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Polyarthralgia

Polyarthralgia. Tanya Potter Consultant Rheumatologist UHCW. Aims Differential diagnosis of polyarthralgia/polyarthritis Investigation of joint pains. What is polyarthralgia? What conditions present with polyarthralgia?. Inflammatory Mechanical Pain syndromes. How do you differentiate

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Polyarthralgia

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  1. Polyarthralgia Tanya Potter Consultant Rheumatologist UHCW

  2. Aims • Differential diagnosis of polyarthralgia/polyarthritis • Investigation of joint pains

  3. What is polyarthralgia? • What conditions present with polyarthralgia?

  4. Inflammatory • Mechanical • Pain syndromes

  5. How do you differentiate between mechanical and inflammatory symptoms?

  6. Mechanical vs Inflammatory • Inflammatory Mechanical • Immobility stiffness latter day • EMS>30-60 mins EMS<30-60 mins • Better with activity and NSAIDs worse with activity • Joint swelling, erythema,heat instability • Systemic symptoms locking • Multi-organ involvement trauma, strain overusage

  7. Age and sex Incidence AGEFEMALEMALE Young adults Middle age Old age

  8. Age and sex Incidence AGEFEMALEMALE Young adults RA Reactive arthritis SLE (Sero-ve) Middle age Old age

  9. Age and sex Incidence AGEFEMALEMALE Young adults RA Reactive arthritis SLE (Sero-ve) Psoriatic arthritis (Sero-ve) Middle age RA Old age

  10. Age and sex Incidence AGEFEMALEMALE Young adults RA Reactive arthritis SLE (Sero-ve) Psoriatic arthritis (Sero-ve) Middle age RA Old age OA Crystal arthritis

  11. OA • Clinical features

  12. Osteoarthritis • Mechanical symptoms • Bony swelling, crepitus • DIP (Heberden), PIP (Bouchard), 1st CMCJ, neck, lower back, hips, knees, 1st MTP

  13. Pathophysiology?

  14. Pathophysiology • Imbalance between degradative and reparative connective tissue processes within joint leading to failure of joint • Occasional genetic association • Pathological stresses may lead to micro trauma and inflammatory change

  15. Radiology - OA

  16. Radiology - OA • Four cardinal features: • Joint space narrowing • Sclerosis • Subchondral cysts • Osteophytes

  17. Other features associated with athralgia • Prodromal events • Associated conditions

  18. CLUES • Prodromal event eg GI/GU infection – reactive arthritis • Associated conditions eg psoriasis, colitis, iritis

  19. Pattern and Symmetry?

  20. CLUES • Multi-organ disease • Fibromyalgia symptoms

  21. Rheumatoid • Female ~ 1 in 100 • symmetrical polyarthritis, targeting small joint and large • DIP sparing

  22. Pathophysiology • Inflammatory condition • Strong genetic component- HLA DR4 • Environmental effects • Inflammation of synovium with high levels of chemokines and cytokines and resultant tissue damage • Systemic features?

  23. Psoriatic arthritis • Psoriasis 2-3% population • 5-10% of these will develop Ps arthritis • Family history 55X more likely (40%) • Pathophysiology?

  24. HLA B27 related arthritis • Arthritis and enthesitis possibly T cell driven, with tissue damage

  25. Sero-ve Spondyloarthritis – psoriatic arthritis • DIP, poly, dactylitis, • enthesitis, spinal • Younger age

  26. Soft tissue swelling • Joint space narrowing • Mouse ear erosions • Periostitis with new bone formation • DIP joint involvement

  27. Polyarticular crystal arthropathy eg gout • Chronic • Tophi • Erosions • Older age • Nb pseudogout

  28. polyarthalgia/polyarthritis • ‘ • Multi-organ disease – CTD and vasculitis • Viral arthritis (eg parvovirus, rubella, hepatitis) • Medical conditions eg • diabetic cheiroarthropathy • Sarcoidosis-

  29. Sarcoid • Acute or chronic • Multisystem disorder, non caseating granulomas • Acute: spring time (?viral) young adults sudden onset of lower limb arthritis and erythema nodosum & red eyes • Fever and cough

  30. Ix • Raised serum ACE • Raised Ca • ESR, CRP • Chest xray

  31. Outcome of acute: good, NSAIDs, oral prednisolone • Chronic: afrocarribean • Grumbling lung disease, jt, muscle, liver disease • Treatment unclear- prednisolone, methotrexate

  32. What are CTD? Symptoms and signs?

  33. Connective tissue disease • Eg SLE, scleroderma, polymyositis, Sjogren’s • Auto-immune • Multi-organ • Anti-nuclear antibodies

  34. SLE • Raynauds • Rashes • Arthralgia • Haem • CNS • Renal • Serositis • thrombosis

  35. Sle- skin • Photosensitive rashes eg SLE • Discoid lupus

  36. Sle- renal • Significant cause of morbidity and mortality- condition and treatment

  37. Sjogrens syndrome • Destruction of exocrine glands • Dry eyes and mouth- caries • Liver, lungs, gut, arthralgia, MNM • Increased B cell lymphoma risk

  38. Scleroderma • Localised (CREST) • Diffuse • Raynauds, finger ulcers • Sclerosis of most organs • GI, skin, ILD, renal crisis

  39. Myositis • Inflammatory muscle condition • Demato or polymyosits • Proximal painless weakness

  40. What are the vasculitides and what type of symptoms and signs?

  41. Vasculitis • Small, medium, large vessel • Eg MPA, Churg Strauss, PAN, Wegeners, GCA • ANCA

  42. Vasculitis- skin • Vasculitis – petechial, purpura, ulcer

  43. Vasculitis • Systemic, vasculitic ulcers/rashes, arthralgias/arthritis – non deforming • Pulmonary – haemoptysis

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