Arthridities-pathophys, management

Question 1

list 3 treatment medications for osteoporosis

Answer 1

biophosphonates e.g. Fosamax: increase osteoclastic apoptosis, inhibiting bone resorption
Selective Oestrogen Receptor Modulators: acts on bone as normal oestrogen, slowing bone loss and reducing fracture risk
Hormone Replacement Therapy: normalises oestrogen levels and slows bone loss

Question 2

identify the 5 pathological phases of osteomyelitis

Answer 2

1. inflammation: lymphocytes to medullary bone
2. suppuration: pus formation
3. necrosis: due to increased intraosseous pressure; sequestrum
4. formation of new bone: 10-14 days involucrum
5. resolution: anti-biotic therapy and pressure release

Question 3

what are treatment options for osteomyelitis

Answer 3

anti-biotics=1st line
drainage
surgery

Question 4

identify the steps of osteoarthritis pathophysiology

Answer 4

chondrocyte damage: genetic/environmental
proliferation: inflammatory mediators e.g. collagenase and protease
breakdown of proteoglycans and type 11 collagen
matrix remodelling and degradation
breakdown, cracking and erosion of cartilage

Question 5

list some ssx of OA

Answer 5

pain: worse in morning, night and cold weather, relieved by rest
bony enlargement, crepitus, restricted movement, tenderness on palpation

Question 6

6 management strategies for OA

Answer 6

education and reassurance
slow release paracetamol
modifiable risk factors (weight loss)
exercise
manual therapy
joint replacement

Question 7

list 5 types of psoriatic arthritis
2 lab findings of psoriatic arthritis
2 ways to differentiate between PA and RA

Answer 7

oligoarticular
polyarticular
spondyloarthritis
distal interphalangeal predominant
arthritis mutilans 

HLA-B27, elevated ESR in acute phase

PA-lack of osteoporosis/normal bone mineralisation, negative rheumatoid factor, skin lesions in PA

Question 8

identify prominent pathophysiology of psoriatic arthritis

Answer 8

genetic/autoimmune/environmental factors
hyperactive T-cells and immunity response (TNF alpha, IL's)
psoriatic plaques
osteoclasts and osteoblasts
joint erosion and ossification
joint deformity

Question 9

what are some treatment options for psoriatic arthritis?

Answer 9

NSAIDs
immunomodulatory drugs
biological response modifiers (TNF inhibitors)
surgery

Question 10

list some pathological processes of AS in regards to synovial, cartilage and entheses effects

Answer 10

synovial effects: pannus forms with synovial proliferation and inflammatory cells infiltrate; erodes subchondral bone, fibrosis, ankylosis

cartilage: subchondral osteitis; inflammatory cells and granulation tissue invade bone
entheses: fibrous tissue to cartilage, then calcified cartilage then to bone

Question 11

list some management strategies for AS

Answer 11

NSAIDs: ibuprofen, naproxen
steroids
TNF inhibitors
osteopathy

Question 12

identify the pathophysiological process of RA

Answer 12

inflammation of synovium
formulation of pannus
bone destruction as pannus erodes cortex in bare area
cartilage is replaced
fibrosis
ankylosis

Question 13

list some treatment options for RA

Answer 13

NSAIDs
steroids-glucocorticoids 
DMARDs 
physical therapy
surgery

Question 14

define systemic lupus erythematosus

Answer 14

an autoimmune disease that is usually characterised by clinical manifestations that are multi-system (any organ or tissue)
presents with a combinations of joint, skin and mucosal symptoms
women of childbearing age

Question 15

explain the pathogenesis of SLE

Answer 15

recurrent activation of the immune system

production of proteins and antibodies that contribute to high levels of inflammation and tissue destruction

Question 16

what generally presents on the skin in SLE?

what is a main risk factor / aggravating factor for SLE?

Answer 16

malar rash

UV sun exposure

Question 17

suggest some management strategies for SLE

Answer 17

reduce environmental triggers (UV, hormone therapy, CV risk)
NSAIDs
Antimalarials
severe cases:
corticosteroids, immunosuppressive drugs

Question 18

define gout, with reference to its pathophysiology

Answer 18

abnormal uric acid metabolism resulting in urate crystal deposition typically in jts, ST and the urinary tract.
uric acid is a normal by-product of the breakdown of xanthine, usually filtered out via the kidneys.
if the body is unable to filter it out, hyperuricaemia occurs which causes saturation in the synovial fluid and ST, which results in crystal formation and tissue damage

Question 19

identify the 4 stages of gout

Answer 19

1. asymptomatic hyperuricaemia
2. acute gouty arthritis
3. intercritical gout
4. chronic tophacious gout and chronic gouty arthritis

Question 20

list some management strategies for gout

Answer 20

lifestyle changes
NSAIDs
corticosteroids
*Allopurinol-xanthine oxidase inhibitor

Question 21

suggest some management strategies for CPPD

Answer 21

treat symptoms of attack
cortisone injection into joint=first line
paracetamol and/or corticosteroids

Question 22

define CPPD

Answer 22

calcium pyrophosphate deposition disease is a disease of crystal deposition in the joint or soft tissues, and is exclusive to articular cartilage.
chondrocalcinosis
excess pyrophosphate production in cartilage

Question 23

what age and gender does osteoporosis affect the most?

Answer 23

post meno-pausal women over 60 years old