Case: A 45 year old woman presents with 3 months of progressively worsening arthralgia in the hands, knees and hips.
Ddx: degenerative joint disease, inflammatory arthropathy, secondary arthralgia
History
HPC
Inflammatory arthropathy: swelling, morning stiffness,
Red flags: nocturnal pain, pain at rest
Septic arthritis: recent viral and throat infection
Degenerative/osteoarthritis: repetitive use of hands, history of trauma to affected joints
Associated symptoms: Bowel or bladder symptoms (associated with sero negative arthropathies, IBD), eyes or skin symptoms, mood changes, altered sleep, malaise
Distribution: OA (large, weight bearing joints, carpometacarpal joint of thumb, DIP)
FHx
Rheumatoid arthrisis, other auto-immune
Meds
Impact on ADLs
Ix
- FBC – anaemia
- ESR, CRP – inflammation
- RF
- Radiography of joints
OA - joint space narrowing, subchondral cysts, sclerosis, osteophytes
RA - joint space narrowing, soft tissue swelling, subchondral erosions, subluxation
- Pain: Reassurance, simple analgesics, anti-inflammatory drugs. Encourage positive lifestyle changes. Occupational therapy for splinting & home aids.
- Osteoarthritis: Education about nature of the problem (wear and tear), pain mx, encourage weight loss and exercise, refer to physiotherapy.
- RA or seronegative arthropathy: education, referral to rheumatologist, long term support, positive messages, slow down disease progression with DMARD (sulfasalazine, MTX- CXR first since pulm fibrosis is a possible SE) & steroids, reassurance
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