13. MSK Flashcards
What is osteoarthritis?
Cartilage destruction exceeds repair, causing pain and instability
What is primary and secondary osteoarthritis?
Primary - wear and tear in obese, older patients etc.
Secondary - altered join architecture that acquires further damage
How does osteoarthritis present?
Large joins
Morning stiffness around 15 mins
Better on rest
Crepitus
Effusion, erythema
Squaring of the base of thumb
Heberden’s and bouchard’s
Investigations for OA?
XRay Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts
Joint aspiration for exclusion of other conditions
OA management?
Lifestyle stuff
Oral paracetamol and topic NSAIDs or capsaicin
Oral NSAID and PPI next
and then Opiates with caution
Intra-articular steroids
Joint replacement
What is RA?
Autoimmune, chronic and progessive inflammation of synovial lining, tendon sheaths and bursa
How is RA diagnosed?
Clinically!
Symmetrical polyarthritis and extra-articular manifestations
Rapid onset or chronic
Systemic upset
What are some clinical signs you many see in RA?
Pain and stiffness better after movement, small joints!
Swelling and tenderness
DIP sparing
Chronic signs - Z deformity Ulnar deviation Swan neck deformity Boutonniere's Rheumatoid nodules
Extra-articular manifestations of RA?
Rheumatoid nodules Tenosynovitis, bursitis Secondary Sjogren's Felty's syndrome Anaemia Pericarditis
SO many more
Investigations for RA?
RF Ab!
Anti-CCP more sensitive and specific
CRP, ESR usually raised
This helps to assess severity of disease and therefore prognosis
Treatment for RA?
Short course steroids for flares NSAIDs and COX-2 inhibitors DMARDS! - Single, then double, then single with a biologic and finally rituximab and methotrexate Surgery
Biologics need infection screening before as can reactivate TB etc.
What are the main seronegative spondyloarthropathies?
Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis
What is ankylosing spondylitis?
Chronic, progressive inflammatory arthropathy of axial skeleton!
HLA B27
Presentation of ankylosing spondylitis?
Pain and stiffness of lower back and hips on waking, slightly better with movement.
Extra-articular - anterior uveitis, apical lung fibrosis and aortic regurg
UC related
Chronic - kyphosis, neck extension, loss of lumbar lordosis
What is seen on imaging for AS?
Bamboo spine!
MRI is better as can pick up soft tissue changes