Welcome back to my blog
Today, let's dive right into today's joint pain, arthlargia
いつもありがとうございます～
今日も問診と診察を極めて行きましょう
本日は関節痛についてです
Joint pain is one of the more common symptoms that patients report.
People who can treat joint pain are really valued in clinical settings,
so let's learn together.
関節痛は多くのひとが悩む症状の一つで、
日常診療でも出会うことの多い疾患でもあります
関節痛をマスターして、自信をもって診察できるようになれば
できレジに一歩近づくこと間違いないでしょう
Since there's a lot of content today, I'll only post it in English.
If you'd like to read it in Japanese, please let me know! If this style is popular,
I’d like to continue it (not because it's easier, haha)
今日の内容は相当濃いものになっているので
英語だけになってしまいました、、、
もし日本語でも読みたいという人がいたら、ぜひ教えてください～
好評なら、このまま続けていこうと思います
（決して楽だからとかではないです、、、）
Well,
let's get it started!
ではでは、始めていきましょう～
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[Approach to Joint Pains]
Well,
let’s talk about how to approach diagnosing joint pains:
Rule Out Trauma:
- Refer to orthopedics if injury-related.
- Common injury: FOOSH (Fall Onto Out-Stretched Hand) leading to possible scaphoid fracture.
Rule Out Inflammation:
- Look for classic signs: Redness, pain, heat, swelling, loss of function.
- Determine if it's acute or chronic, and if it's affecting one or multiple joints.
- Acute Monoarticular Arthritis: Bacterial infection, crystal-induced arthritis.
- Acute Polyarticular Arthritis: Bacterial or viral infection.
- Chronic Monoarticular Arthritis: TB arthritis.
- Chronic Polyarticular Arthritis: Rheumatic disorders.
Non-Inflammatory Arthritis:
- Commonly osteoarthritis (OA).
[Causes of Arthritis]
Understanding the possible causes of arthritis can help narrow down the diagnosis:
- Bacterial Infection:
- From trauma (S. epidermidis), syphilis (gonorrhea), infective endocarditis (S. aureus), Lyme disease (Borrelia burgdorferi), TB (Mycobacterium tuberculosis).
- Crystal-Induced Inflammation:
- Gout (sodium urate), pseudogout (calcium pyrophosphate).
- Rheumatic Disorders:
- RA, SLE, Sjogren’s syndrome, Behcet’s disease, Adult-onset Still’s Disease (AOSD).
- Viral Infection:
- Influenza.
- Paraneoplastic Syndrome (PNS)
[History Taking]
What's Causing Your Pain?
First things first, you need to understand what might be causing the joint pain.
- “Do you know what might be causing your joint pain?”
- “Have you had any injuries recently?”
Diving into Details (HPI)
Next, get into the specifics of the pain by using the OPQRST method:
Onset, Provocation, Quality, Region/Radiation, Severity, Time.
- Is it just one joint (Monoarticular) or more (Polyarticular)?
- Is it sudden (Acute) or has it been around for a while (Chronic)?
- Acute: Could be an infection, early chronic issue, trauma, or virus. Think about RA or OA.
- Chronic: Could be conditions like RA, TB, gout, or OA.
Other Symptoms to Look Out For:
Now,
consider if there are any other symptoms that might be associated with the joint pain:
- Infections:
- Fever, cough, breathing issues, heart palpitations, skin problems, coughing blood, pain during urination, genital issues.
- Crystal-Induced Pain:
- Back pain, pain during urination.
- Rheumatic Issues:
- Fever, fatigue, weight loss, skin rashes (like butterfly-shaped malar rash), muscle pain or weakness, dry cough, Raynaud’s phenomenon (fingers changing color), protein or blood in urine, dry eyes, dry mouth, painful sex.
- Viral Infections:
- Fever, cough, runny nose.
[Medical History]
Key Points (PAM HITS FOSS):
With the history in mind, let’s dive into the patient’s medical background:
- Past Health Issues:
- Cancer, gout, collagen diseases, TB, upper respiratory infections, STDs.
- Family History:
- Cancer, TB, collagen diseases.
- Sexual History:
- Syphilis, STDs.
- Social History:
- Alcohol use, job-related exposures, drug use.
- Patient’s Profile:
- Contacts with sick people, animal contact, recent travel.
[Physical Exam]
Now, move on to a thorough physical examination:
General Check:
- Fatigue, skin issues
Head, Eyes, Ears, Nose, Throat (HEENT):
- Pale eyes (anemia), red eyes (RA or viral), specific rashes (like heliotrope rash for polymyositis/dermatomyositis), tonsillitis, dry mouth, cavities, butterfly rash (SLE), swollen lymph nodes.
