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Non-Inflammatory Rheumatological Conditions - Coggle Diagram
Non-Inflammatory Rheumatological Conditions
History
First question
Is it actually joint pain
Joint Pain
Pattern of distribution
Symmetrical / asymmetrical
ddx
Radiculopathy
Oedema
Neuropathy
Fatigue
Myalgia
PAD
Underlying malignancy
Is it inflammatory joint pain
Associated early morning stiffness lasting more than 30min
Improves as day goes on
Can improve with exercise
Visible joint swelling
Erythema / redness
Warm to palpation
Anatomical distribution
Examination
Arthralgia versus ARthritis
Rubor
Calor
Tumour
Dolor
Decreasing specificity for inflammation
Causes of Arthralgia w/o arthritis
Osteoarthritis OA
DIP
Haemachromatosis
Similar presentation to OA
Hands - MCPs
Features of CPPD (calcium deposition) on Xray
Younger age of presentation
Connective Tissue Diseases
SLE
Sjorgen's syndrome
Mixed
Targeted questions
Mouth ulcers
Rashers
Sicca
Photosensitivity
Sarcoidosis
Young peoeple with
Atraumatic
Bilateral ankle / lowe leg pain
Skin changes - erythema nodosum
Low threshold to
Check Inflam markers
CXR / CTT
Bilateral hilar lymphadenopathy
Raynaud's sydnrome - Hand Discomfort
Spasm of blood vessels, feet
Response to cold, stress, emotional distress
Very common in young women
May be associated with underlying Connective Tissu Disease - Systemic Sclerosis - men, older adults >40y/o
Dupuytren's contracture
Proliferation of fibroblasts in palmar fascia
Associated with
Acohol
Smoking
Diabetes
Vascular disease
Stenosing Tenosynovitis / Trigger Finger
Thickened retinaculum / tendon sheath
Flexed position fixed
Carpal Tunnel Syndrome
Nubness
Tingling
Pain
Associated with
Pregnancy
Thyroid
Vibrating power tools
Weight changes
De Quervain's Tenosynovitis
Pregnancy
Occupations that involve repetitive hand and wrist motions
NSAIDs
Splints
Occupational therapy
Steroid injections
Ganglion Cysts
Common
Smooth , round, flucuatn
Resolve spontaneously
Tumour
Giant cell tumour
Enchondroma
Rarely malignant
Melanoma, sarcoma
Mets
Osteoarthritis
Presentation
Ubiquitous
Large weight bearing joints
Hips
Knees
Lumbar spine
Hands very common in older
50% of women by 85
Pain
Duscomfort with increased use
Pathophysiology
Multifactorial
Genetic
Mechnical
Gut joint axis
Cartilage breakdown / erosion
Subchondral sclerosis
Osteophyte formation
Radiographic Features
Joint space narrowing - often assymetric
Subchondral cysts
Hand OA
DIP prdedominance
1st Carpometacarpal (CMC)
Pattern different from RA
Plain radiograph : evidence of small joint erosions
Errosive (inflammatory) osteoarthritis
Management
Lifestyle
Healthy weight
Regular xercise
MDT
Occupational Therapy
Physiotherapy
Medication
Symptom control
Paracetamol
NSAIDs
Optiods
Topica tx
Intr-articular steroid injections
Lack of evidence ofr disease modifying supplements
Glucosamine
Chondroitin
Tumeric
Surgery