Approach to the Patient with Acute Swollen/Painful Joint

2005 ◽  
Vol 7 (2) ◽  
pp. 305-319 ◽  
Author(s):  
H FAGAN
Keyword(s):  
Painful Joint

scholarly journals THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 497.2-497
Author(s):  
J. Arroyo Palomo ◽  
M. Arce Benavente ◽  
C. Pijoan Moratalla ◽  
B. A. Blanco Cáceres ◽  
A. Rodriguez
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Statistical Tests ◽  
Median Number ◽  
Painful Joint ◽  
Significant Difference ◽  
The Mean ◽  
Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

scholarly journals FRI0659 Investigation of self-reported painful joint count as outcome measure in hand osteoarthritis

2018 ◽  
Author(s):  
F. Kroon ◽  
J. van der Plas ◽  
S. van Beest ◽  
W. Damman ◽  
M. Kloppenburg
Keyword(s):  
Outcome Measure ◽  
Hand Osteoarthritis ◽  
Painful Joint

scholarly journals Systemic inflammation and painful joint burden in osteoarthritis: a matter of sex?

2017 ◽  
Vol 25 (1) ◽  
pp. 53-59 ◽  
Author(s):  
A.V. Perruccio ◽  
V. Chandran ◽  
J.D. Power ◽  
M. Kapoor ◽  
N.N. Mahomed ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Painful Joint

scholarly journals Self-reported painful joint count and assessor-reported tender joint count as instruments to assess pain in hand osteoarthritis

Rheumatology ◽  
2019 ◽  
Vol 59 (5) ◽  
pp. 1094-1098
Author(s):  
Féline P B Kroon ◽  
Wendy Damman ◽  
Johan L van der Plas ◽  
Sjoerd van Beest ◽  
Frits R Rosendaal ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Visual Analogue Scale Pain ◽  
Tender Joint Count ◽  
Hand Osteoarthritis ◽  
Joint Activity ◽  
Tender Joint ◽  
Painful Joint ◽  
Bone Marrow Lesions ◽  
Joint Level ◽  
Absolute Agreement

Abstract Objectives To evaluate self-reported and assessor-reported joint counts for pain and their value in measuring pain and joint activity in hand OA patients. Methods A total of 524 patients marked painful joints on hand diagrams. Nurses assessed tenderness upon palpation. Pain was measured with a visual analogue scale pain and the Australian/Canadian hand OA index subscale pain. Synovitis and bone marrow lesions in right hand distal/proximal interphalangeal joints on MRI served as measure of joint activity. Agreement was assessed on the patient (intraclass correlation coefficient, Bland–Altman plot) and joint level (percentage absolute agreement). Correlations with measures of pain and joint activity were analysed, and joint level associations with synovitis/bone marrow lesions were calculated. Results Self-reported painful joint count (median 8, interquartile range 4–13) was consistently higher than assessor-reported tender joint count (3, 1–7). Agreement between patients and nurses on overall scores was low. Percentage absolute agreement on the joint level was 61–89%. Joint counts correlated similarly but weakly with measures of pain and joint activity (r = 0.14–0.38). On the joint level, assessor-reported tenderness was more strongly associated with synovitis/bone marrow lesions than self-reported pain. Conclusion In hand OA, self- and assessor-reported joint counts cannot be used interchangeably, and measure other pain aspects than questionnaires. Assessor-reported tenderness was most closely related to MRI-defined joint activity.

scholarly journals Fibromyalgia Assessment Screening Tool: Clues to Fibromyalgia on a Multidimensional Health Assessment Questionnaire for Routine Care

2019 ◽  
Vol 47 (5) ◽  
pp. 761-769 ◽  
Author(s):  
Kathryn A. Gibson ◽  
Isabel Castrejon ◽  
Joseph Descallar ◽  
Theodore Pincus
Keyword(s):  
Health Assessment Questionnaire ◽  
Health Assessment ◽  
Area Under The Curve ◽  
Routine Care ◽  
Self Report ◽  
Screening Tools ◽  
Symptom Checklist ◽  
Painful Joint ◽  
Multidimensional Health ◽  
Assessment Questionnaire

Objective.To develop feasible indices as clues to comorbid fibromyalgia (FM) in routine care of patients with various rheumatic diseases based only on self-report multidimensional Health Assessment Questionnaire (MDHAQ) scores, which are informative in all rheumatic diagnoses studied.Methods.All patients with all diagnoses complete an MDHAQ at each visit; the 2011 FM criteria questionnaire was added to the standard MDHAQ between February 2013 and August 2016. The proportion of patients who met 2011 FM criteria or had a clinical diagnosis of FM was calculated. Individual candidate MDHAQ measures were compared to 2011 FM criteria using receiver-operating characteristic (ROC) curves; cutpoints to recognize FM were selected from the area under the curve (AUC) for optimal tradeoff between sensitivity and specificity. Cumulative indices of 3 or 4 MDHAQ measures were analyzed as fibromyalgia assessment screening tools (FAST).Results.In 148 patients, the highest AUC in ROC analyses versus 2011 FM criteria were seen for MDHAQ symptom checklist, self-report painful joint count, pain visual analog scale (VAS), and fatigue VAS. The optimal cutpoints were ≥ 16/60 for symptom checklist, ≥ 16/48 for self-report painful joint count, and ≥ 6/10 for both pain and fatigue VAS. Cumulative FAST indices of 2/3 or 3/4 MDHAQ measures correctly classified 89.4–91.7% of patients who met 2011 FM criteria.Conclusion.FAST3 and FAST4 cumulative indices from only MDHAQ scores correctly identify most patients who meet 2011 FM criteria. FAST indices can assist clinicians in routine care as clues to FM with a general rheumatology rather than FM-specific questionnaire.

scholarly journals Systemic inflammation and painful joint burden in osteoarthritis: A matter of sex

2015 ◽  
Vol 23 ◽  
pp. A324
Author(s):  
A.V. Perruccio ◽  
V. Chandran ◽  
M. Kapoor ◽  
J.D. Power ◽  
R. Gandhi
Keyword(s):  
Systemic Inflammation ◽  
Painful Joint

scholarly journals Investigation of self-reported painful joint count as an outcome measure in hand osteoarthritis

2018 ◽  
Vol 26 ◽  
pp. S213-S214 ◽  
Author(s):  
F.P. Kroon ◽  
J.L. van der Plas ◽  
S. van Beest ◽  
W. Damman ◽  
M. Kloppenburg
Keyword(s):  
Outcome Measure ◽  
Hand Osteoarthritis ◽  
Painful Joint

Radiologic Evaluation of Painful Joint Prostheses

1982 ◽  
Vol &NA; (170) ◽  
pp. 156???168
Author(s):  
ROBERT SCHNEIDER ◽  
ROBERT H. FREIBERGER ◽  
BERNARD GHELMAN ◽  
CHITRANJAN S. RANAWAT
Keyword(s):  
Painful Joint ◽  
Radiologic Evaluation ◽  
Joint Prostheses
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