2- osteoarthritis & crystal arthropathies Flashcards
what is osetoarthritis?
chronic disease characterised by cartilage loss & accompanying periarticular change (one also known as wear & tear)
what is pathophysiology of osteoarthritis?
- osteoarthritis causes cartilage to break down making thinner and then cracks in surface
- gaps expand until reach bone itself
- 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)
- if not treated, the damage can progress to point where bones become seriously & permanently deformed
what are 2 types of osteoarthritis?
- localized = only 1 joint affected
- generalised = at least 3 joints involved
what joints are commonly affected in osteoarthritis?
- neck
- lower back
- hips
- base of thumb
- knee
- base of toe
- finger joints (DIP)
what is bouchards nodes?
osteophytes at proximal interphalangeal joints of hand
what are heberdens nodes?
osteophytes at distal interphalangeal joints (DIP) joint of hand
how does osteoarthritis present?
- 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)
what is found on examination for osteoarthritis?
- 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
what are some specific deformities seen in knee osteoarthritis?
- 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
where is hip joint problem pain always felt?
in groin (can also radiate to knee)
what type of symptoms come with neck or spine arthritis?
- 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
what is management of osteoarthritis?
- 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
what is locking of joint in osteoarthritis caused by?
loose cartilage bodies
what are crystal arthropathies?
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
what are 2 main crystal arthropathies?
- gout-monosodium urate crystals (uric acid)
- pseudogout-calcium pyrophosphate crystal deposition (calcium- rhombus shaped depositis)
what age is rare for gout?
under age of 20 and rare in women before menopause (as oestrogen promotes excretion of uric acid)
what are risk factors for gout?
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
what happens if don’t treat gout?
repeated episodes of inflammation will damage joints. it can be very painful and would get worse until impacts quality of life
how would gout present?
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)
what is tophi?
aggregated uric crystals due to unstable uricaemia
what investigations can be done for gout?
- 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
what is treatment for acute gout?
NSAIDS (MAIN ONE), colchicine (reduces inflammation, old), steroids
what is preventative treatment for gout?
- lifestyle modification = alcohol consumption, stop diuretics, reduce fizzy drinks or protein powder
- allopurinol & febuxostat = xanthine oxidase inhibitors (inhibits production of uric acid so prevents deposition)
- probenecid & benzbromarone = uricosuric drugs which inhibits reabsorption of uric acid forcing more to be excreted in urine
what is Calcium pyrophosphate deposition disease (pseudogout)?
calcium deposits in joints
what is treatment of pseudogout?
- NSAIDS
- Colchicine
- Steroids
- Rehydration
what is soft tissue rheumatism?
general term to describe pain caused by inflammation of ligaments, tendons, muscle or nerve near a joint
what is most common area of soft tissue rheumatism?
shoulder - since has lots of muscles (rotator cuff) and
what is joint hypermobility syndrome
when pain at hypermobile joints
(hypermobility common, it’s when pain starts that its called syndrome)
what is score to diagnose joint hypermobility syndrome?
beighton score (extend wrists, fingers, bend over etc) = if above 4 then diagnosis
what is paget’s disease?
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.
how does pagets disease present?
big skull, often feel hot & warm skin as fast turn over. can then get osteosarcoma. usually affects big bones
