What are the three screening questions for MSK disease?
- Are you free of any pain or stiffness in joints, muscles or back?
- Can you dress yourself without difficulty?
- Can you manage walking up and down stairs?
*If yes to all 3 = MSK disease unlikely
What acronym will you use to explore rheumatological sx?
- Pain
- Rashes, skin lesions, nail changes
- Immune
- Stiffness
- Malignancy
- Swelling, sweats
How would you further explore pain?
- Use SOCRATES
Site
- monoarthritis/oligoarthritis/polyarthritis
- asymmetrical/symmetrical
- extensor/flexor region
Onset
- sudden/gradual
Character
- dull ache, burning, sharping
- constant/come and go
Radiation
Associated Sx
- joint stiffness
- skin rashes
- fever
Time
- duration
- occurance in a particular day
Exacerbating & Releiving factors
Severity
How would you further explore Rashes, skin lesions and nail changes?
- Rashes - SLE
- Raynaud’s - SLE, SS, polymyositis, dermatomyositis
- Nodules - Gout
- Koilonychia - SLE
- Onycholysis - PA, sarcoidosis
- Pitting - PA
- Telengactasia - SS
What are the 3 diseases you can explore relating to immune in PRISMS?
- SS
- SLE
- Sjogren’s syndrome
What acronym will you use for exploring Systemic Sclerosis?
- Calcinosis
- Raynaud’s phenomenon
- Esophageal dysmotility
- Sclerodactylyl
- Telangiectasia
What sx would you explore for SLE?
- Constitutional symptoms: fatigue, fever and weight loss.
- Musculoskeletal symptoms: arthralgia and myalgia.
- Dermatological symptoms: malar rash, photosensitivity and discoid lupus(coin shaped lesion)
- Renal symptoms: haematuria and oedema (acute nephritic disease).
- Neuropsychiatric symptoms: seizures and psychosis.
- Respiratory symptoms: shortness of breath, cough and chest pain (e.g. pneumonitis and interstitial lung disease).
- Gastrointestinal symptoms: nausea, dyspepsia and abdominal pain.
- Cardiac symptoms: chest pain and shortness of breath (e.g. pericarditis, myocarditis).
- Haematological symptoms: fatigue, shortness of breath, fevers and bruising (e.g. leukopenia, anaemia, thrombocytopenia).
What are the key features of Sjogren’s syndrome?
- Dry eyes
- Dry mouth
- Chronic cough
Which Rheumatoid diseases causes joint stiffness?
- RA
- AP
- SLE
- Reactive Arthritis
How would you explore malignancy?
- Weight loss
- Fatigue
- Night sweats
- Change in diet
What are the examples of paraneoplastic syndromes that can have arheumatological presentation?
- Carcinomatous Polyarthritis
- Paraneoplastic vasculitis
- Lambert Eaton Syndrome
- Hypertrophic Osteoarthropathy
List examples of extra-articular manifestation of rheumatological disease
- Dry eyes - Sjogren’s syndrome
- Red eyes - AS
- Urethritis - Reactive Arthritis
- Mouth/genital ulcers - SLE
- ILD - SLE
- Back pain - AS
What PMH is a typical indicator of rheumatological disease?
- UC/Chrons - AS
- Perceding infections
- Psoriasis
What drugs are rheumatoid patients typically on?
- Analgesics
- paracetamol, NSAIDs, opiates
- Corticosteroid
- prednisolone
- Anti-TNF
- infliximab
- Biologics
- rituximab
What would you like to clarify in SHx?
- Living conditions
- Smoking
- Alcohol
- Recreational/elicit drug use
- Sexual Hx
- Occupation
What arthritides causes monoarthritis?
- septic arthritis
- OA
- Gout
- haemarthrosis
What arthritides causes oligoarthritis? (5 or less joints)
- Gout
- PA
- Reactive arthritis
- AS
- OA
What arthritides causes polyarthritis? (5 or more joints)
- RA
- PA
- RA
- SLE
- OA
What FHx is typical of rheumatological patients?
- RA
- Gout
- misscarriages
-
Rheumatoid Arthritis42
-
Psoriathic Arthritis13
-
Ankylosing Spondylitis12
-
Systemic Lupus Erythematosus21
-
Hx Taking19
-
Gout22
-
Enteropathic and Reactive arthritis12
-
Polymyalgia Rheumatica11
-
Giant Cell Arteritis15
-
Vasculitis12
-
Systemic Sclerosis14
-
Polymyositis & Dermatomyositis10
-
Sjogren's Syndrome23
-
Osteoporosis25
-
Eosinophilic Granulomatosis14
