JointDiseases

A talk I developed for Emergency Medicine residents. Includes links to YouTube videos demonstrating some of the procedures described on the slides.  

Medical Protection Society Website  

 

Disease Location  

Osteoarthritis is a condition that results from the loss of cartilage at synovial joints, and is often accompanied by degeneration of the underlying bone.   Radiologically there are: osteophytes Joint space narrowing   Epidemiology most common type of arthritis 80% people >60 will have some radiographic features  

RA is a type of inflammatory arthritis. Other examples include seronegative spondyarthritides, reactive arthritis, lyme arthritis, crystal arthritis and postviral arthritis.   Features of inflammatory arthritis Pain and stiffness worse in the morning and after rest Early morning pain and stiffness may last several hours (in OA, duration is much shorter)  

Spondyloarthritides (aka spondyarthritis, SpA, seronegative spondylarthropathy) – these are inflammatory joint diseases of the vertebral column and sacro-iliac joints. These conditions tend to mimic rheumatoid conditions (e.g. rheumatoid arthritis), but are serologically different, as rheumatoid factor is usually negative.  

Objective To investigate whether objectively measured time spent in light intensity physical activity is related to incident disability and to disability progression.  

Objective To investigate whether objectively measured time spent in light intensity physical activity is related to incident disability and to disability progression.  

Educational video describing differential diagnosis of SI joint pain. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: h...  

“Psoriatic arthritis X-ray of the wrist of a patient with psoriatic arthritis; note the 'pencil in cup' deformity (tapered proximal osseous surface and…”  

The GALS screening examination is designed for routine clerking of a patient. It is available in both video and CD format elsewhere. A brief revision form is presented here.  

It is most comfortable for the patient to have their hands positioned on a pillow. In this position look for obvious swellings, loss of alignment, muscle wasting and scars. Try to decide if changes are symmetrical or asymmetrical. Look at the nails for psoriatic changes of pitting and onycholysis, and also nailfold vasculitis.  

Begin with looking at the patient from the front for the normal carrying angle, and from the side for any flexion deformity. The posterior aspect of the elbow is inspected for obvious scars, swellings, rashes or signs of olecranon bursitis, or rheumatoid nodules or psoriatic plaques and, again, the medial aspect should also be inspected. Temperature is assessed by comparing adjacent sites.  

With both shoulders fully exposed, look from the front, the side and behind the patient for obvious loss of symmetry, muscle wasting or scars.  

With the patient lying as flat as possible look from the end of the bed comparing for symmetry. In a fractured neck of femur, for example, one leg may be shortened and externally rotated.  

Look initially from the end of the bed for loss of symmetry and loss of normal leg alignment such as varus deformity – where distal to the knee is deviated medially leading to a bow-legged appearance – or valgus deformity – where distal to the knee is deviated laterally leading to a knock-kneed appearance.  

With the patient on a couch and their feet overhanging the end of it, look at the feet, comparing for symmetry. In the forefoot look for nail changes and skin rashes. Look for the alignment of the toes and any evidence of hallux valgus of the big toe. Look for clawing of the toes, joint swelling and callus formation. Look at the underside or plantar surface for callus formation. Look at the patient’s shoes for asymmetrical wearing of the sole, the presence of insoles or other signs of poor fit.  

Look initially from behind the patient for any obvious muscle wasting, asymmetry or scoliosis of the spine. Look from the side for normal: cervical lordosis thoracic kyphosis and lumbar lordosis.  

Rheumatoid arthritis (RA) is a chronic systemic disease. Early diagnosis of RA and effective treatment with disease-modifying anti-rheumatic drugs. Find out arthritis diets rheumatoid arthritis treatment.