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MSK Week 2 2017/18 > 3: Osteoarthritis and crystal arthropathies > Flashcards

3: Osteoarthritis and crystal arthropathies Flashcards

1
Q

What is the most common type of arthritis?

A

Osteoarthritis

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2
Q

What is osteoarthritis?

A

Progressive, degenerative joint inflammation due to loss of cartilage

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3
Q

In osteoarthritis, much of the joint space is ___.

A

lost

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4
Q

What forms at the edges of bone in osteoarthritis?

A

Bony spurs (osteophytes)

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5
Q

Which protein makes up most of cartilage?

A

Type 2 collagen

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6
Q

What cells form the matrix of cartilage?

A

Chondrocytes

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7
Q

In osteoarthritis, the matrix of cartilage is ___.

A

lost

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8
Q

Why do osteophytes form in osteoarthritis?

A

Attemped bone repair (sclerosis as well)

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9
Q

Osteoarthritis tends to have a(n) (acute / gradual) onset.

A

gradual

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10
Q

What type of pain do people with osteoarthritis get?

A

Mechanical pain

i.e worse on activity, relieved by rest

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11
Q

When is mechanical pain of osteoarthritis at its worst?

A

End of the day

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12
Q

What name is given to grinding/creaking of joints on movement?

A

Crepitus

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13
Q

How long does stiffness tend to last in osteoarthritis?

A

< 30 minutes

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14
Q

Osteoarthritis (does / doesn’t) affect the DIP joints.

A

does

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15
Q

At which joints do:

a) Heberden’s nodes
b) Bouchard’s nodes

form during osteoarthritis?

A

a) DIP joint

b) PIP joint

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16
Q

Bony enlargements seen in osteoarthritis are (soft / hard).

A

hard

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17
Q

Just as in RA, osteoarthritis may cause ___ of the thumbs.

A

squaring

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18
Q

What is a Baker’s cyst?

A

Swelling in the popliteal fossa

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19
Q

Where is hip pain felt?

“Hip pain” described by patients may actually be caused by osteoarthritis of ___ joints.

A

groin

back joints

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20
Q

When does osteoarthritis tend to start?

A

40s onwards

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21
Q

Osteoarthritis is more common in (men / women).

A

women

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22
Q

Occupations involving a lot of heavy ___ accelerate the onset of OA.

A

labour

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23
Q

What are some underlying conditions which can accelerate the onset of OA?

A

RA

Gout

Acromegaly

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24
Q

What type of arthritis must be excluded when taking a history from patients?

A

Septic arthritis

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25
Q

The inflammatory markers of OA patients are usually ___.

A

normal

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26
Q

What are some X-ray features of OA?

A

LOSS:

Loss of joint space

Osteophytes

Sclerosis

Subchondral cysts

27
Q

What are the primary hand joints affected in OA versus RA?

A

OA - DIPs

RA - PIPs, MCPs

28
Q

How do joints feel in OA versus RA?

A

OA - hard, bony

RA - soft, hot and tender

29
Q

When is stiffness at its worst in OA versus RA?

A

At the end of the day as opposed to in the mornings

30
Q

What sort of exercise are OA patients encouraged to do?

A

Low impact exercise (e.g pilates, swimming) so weight is loss but joints aren’t damaged further

31
Q

What non-pharmacological therapies may OA patients require?

A

Physiotherapy

Weight loss

Occupational therapy - footwear, mobility aids

32
Q

What drugs can OA patients be prescribed?

A

Analgesics e.g paracetamol

NSAIDs but be careful

+/-

Opiates, pain modulars e.g amitryptyline, IA steroids for short term relief

33
Q

If OA has progressed to a point where it causes constant pain or reduced mobility, patients may be referred for ___.

A

surgery

34
Q

What are the most common joint replacements carried out by the NHS?

A

Knee

Hips

(Uncommonly shoulder, elbow, fingers)

35
Q

What are the two main crystal arthropathies?

Which crystals cause them?

A

Gout (uric acid)

Pseudogout (calcium pyrophosphate)

36
Q

What is gout?

A

Inflammatory arthritis caused by uric acid crystals deposited in joints

37
Q

Gout is more common in (men / women).

A

men

38
Q

What is the metabolic product responsible for gout?

A

Purines

39
Q

Apart from being a metabolite of food, purines are also produced when cells are __ __.

A

broken down

40
Q

What is the biochemical pathway producing uric acid?

A

Diet

Purines

Xanthine

Uric acid

(simplified)

41
Q

How is uric acid excreted?

A

Via urine

42
Q

What is hyperuricaemia?

A

Serum uric acid > 7 mg/dL

43
Q

Why can people with psoriasis develop gout?

A

High cell turnover

44
Q

Does everyone who is hyperuricaemic develop gout?

A

No, don’t blindly treat without symptoms

45
Q

What change re: uric acid actually causes gout?

A

Acute changes in uric acid level

46
Q

What is the main presentation of gout?

A

Rapid onset of severe pain in joint

Bright-red, hot, lasts up to 2 weeks

47
Q

What are the most common sites for gout?

A

Hallux

Ankle

Knee

can affect upper limb and spine too

48
Q

Which medications can cause gout?

A

Diuretics

49
Q

What must be excluded in someone with a hot, swollen joint?

A

Septic arthritis

50
Q

What are depositions of uric acid in the skin called?

A

Tophi

51
Q

In gout, inflammatory markers will be (raised / reduced).

A

raised

52
Q

WCC may be raised in gout - what must be excluded at this stage?

A

Infection

osteomyelitis, cellulitis, septic arthritis…

53
Q

X-rays appear normal in acute attacks of gout. How may they appear after chronic attacks?

A

Erosions

Osteophytes

Joint destruction

54
Q

What is the gold standard investigation for gout?

A

Joint aspirate

55
Q

How is an acute attack of gout managed?

A

NSAIDs for pain

(If contraindicated, colchicine)

(If both contraindicated, steroids)

And loads more analgesia (paracetamol, opiates)

56
Q

What is an inconvenient side effect of colchicine?

A

Diarrhoea

57
Q

What are some lifestyle recommendations for gout patients?

A

Reduce protien intake - red meat, beans, shellfish

Reduce alcohol intake

Lose weight

Drink plenty of fluids (but not fizzy drinks)

58
Q

What drugs are used as prophylaxis for gout?

Which enzyme do they inhibit?

A

Allopurinol or Febuxostat

Xanthine oxidase

59
Q

Allopurinol is started 2-4 weeks after acute gout in a low dose - why?

A

Sudden changes in uric acid level will cause another episode of gout

60
Q

Pseudogout is more common in (young / old) people.

Which crystal is deposited?

A

old

calcium pyrophosphate

61
Q

What shape are the crystals seen in:

a) gout
b) pseudogout?

A

Gout - needle shaped crystals

Pseudogout - rhomboids

62
Q

Can patients have both gout and pseudogout?

A

Yeah

63
Q

Is allopurinol used in pseudogout?

A

No - xanthines not involved

64
Q

How is pseudogout treated?

A

NSAIDs / colchicine / steroids

Rehydration

MSK Week 2 2017/18 (11 decks)

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