Medical Screening

 

Axial Spondylarthritis (AxSpa) screening

This is based on the SPADE tool by Zoe Clark Osteopath. www.spadetool.co.uk:

  • Did your back pain and stiffness start before the age of 45?
  • Did your pain and stiffness develop gradually, with symptoms persisting at least three months?
  • Does your pain and stiffness tend to ease with physical activity and exercise?
  • Do you find there is no improvement in your back pain when you rest?
  • Do you suffer from increased back pain and discomfort when immobile during sleep, and start to feel better once up and moving?
  • Does the pain improve with NSAIDs?
  • Do you experience fatigue?
  • Do you have/have you had heel pain (enthesitis)?
  • Do you have peripheral arthritis/other joint pains or swellings? Do you have/have you had dactylitis?
  • Do you have a history of iritis/uveitis?
  • Do you have psoriasis?
  • Do you have inflammatory bowel disease (Crohn’s or Ulcerative Colitis)?
  • Do you have a family history of: - Axial SpA? - Reactive Arthritis? - Psoriasis? - IBD (Crohn’s or Ulcerative Colitis)? - Uveitis?
  • Have you had a blood test for ESR or CRP? If so, were they raised?
  • Are you HLA-B27 positive?
  • Do you have sacroiliitis shown by MRI?

Osteoporosis screening

This work is based on the FRAX tool https://www.sheffield.ac.uk/FRAX/tool.aspx

There are several factors generally accepted to be risk factors in osteoporosis and related fractures. These include:

  • Genetics: Check your family history.
  • Gender: Osteoporosis is not exclusively a female disease but it is more prevalent in women.
  • Age: The older you are the higher the risk. Bone loss starts between 20 and 40 but increases in later life.
  • Body weight: You need to carry a bit of weight! Those with a body mass index less than 19kg/m sqd are more likely to get osteoporosis.
  • Previous fracture: If you have sustained a previous fracture either spontaneously or from a trauma, which, in a healthy individual, would not normally result in a fracture then there’s more risk of it happening again.
  • Alcohol: The NHS advise there is no safe level of alchol consumption but to not exceed 14 units a week. 3+ units a day increases your likelihood of developing osteoporosis.
  • Smoking: Smoking increases your chance of osteoporosis.
  • Steroids (glucocorticoids): If you’ve been taking a daily dose of 5+mg prednisolone for more than 3 months there is a risk of developing osteoporosis. Do not come off your medication consult with your GP.
  • Other illnesses: Illnesses associated with osteoporosis are: rheumatoid arthritis (not ‘wear and tear’ osteoarthritis), bone cancer, multiple myeloma, Cushing’s disease, type I diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (before 45), chronic malnutrition, or malabsorption and chronic liver disease.

Hypermobility screening

Risk factors: family history of EDS or hypermobility, Just GAPE questions: Joints and (U)other Soft Tissues, Gut, Allergy/atopy/autoimmune, Postural Symptoms, Exhaustion.

Beighton score >4:

  • Passive hyperextension of the 5th MCP beyond 90 degs.
  • In wrist flexion the thumb touches the forearm.
  • Hyperextension of the eblow 10+ degs.
  • Passive extension of the knee 10+ degs.
  • In forward flexion the hands touch the floor.