Priority Topic: JOINT DISORDER

Joint DisordersKey Features: Think Rheumatology > Orthopedics
1. In a pa1ent presen1ng with joint pain, dis1nguish benign from serious pathology (e.g., sarcoma, sep1c joint):
a) By taking per1nent history
b) By inves1ga1ng in a 1mely and appropriate manner (e.g., aspirate, blood work, an X-ray examina1on).
What you should study:
Sep1c Arthri1s AAFP 2011 Osteosarcoma AAFP 2002 Knee Aspira1on AAFP 2002
2. In a pa1ent presen1ng with non-specific musculoskeletal pain, make a specific rheumatologic diagnosis when one is evident through history, physical examina1on, and inves1ga1ons. (e.g., gout, fibromyalgia, monoarthropathy vs. polyarthropathy).
What you should study:
What you should study:
Lyme Disease AAFP 2012
Gonococcal Arthri1s: Sep1c Arthri1s AAFP 2011 Monoarthri1s AAFP 2016
4. In pa1ents presen1ng with musculoskeletal pain, include referred and visceral sources of pain in the differen1al diagnosis. (e.g., angina, slipped capital epiphysis presen1ng as knee pain, neuropathic pain).
It's a good idea to write down your own DDx for Joint Pain
5. Clinically diagnose ligamentous injuries. Do NOT do an X-ray examina1on.
What you should study:
Video: Knee Examina1on Ligament tests start at 3:45
6. In a pa1ent presen1ng with joint pain, include systemic condi1ons in the differen1al diagnosis (e.g., Wegener’s granulomatosis, lupus, ulcera1ve coli1s).
What you should study:
Systemic Vasculi1s AAFP 2011 Lupus AAFP 2016 Enteropathic Spondyloarthri1s 2013 Osteoarthri1s AAFP 2018 (wasn’t sure where to put this…)
What you should study:
NSAID Prescribing Precau1ons AAFP 2009
Opioid Prescribing Guidelines 2017 Summary
8. In assessing pa1ents with a diagnosed rheumatologic condi1on, search for disease-related complica1ons (e.g., iri1s).
What you should study:
Extra-ar1cular RA 2010
What you should remember:
• FIFE • Screen for Depression • Offer Psychotherapy or Counselling • Consider ways of modifying acNviNes • Assisted transport opNons
b) Treat with appropriate doses of analgesics.
What you should study: Arthri1s Society
Pain Management in Rheumatoid Arthri1s 2015 This is a GREAT arNcle! c) Arrange for community resources and aids (e.g., splints, cane), if necessary.
MulNdisciplinary team: • Occupa1onal Therapy • Physiotherapy
10.In pa1ents with rheumatoid arthri1s, start treatment with disease-modifying agents within an appropriate 1me interval.
What you should study:
Rheumatoid Arthri1s Q&A AAFP 2018 SecNon: What are the First-Line treatments for RA?
Managing Pa1ents on DMARDs BMJ Graphic 2017 Rheumatoid Arthri1s Drug Op1ons 2013