30 Questions
What is the term for joint pain with inflammation?
Arthritis
Which type of joint pain involves 2-4 joints?
Oligoarticular
What is the term for pain from soft tissue surrounding the joint?
Periarticular pain
Which type of arthritis is characterized by a combination of redness, swelling, warmth, and/or tenderness?
Inflammatory arthritis
What is the typical presentation of tophi in gout?
Mottled hypopigmentation on the dorsa
What is the term for a bacterial infection of the joint?
Septic joint
What is the term for a type of joint pain that affects both sides of the body?
Symmetrical arthritis
What is the purpose of the 2015 ACR-EULAR Gout Classification Criteria?
To identify subjects for clinical studies
What is the gold standard for diagnosing gout?
Joint aspiration and microscopy analysis
What is the characteristic appearance of monosodium urate crystals under microscopy?
Needle-like appearance with strong negative birefringence
What is the primary role of serum uric acid levels in gout diagnosis?
To identify hyperuricaemia
What is shown in the dual-energy CT image of the feet in a patient with tophaceous gout?
Monosodium urate crystal deposition (green)
What is the main purpose of measuring serum uric acid in a patient with suspected septic arthritis?
To rule out gout
What is the significance of a positive PCR test in a patient with suspected septic arthritis?
It is an indication of Borrelia burgdorferi infection
What is the significance of a WBC count of > 50,000 WBC/mm3 in synovial fluid analysis?
It is a characteristic of septic arthritis
What is the purpose of performing arthrocentesis in a patient with suspected septic arthritis?
To collect synovial fluid for analysis
What is the significance of an elevated ESR and CRP in a patient with suspected septic arthritis?
They are used to monitor therapeutic response
What is the significance of a medical emergency in septic arthritis?
It requires immediate diagnosis and referral for treatment
What is a complication of Rheumatoid Arthritis?
Pleuritis
What is the goal of early diagnosis and early initiation of treatment in Rheumatoid Arthritis?
To prevent irreversible joint damage
What is a characteristic of Rheumatoid Arthritis?
Non-traumatic, chronic, and progressive symmetric oligoarthritis
What is a consequence of a 12-week delay in treatment of Rheumatoid Arthritis?
Reduced chance of drug-free remission
What is another possible diagnosis besides Rheumatoid Arthritis in Zain Mara's case?
Osteoarthritis
What is a common extra-articular complication of Rheumatoid Arthritis?
Vasculitis
What percentage of people aged 65 and older have osteoarthritis?
50%
What is a characteristic of osteoarthritis onset?
Gradual
What is a common feature of osteoarthritis in the hands?
Heberden nodes on proximal interphalangeal joints
What is a risk factor for osteoarthritis?
Family history
What is a characteristic of joint pain in osteoarthritis?
Worsened by movement
What is a common feature of advanced osteoarthritis?
Bony enlargement
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
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.
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