EMQs in Clinical Medicine.pdf - Peshawar Medical College

124 Orthopaedics and rheumatology
ANSWERS
42 Arthritis
Answers: C N E H A
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A 54-year-old woman presents to her GP with swollen painful hands
and feet, which are stiffer in the mornings. On examination there are
signs of ulnar deviation and subluxation at the MCP joints.
Ulnar deviation and subluxation of MCP joints are signs of advanced
disease. Swelling of the fingers (sausage-like) and MCP joint swelling are
earlier signs.
A 65-year-old woman complains of pain in her fingers on movement,
which is worst at the end of the day. On examination there is joint
tenderness and bony lumps at the DIP joints. A radiograph shows loss
of joint space.
The radiological changes of osteoarthritis include loss of joint space,
subchondral sclerosis, osteophytes and subchondral cyst formation.
Osteophytes at the proximal interphalangeal and DIP joints are called
Bouchard’s and Heberden’s nodes respectively. Previous joint damage is a
risk factor for the development of osteoarthritic disease. Simple analgesics
such as paracetamol should be prescribed for pain relief rather
than long courses of non-steroidal anti-inflammatory drugs (NSAIDs)
(risk of gastrointestinal bleeding with prolonged use).
A 30-year-old woman complains of joint pain in her hands and feet.
Her chest radiograph shows reduced lung volumes.
Systemic lupus erythematosus (SLE) is an inflammatory multisystemic
disorder that is nine times more common in women than in men. The
joints are most often affected in a symmetrical fashion with no bony
erosion (unlike rheumatoid arthritis). Rarely, there may be markedly
deformed joints caused by joint laxity that resemble rheumatoid arthritis
(Jaccoud’s arthropathy).
Lung involvement occurs in up to half of patients with SLE.
Manifestations include pleuritic chest pain, pleural effusions (these are
common and often bilateral), acute/chronic pneumonitis and the rare
‘shrinking lung syndrome’.
A 22-year-old man presents with an acute arthritis of the left knee,
dysuria and bilateral conjunctivitis. He has recently suffered from
gastroenteritis.
Reiter’s disease involves a triad of urethritis, conjunctivitis and seronegative
arthritis. Joint symptoms may be the presenting complaint. It is often