Musculoskeletal Complaint Assessment

What is the first step in determining if the musculoskeletal complaint is articular?

Which of the following is a potential red flag condition when the complaint is acute and articular?

In chronic inflammatory arthritis, what indicates involvement of >3 joints?

What symptom is NOT typically associated with chronic noninflammatory arthritis?

Which factor is used to differentiate between rheumatoid arthritis and conditions such as SLE, scleroderma, and polymyositis?

Which symptom is indicative of chronic inflammatory arthritis?

What is a common nonarticular condition that might be mistaken for an articular problem?

When assessing conditions for rheumatoid arthritis, which joints need to be involved for a likely diagnosis?

Which condition is characterized by the presence of soft tissue swelling and systemic symptoms along with joint involvement?

What is NOT included in the consideration for a nonarticular condition?

Musculoskeletal Complaint Assessment

Initial evaluation includes assessing rheumatic history and physical examination.
Determine if the condition is articular or nonarticular, and identify acute vs chronic presentation.
Key questions: Is inflammation present? How many joints are involved? Is the condition acute, focal, or monoarticular?

Nonarticular Conditions

Common nonarticular conditions to consider:
- Trauma or fracture
- Fibromyalgia
- Polymyalgia rheumatica (PMR)
- Bursitis
- Tendinitis
- Myopathy or myositis

Articular Conditions

If articular, assess duration of symptoms:
- Less than 6 weeks: check for "red flag" conditions like:
  - Gout
  - Septic arthritis
  - Fracture
  - Vascular ischemia
  - Carpal tunnel syndrome
- More than 6 weeks: investigate the presence of inflammation.

Inflammation Assessment

Evaluate for signs of inflammation:
- Prolonged morning stiffness
- Soft tissue swelling
- Presence of systemic symptoms
- Elevated ESR (erythrocyte sedimentation rate) or CRP (C-reactive protein)

Outcomes Based on Inflammation and Duration

No inflammation results in chronic noninflammatory arthritis.
Presence of inflammation leads to chronic inflammatory arthritis:
- Joint involvement is assessed:
  - Mono/oligoarthritis (1 - 3 joints):
    - Check for involvement of DIP, CMC1, hip, or knee joints.
      - Absence suggests unlikely osteoarthritis, consider conditions like osteonecrosis, Charcot arthritis, or hemochromatosis.
      - Presence indicates osteoarthritis.
  - Polyarthritis (>3 joints):
    - Check for symmetry of joint involvement:
      - Asymmetric involvement: consider psoriatic arthritis, reactive arthritis, or enteropathic arthritis.
      - Symmetric involvement: Examine if PIP, MCP, or MTP joints are affected.
        
        Absence suggests unlikely rheumatoid arthritis; consider other conditions like SLE or scleroderma.
        
        Presence indicates rheumatoid arthritis.

Important Abbreviations

DIP: distal interphalangeal
ESR: erythrocyte sedimentation rate
MCP: metacarpophalangeal
MTP: metatarsophalangeal
PMR: polymyalgia rheumatica
SLE: systemic lupus erythematosus

This quiz focuses on the initial evaluation of musculoskeletal complaints, including both articular and nonarticular conditions. It covers the determination of the nature of the pain, joint involvement, and potential diagnoses such as fibromyalgia and bursitis. Test your knowledge on how to approach and assess various musculoskeletal issues effectively.