Joints, Rheumatology, and the Shelf. Paul Johnson prepared by Ryan Sanford Chief Lecture. The Joints.
prepared by Ryan Sanford
44F mother of four children ages 3-8y is evaluated for 2wk of aching in joints of wrists, hands, and knees. Pain and swelling were severe for ~ 1 week, then subsided to aching. Pain is worse in the morning and abates somewhat with activity. On PE there is tenderness with pressure on the dorsa of the wrists and pain with wrist motion. One side of the patient’s face shows faint redness. She has noticed patchy sloughing of the epidermis of her hands. What is the diagnosis?
What is the DDx for acute arthritis?
Infection [septic arthritis]
Crystals! Gout and CPPD
Activity doesn’t help
Activity helps, stiff in AM [>1h]!
No = OA
# Joints Involved
RA = symmetric
SLE = symmetric
Systemic Sclerosis = symmetric
But ALSO: constitutional complaints, abd pain, alopecia, vasculitis, raynaud’s, eye problems, etc.
29 AA Fw/ 2mo of arthralgias of knees, elbows, hands, and swelling in legs. BP 150/95. HR 79. 2+ pitting LEE.
66F with severe pain in L calf, sudden onset. Has RA of many joints. Has had many knee injections because of pain and effusions with triamcinolone. Now is treated with etanercept and methtotrexate. PE with large R knee effusion and L knee is smaller in size. The knee was similar in size to the R until the pain began. The L calf is 5cm larger in diameter than the R.
Chondrocalcinosis of CPPD or Pseudogout
Enteropathic IBD Associated
Can look just like AS
Also can see