Orthopedics - Rheumatologic Conditions
1. Who is fibromyalgia MC in?: - MC in women 20-50 y/o
2. What are common symptoms of fibromyalgia?: - chronic widespread MSK pain syndrome
with multiple tender points & stiffness-> MC in neck, shoulders, low back, and hips
- fatigue, headaches, numbness are common
- minor exertion aggravates pain and increases fatigue
- sleep disorders, subjective numbness, IBS
3. Why is fibromyalgia difficult to diagnose?: - NO objective signs of inflammation
- NORMAL laboratory studies
4. What are possible causes of fibromyalgia?: - abberant perception of painful stimuli
- sleep disorders
- depression
- viral infections
- possible rare complication of hypothyroidism, RA, or sleep apnea in men
5. How is fibromyalgia diagnosed?: - diagnosis of exclusion
6. What are common trigger points of pain on exam for fibromyalgia?: - trapezius
,- medial fat pad of knee
- lateral epicondyle of elbow
7. What type of workup should you conduct for fibromyalgia?: 1. rule out RA and SLE
2. rule out hypothyroidism
3. rule out osteomalacia
8. Which age group is fibromyalgia MC in?: MC UNDER age 50
- if a patient is OVER 50, it is NOT fibromyalgia
9. What is the treatment approach for fibromyalgia?: 1. Multidisciplinary approach
- mediation, CBT
2. Amitryptyline 10 mg one tablet PO
3. Fluoxetine -> usually helpful, especially since depression/anxiety is also possible with fibromyalgia patients
4. Exercise programs are IMPORTANT -> do not stop this
- tai chi
- yoga
, - resistance exercises (pilates)
5. Possibly cyclobenzaprine or gabapentin if severe pain, but not really used
10. Describe the onset and location of gouty arthritis.: - acute onset with recurring attacks
- monoarticular and MC in the first MTP joint
11. Who is polyarticular involvement with gouty arthritis MC in?: - MC in patients with
long standing disease
12. What is necessary for a diagnosis of gouty arthritis?: Identification of urate crystals in
joint fluid OR TOPHI is DIAGNOSTIC
13. Where does uric acid deposit with chronic gouty arthritis?: - subcutaneous tissue
- bone
- cartilage
- joints
- other tissues
14. How does gouty arthritis response to NSAIDs?: - dramatic therapeutic response to NSAIDs
15. Who is gouty arthritis MC in?: - MC in Pacific islanders (Filipinos and Samoans)
1. Who is fibromyalgia MC in?: - MC in women 20-50 y/o
2. What are common symptoms of fibromyalgia?: - chronic widespread MSK pain syndrome
with multiple tender points & stiffness-> MC in neck, shoulders, low back, and hips
- fatigue, headaches, numbness are common
- minor exertion aggravates pain and increases fatigue
- sleep disorders, subjective numbness, IBS
3. Why is fibromyalgia difficult to diagnose?: - NO objective signs of inflammation
- NORMAL laboratory studies
4. What are possible causes of fibromyalgia?: - abberant perception of painful stimuli
- sleep disorders
- depression
- viral infections
- possible rare complication of hypothyroidism, RA, or sleep apnea in men
5. How is fibromyalgia diagnosed?: - diagnosis of exclusion
6. What are common trigger points of pain on exam for fibromyalgia?: - trapezius
,- medial fat pad of knee
- lateral epicondyle of elbow
7. What type of workup should you conduct for fibromyalgia?: 1. rule out RA and SLE
2. rule out hypothyroidism
3. rule out osteomalacia
8. Which age group is fibromyalgia MC in?: MC UNDER age 50
- if a patient is OVER 50, it is NOT fibromyalgia
9. What is the treatment approach for fibromyalgia?: 1. Multidisciplinary approach
- mediation, CBT
2. Amitryptyline 10 mg one tablet PO
3. Fluoxetine -> usually helpful, especially since depression/anxiety is also possible with fibromyalgia patients
4. Exercise programs are IMPORTANT -> do not stop this
- tai chi
- yoga
, - resistance exercises (pilates)
5. Possibly cyclobenzaprine or gabapentin if severe pain, but not really used
10. Describe the onset and location of gouty arthritis.: - acute onset with recurring attacks
- monoarticular and MC in the first MTP joint
11. Who is polyarticular involvement with gouty arthritis MC in?: - MC in patients with
long standing disease
12. What is necessary for a diagnosis of gouty arthritis?: Identification of urate crystals in
joint fluid OR TOPHI is DIAGNOSTIC
13. Where does uric acid deposit with chronic gouty arthritis?: - subcutaneous tissue
- bone
- cartilage
- joints
- other tissues
14. How does gouty arthritis response to NSAIDs?: - dramatic therapeutic response to NSAIDs
15. Who is gouty arthritis MC in?: - MC in Pacific islanders (Filipinos and Samoans)