Heart and Lungs:
- Arrhythmias (Lyme disease), valve issues (infective endocarditis), lung hypertension (collagen diseases)
Skin and Joints:
- Tenderness, swelling, specific signs like Gottron’s sign (PM/DM), nail fold bleeding, erythema migrans (Lyme disease)
Nervous System:
- Muscle strength testing, facial nerve issues (Lyme disease)
[Tests to Consider]
After the physical exam, consider the following tests to get a better understanding of what might be causing the joint pain:
- Blood work (CBC, CRP, etc.)
- Imaging (X-ray, CT/MRI)
- Specific tests (ANA, RPR for syphilis, blood cultures for infections)
- Joint-specific tests (arthroscopy, arthrocentesis, polarizing microscopy).
[Useful Expressions]
Here are some useful expressions to describe joint pain and related conditions:
- Joint pain: Arthralgia
- Joint: Articulation
- Adjective: Articular
- One joint: Monoarticular
- 2-4 joints: Oligoarticular
- 5 or more joints: Polyarticular
Carpal Bones Mnemonic:
- "So Long To Pinky, Here Comes The Thumb"
- Scaphoid, Lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid, Trapezium
Useful Phrases and Idioms:
- Ache like the devil: To experience severe pain.
Example: "My knees ache like the devil after that hike." - A pain in the neck: Something or someone that is very annoying. It can also be used literally for neck pain.
Example: "This arthritis is a real pain in the neck." - Creaky joints: Referring to joints that make noises or feel stiff, often due to arthritis.
Example: "My creaky joints are acting up again today." - To be laid up: To be confined to bed or unable to move around much due to illness or injury.
Example: "I was laid up with a bad case of gout last week." - On pins and needles: Feeling anxious or in a state of suspense. It can also describe a tingling sensation in the body.
Example: "I've been on pins and needles waiting for my test results."
Layman's Terms:
- Joint pain: Simply called "sore joints" or "aching joints."
- Arthritis: Often referred to as "joint inflammation" or "joint trouble."
- Swelling: Sometimes called "puffiness" or "bloating" in the affected area.
- Stiffness: Often described as "feeling tight" or "hard to move."
- Inflammation: Commonly referred to as "swelling and redness."
Slang and Casual Expressions:
- Old bones:
A colloquial way to refer to someone who feels the effects of aging, especially joint pain.
Example: "These old bones aren't what they used to be."
- Bone tired:
Extremely tired or fatigued, often used when joint pain is involved.
Example: "I'm bone tired after all that walking."
- To feel like you’ve been hit by a truck:
Feeling very sore and achy, usually after strenuous activity or due to an illness.
Example: "I woke up feeling like I'd been hit by a truck; my whole body hurts."
- Cracking up:
When joints make a cracking noise, often due to air bubbles in the joint fluid.
Example: "My knees keep cracking up every time I stand up."
- Stiff as a board:
Feeling very stiff and unable to move easily.
Example: "I'm stiff as a board after sitting for so long."
Medical Terms in Casual Language:
- Bursitis: Often referred to as "joint bursitis" or "bursa inflammation."
- Tendinitis: Commonly called "tendonitis" or "tendon trouble."
- Gout: Sometimes called "rich man's disease" because it was historically linked to a diet high in rich foods.
- Rheumatoid Arthritis: Often shortened to "RA."
- Osteoarthritis: Sometimes referred to as "wear-and-tear arthritis."
[Specific ds]
# Rheumatic Diseases
Rheumatic diseases are often referred to as ‘invisible illnesses’ because their symptoms are not always visible.
Time-course: Flare vs. Remission
- Flare up: Worsening of symptoms
Key Features:
- SLE/Lupus: Butterfly-shaped malar rash
- RA: Affects MCP & PIP joints (OA affects DIP joints), causes deformities like swan-neck and boutonniere, measured by the Simplified Disease Activity Index (SDAI).
# Lyme Disease
Lastly, let’s touch on Lyme disease, a tick-borne illness:
Cause: Borrelia burgdorferi (from deer ticks) Symptoms:
- Bulls-eye rash (erythema migrans), arthritis, facial nerve paralysis (Bell’s palsy), arrhythmia (AV block).
Mnemonic: ‘A key Lime pie to the FACE’
- Facial nerve paralysis
- Arthritis
- Cardiac block
- Erythema migrans
