CIMS-Case-2-Approach to Articular and Musculoskeletal Disorders (Unofficial)

Taken from Harrison's

What is often needed for self-limited musculoskeletal conditions

Minimal evaluation, reassurance, and symptomatic therapy

What are the three "red flag" diagnoses in musculoskeletal disorders

Septic arthritis, acute crystal-induced arthritis (e.g., gout), and fracture

What are the four aspects to assess in musculoskeletal complaints

Articular or nonarticular, inflammatory or noninflammatory, acute or chronic, and localized or widespread

What can ankle pain result from

Conditions like gouty arthritis, calcaneal fracture, Achilles tendinitis, plantar fasciitis, cellulitis, or neuropathy

What structures are considered articular

Synovium, synovial fluid, articular cartilage, intraarticular ligaments, joint capsule, and juxtaarticular bone

What structures are considered nonarticular or periarticular

Extraarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin

Which type of disorder is more frequently confused with arthritis

Nonarticular disorders

What characterizes pain in articular disorders

Deep or diffuse pain with limited active and passive range of motion, swelling, crepitus, instability, “locking,” or deformity

What characterizes pain in nonarticular disorders

Painful on active but not passive range of motion with point or focal tenderness and no swelling, crepitus, instability, or deformity

Do nonarticular disorders typically show physical findings like swelling or deformity

No, they seldom demonstrate swelling, crepitus, instability, or deformity

What type of pain is associated with nonarticular disorders

Pain that may radiate or be elicited with specific movements or positions

What are possible causes of inflammatory musculoskeletal disorders

Infections, crystal-induced issues, immune-related diseases, reactive conditions, or idiopathic causes

What are the four cardinal signs of inflammation

Erythema, warmth, pain, and swelling

What systemic symptoms may suggest an inflammatory disorder

Fatigue, fever, rash, and weight loss

What lab findings may indicate inflammation

Elevated ESR or CRP, thrombocytosis, anemia of chronic disease, or hypoalbuminemia

How does stiffness in inflammatory disorders typically present

Prolonged (hours) and improves with activity

What characterizes stiffness in noninflammatory disorders

Shorter duration (<60 min), worsens with activity, and known as the gel phenomenon

What are some causes of noninflammatory musculoskeletal disorders

Trauma, repetitive use, degeneration, neoplasm, or pain amplification

How are noninflammatory disorders typically identified

Pain without synovial swelling, absence of inflammatory or systemic features, and normal/negative labs

What are common causes of musculoskeletal pain to consider first

Trauma, fracture, overuse syndromes, and fibromyalgia

Which conditions are common for patients under 60

Repetitive use disorders, gout (men), RA, spondyloarthritis, and sometimes infectious arthritis

Which conditions are common for patients over 60

OA, crystal arthritis, PMR, osteoporotic fractures, and occasionally septic arthritis

What is a key approach for diagnosing musculoskeletal complaints

Using clinical and historical features over lab tests

Which age group is more frequently affected by SLE and reactive arthritis

Younger individuals

Which conditions are more common in middle-aged individuals

Fibromyalgia and rheumatoid arthritis (RA)

Which conditions are more prevalent among the elderly

Osteoarthritis (OA) and polymyalgia rheumatica (PMR)

Which conditions are more common in men

Gout, spondyloarthritis, and ankylosing spondylitis

Which conditions are more common in women

Rheumatoid arthritis (RA), fibromyalgia, osteoporosis, and lupus

Which conditions commonly affect white individuals

PMR, giant cell arteritis, and granulomatosis with polyangiitis (GPA)

Which conditions more commonly affect African Americans

Sarcoidosis and systemic lupus erythematosus (SLE)

What is familial aggregation, and in which conditions may it be seen

A genetic tendency seen in ankylosing spondylitis, gout, and Heberden’s nodes of OA

How can the onset of a musculoskeletal complaint help in diagnosis

Acute onset is common in septic arthritis and gout, while OA, RA, and fibromyalgia have more indolent presentations

How are musculoskeletal disorders classified by symptom duration

Acute (<6 weeks) and chronic (>6 weeks)

What types of conditions tend to be acute

Infectious, crystal-induced, or reactive conditions

What types of conditions tend to be chronic

Noninflammatory or immunologic arthritis (e.g., OA, RA) and nonarticular disorders (e.g., fibromyalgia)

How are articular disorders classified based on joint involvement

Monarticular (one joint), oligoarticular/pauciarticular (two or three joints), or polyarticular (four or more joints)

Which types of arthritis are often mono- or oligoarticular

Crystal and infectious arthritis

Which types of arthritis are usually polyarticular

Osteoarthritis (OA) and rheumatoid arthritis (RA)

How are nonarticular disorders classified

As either focal or widespread

What is a common presentation of focal nonarticular complaints

Conditions like tendinitis or carpal tunnel syndrome

What is a common presentation of widespread nonarticular complaints

Conditions like polymyositis or fibromyalgia

How does joint involvement in RA typically present

Symmetric and polyarticular

Which conditions often present as asymmetric and oligoarticular

Spondyloarthritis, reactive arthritis, gout, and sarcoidosis

Can OA and psoriatic arthritis be symmetric or asymmetric

Yes, they can be either symmetric or asymmetric and oligo- or polyarticular

Which joints are commonly affected in RA and OA

The upper extremities

Which joints are commonly affected at the onset of reactive arthritis and gout

The lower extremities

In which conditions is axial skeleton involvement common

OA and ankylosing spondylitis

Which condition, except for the cervical spine, rarely involves the axial skeleton

Rheumatoid arthritis (RA)

What musculoskeletal conditions are associated with diabetes mellitus

Carpal tunnel syndrome

What musculoskeletal condition is associated with renal insufficiency

Gout

What musculoskeletal condition is associated with depression or insomnia

Fibromyalgia

What musculoskeletal condition is associated with myeloma (cancer of plasma cells)

Spinal pain

What musculoskeletal condition is associated with cancer

Myositis

What musculoskeletal condition is associated with osteoporosis

Fracture

What are some musculoskeletal conditions caused by glucocorticoids

Osteonecrosis and septic arthritis

Which musculoskeletal conditions may cause fever

Still’s disease and infection

Which musculoskeletal conditions are associated with rash

Systemic lupus erythematosus (SLE) and psoriatic arthritis

Which musculoskeletal conditions are associated with nail abnormalities

Psoriatic arthritis and reactive arthritis

Which musculoskeletal conditions are associated with myalgias

Fibromyalgia, statin- or drug-induced myopathy

Which musculoskeletal conditions are associated with eye involvement

Behçet’s disease, sarcoidosis, and spondyloarthritis

Which musculoskeletal conditions are associated with gastrointestinal involvement

Scleroderma and inflammatory bowel disease

Which musculoskeletal conditions are associated with genitourinary involvement

Reactive arthritis and gonococcemia

Which musculoskeletal conditions are associated with nervous system involvement

Lyme disease and vasculitis