Podcast
Questions and Answers
What is the first step in determining if the musculoskeletal complaint is articular?
What is the first step in determining if the musculoskeletal complaint is articular?
- Assess the number of joints involved.
- Identify if the complaint is acute or chronic. (correct)
- Evaluate the history of trauma.
- Determine if there is inflammation present.
Which of the following is a potential red flag condition when the complaint is acute and articular?
Which of the following is a potential red flag condition when the complaint is acute and articular?
- Polymyalgia rheumatica
- Osteoarthritis
- Fibromyalgia
- Fracture (correct)
In chronic inflammatory arthritis, what indicates involvement of >3 joints?
In chronic inflammatory arthritis, what indicates involvement of >3 joints?
- Rheumatoid arthritis
- Chronic inflammatory polyarthritis (correct)
- Septic arthritis
- Chronic inflammatory mono/oligoarthritis
What symptom is NOT typically associated with chronic noninflammatory arthritis?
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 factor is used to differentiate between rheumatoid arthritis and conditions such as SLE, scleroderma, and polymyositis?
Which symptom is indicative of chronic inflammatory arthritis?
Which symptom is indicative of chronic inflammatory arthritis?
What is a common nonarticular condition that might be mistaken for an articular problem?
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?
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?
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?
What is NOT included in the consideration for a nonarticular condition?
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Study Notes
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.
- Less than 6 weeks: check for "red flag" conditions like:
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.
- Check for involvement of DIP, CMC1, hip, or knee joints.
- 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.
- Check for symmetry of joint involvement:
- Mono/oligoarthritis (1 - 3 joints):
- Joint involvement is assessed:
Important Abbreviations
- DIP: distal interphalangeal
- ESR: erythrocyte sedimentation rate
- MCP: metacarpophalangeal
- MTP: metatarsophalangeal
- PMR: polymyalgia rheumatica
- SLE: systemic lupus erythematosus
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