthritis?

50% Signup and view all the answers

What is a characteristic of osteoarthritis onset?

Gradual Signup and view all the answers

What is a common feature of osteoarthritis in the hands?

Heberden nodes on proximal interphalangeal joints Signup and view all the answers

What is a risk factor for osteoarthritis?

Family history Signup and view all the answers

What is a characteristic of joint pain in osteoarthritis?

Worsened by movement Signup and view all the answers

What is a common feature of advanced osteoarthritis?

Bony enlargement Signup and view all the answers

Study Notes

Joint Pain Classifications

Joint pain can be classified into inflammatory and non-inflammatory causes
Inflammatory causes include septic arthritis, gout, and rheumatoid arthritis
Non-inflammatory causes include osteoarthritis

Monoarticular, Oligoarticular, and Polyarticular Joint Pain

Monoarticular: involving a single joint
Oligoarticular: involving 2-4 joints
Polyarticular: involving ≥ 5 joints

Inflammatory Arthritis

Characterized by combination of redness, swelling, warmth, and/or tenderness
Examples include septic arthritis, gout, and rheumatoid arthritis

Septic Arthritis

Generally refers to bacterial infection of the joint
Medical emergency that requires immediate diagnosis and urgent referral for treatment
Evaluation includes complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum uric acid, and arthrocentesis for synovial fluid analysis
Management involves immediate diagnosis and urgent referral for treatment

Gout

Evaluation includes clinical diagnosis, classification criteria, and microscopy-based diagnosis of synovial fluid
2015 ACR-EULAR Gout Classification Criteria can help inform the clinician but is not meant for diagnosis
Serum uric acid levels can identify hyperuricaemia
Gold standard for diagnosis is joint aspiration and microscopy analysis showing presence of monosodium urate crystals

Rheumatoid Arthritis (RA)

Management involves low threshold for referral to rheumatologist
Goals of treatment include early diagnosis and early initiation of treatment to prevent irreversible joint damage, achieve long-term clinical remission, optimize quality of life, and monitor for extra-articular complications
Complications of RA include osteopenia and osteoporosis, lung manifestations, accelerated atherosclerosis, increased insulin resistance, vasculitis, thromboembolic disease, depression, anemia of chronic disease, and Felty syndrome

Osteoarthritis

Prevalence increases with age, affecting 7.3% in ages 18-44, 30% in ages 45-64, and 50% in ages 65 and older
Women are more commonly affected than men
Other risk factors include overweight/obese, previous joint injury, family history, frequent bending/squatting, and repetitive impact
Degenerative disorder of articular cartilage associated with hypertrophic bone changes
Onset is gradual, and duration is lifelong with flares
Typically, there is no morning pain or stiffness (or short-lived)

Osteoarthritis – Clinical Features

Asymmetric joint pain and stiffness, commonly affecting hands, knees, hips, feet, and spine
Joint pain worsened by movement/activity, especially following a period of rest
Joint swelling and tenderness
Bony enlargement in prolonged or severe OA
Pain on range of motion and limitation of range of motion
Crepitus (typically knee) may be felt and heard
Bouchard nodes on proximal interphalangeal joint and Heberden nodes on distal interphalangeal joints

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Description

Assess your understanding of joint pain classification, diagnosis, and causes, including inflammatory and non-inflammatory, monoarticular, oligoarticular, and polyarticular, and infectious and non-infectious causes.