2- osteoarthritis & crystal arthropathies

Question 1

what is osetoarthritis?

Answer 1

chronic disease characterised by cartilage loss & accompanying periarticular change (one also known as wear & tear)

Question 2

what is pathophysiology of osteoarthritis?

Answer 2

1. osteoarthritis causes cartilage to break down making thinner and then cracks in surface
2. gaps expand until reach bone itself
3. synovial fluid leaks into cracks which form in bones surface when replacement cartilage wears away. causes further damage & can lead to cysts in bone (osteophytes)
4. if not treated, the damage can progress to point where bones become seriously & permanently deformed

Question 3

what are 2 types of osteoarthritis?

Answer 3

1. localized = only 1 joint affected
2. generalised = at least 3 joints involved

Question 4

what joints are commonly affected in osteoarthritis?

Answer 4

• neck
• lower back
• hips
• base of thumb
• knee
• base of toe
• finger joints (DIP)

Question 5

what is bouchards nodes?

Answer 5

osteophytes at proximal interphalangeal joints of hand

Question 6

what are heberdens nodes?

Answer 6

osteophytes at distal interphalangeal joints (DIP) joint of hand

Question 7

how does osteoarthritis present?

Answer 7

• pain (unlike inflammatory, its worse with activity)
• stiff in morning but short lived (less than an hour)
• inactivity gelling (stiffness after sitting down for a while)
• instability
• poor grip in thumb (if osteoarthritis in thumb base)

Question 8

what is found on examination for osteoarthritis?

Answer 8

• joint line tender
• crepitus (2 bony surfaces rub together, can hear creaky sound)
• joint effusion ()increase in synovial fluid because increase cartilage loss)
• bony swelling ( because of remodelling deformity)
• limitation of motion

Question 9

what are some specific deformities seen in knee osteoarthritis?

Answer 9

• genu varus (bow legged)
• valgus deformities (joint abnormally bent outward)
• baker cysts (popliteal cyst - fluid swelling back of knee)

*varus = knees out, valgus = knees in

Question 10

where is hip joint problem pain always felt?

Answer 10

in groin (can also radiate to knee)

Question 11

what type of symptoms come with neck or spine arthritis?

Answer 11

• muscles go into spasm to protect joint so in neck this restricts lateral flexion and pain can radiate to back of head (occipital headaches)
• osteophytes can impinge on nerve roots causing tingling in arms and spinal stenosis can occur from osteophytes causing pain in legs & falling in old people

Question 12

what is management of osteoarthritis?

Answer 12

• positive lifestyle like lose weight
• exercise like yoga, walking, cycling (strengthen muscles
• can get occupational therapy
• ibuprofen gel is good (but don’t work for spine osteoarthritis)
• can inject with steroids for short term relief

Question 13

what is locking of joint in osteoarthritis caused by?

Answer 13

loose cartilage bodies

Question 14

what are crystal arthropathies?

Answer 14

umbrella term for conditions that have crystal deposits in joints

• joints think foreign body and make intense reaction with macrophages etc →severe inflammatory reaction = excruciating pain
• once macrophages remove crystals, joint goes back to normal again

Question 15

what are 2 main crystal arthropathies?

Answer 15

1. gout-monosodium urate crystals (uric acid)
2. pseudogout-calcium pyrophosphate crystal deposition (calcium- rhombus shaped depositis)

Question 16

what age is rare for gout?

Answer 16

under age of 20 and rare in women before menopause (as oestrogen promotes excretion of uric acid)

Question 17

what are risk factors for gout?

Answer 17

things that mean more uric acid e.g. genetic, alcohol, sugary fizzy drinks, excessive protein powder, shellfish

conditions where uric acid produced normal but excreted badly e.g. kidney failure, diuretics, hypothyroidism

Question 18

what happens if don’t treat gout?

Answer 18

repeated episodes of inflammation will damage joints. it can be very painful and would get worse until impacts quality of life

Question 19

how would gout present?

Answer 19

often starts at night, can’t walk, symptoms around 10 days unless treatment then 3 days. very painful

• hyperuricemia (high uric acid but will often be normal in serum as all in joint)

Question 20

what is tophi?

Answer 20

aggregated uric crystals due to unstable uricaemia

Question 21

what investigations can be done for gout?

Answer 21

• aspirate joint (to exclude septic arthritis)
• serum uric acid raised (may be normal in acute attack) - 50% hve normal uric acid in acute attack as in joint
• raised inflammatory markers
• check for renal impairment

Question 22

what is treatment for acute gout?

Answer 22

NSAIDS (MAIN ONE), colchicine (reduces inflammation, old), steroids

Question 23

what is preventative treatment for gout?

Answer 23

1. lifestyle modification = alcohol consumption, stop diuretics, reduce fizzy drinks or protein powder
2. allopurinol & febuxostat = xanthine oxidase inhibitors (inhibits production of uric acid so prevents deposition)
3. probenecid & benzbromarone = uricosuric drugs which inhibits reabsorption of uric acid forcing more to be excreted in urine

Question 24

what is Calcium pyrophosphate deposition disease (pseudogout)?

Answer 24

calcium deposits in joints

Question 25

what is treatment of pseudogout?

Answer 25

• NSAIDS
• Colchicine
• Steroids
• Rehydration

Question 26

what is soft tissue rheumatism?

Answer 26

general term to describe pain caused by inflammation of ligaments, tendons, muscle or nerve near a joint

Question 27

what is most common area of soft tissue rheumatism?

Answer 27

shoulder - since has lots of muscles (rotator cuff) and

Question 28

what is joint hypermobility syndrome

Answer 28

when pain at hypermobile joints

(hypermobility common, it’s when pain starts that its called syndrome)

Question 29

what is score to diagnose joint hypermobility syndrome?

Answer 29

beighton score (extend wrists, fingers, bend over etc) = if above 4 then diagnosis

Question 30

what is paget’s disease?

Answer 30

it’s a metabolic disease where there’s abnormality of bone turn over (due to increase in osteoclastic activity - bone munchers)

*usually constant bone turn over and in paget’s rate of turn over is massive, it makes weak & not proper structured bone so prone to fracture, don’t know cause.

Question 31

how does pagets disease present?

Answer 31

big skull, often feel hot & warm skin as fast turn over. can then get osteosarcoma. usually affects big bones