Rheumatologic Conditions
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Transcript of Rheumatologic Conditions
Characterization of an MSK problem
What are the symptoms?
Site and distribution of symptoms
Chronology
Associated symptoms
Symptom response to health interventions
Preceding factors
What is its impact?
Symptoms of an MSK Problem
Pain
Stiffness
Swelling
Deformity
Weakness
Instability
Loss of function
Fatigue and malaise
Depression and fear
Sleep disturbance
Symptoms of systemic disease
MSK exam
In examining the MSK system, it is important to keep the concept of function in mind.
Note any gross abnormalities of mechanical function with the initial introduction to the patient.
Continue to observe for such problems throughout the interview and the examination.
Case #1
40 yo W who was previously in her normal state of health.
She presents with a 4 month history of worsening pain and swelling involving her 2,3,4 and 5 PIPs bilaterally, right 2 and 3 MCPs, wrists and feet bilaterally.
She also endorses “bumps” on the dorsal aspect of her hands, morning stiffness lasting approximately 2 hours, dryness in her eyes and mouth and, Raynaud’s phenomenon.
Case #2
35 yo M with a h/o psoriasis for 5 years.
He endorses a 2 month history of pain and swelling in his right knee and left second toe, associated with 2 hours of morning stiffness.
He takes ibuprofen 800 mg as needed for pain with partial relief.
Seronegative Spondyloarthropathies
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
IBD arthritis
RF negative
HLA-B27
Sacroilitis/ spondylitis
Inflammatory peripheral arthritis (often asymetrical)
Extra-articular manifestations Ocular inflammation Enthesopathy Skin changes (psoriasis,
erythema nodosum)
Case #3
54 yo M with a history of HTN, DM2 and CRI presenting with sudden onset pain and swelling in his R 1st MTP joint that started 2 days ago.
Look: skinRedness as seen in gout.
This is a valuable indicator of the intensity of underlying joint inflammation
What is the pattern of the arthritis distribution?
Diagnosis Symmetry
No joints involved
Large or small
Distribution
Upper or lower limbs
Rheumatoid Arthritis
Symmetrical
Polyarthritis
Large/ small
Peripheral Upper/ lower
Ankylosing Spondylitis
Asymmetrical
Oligoarthritis
Large Central and peripheral
Lower
Psoriatic Arthritis
Asymmetrical
Oligo/ Polyarthritis
Large/ small
Peripheral Upper/ lower
ReaciveArthritis
Asymmetrical
Oligo/Polyarthritis
Large/dactylitis
Peripheral Lower
Gout Asymmetrical
Mono/ oligoarthritis
Large/ small
Peripheral Lower/ upper
Conclusion
What are the symptoms?Site and distribution of symptoms
Chronology
Other associated symptoms
Symptom response to health interventions
Preceding factors
What is its impact?