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MSK Diseases > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What is osteoarthritis, and how does it occur?

A

Chronic synovial joint wear and tear.

Genetic factors, overuse, and injury -> imbalance between cartilage damage and chondrocyte response, causing structural issues in the joint

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2
Q

What are the risk factors for osteoarthritis?

A

obesity, age, occupation, trauma, being female, and family history

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3
Q

Which joints are commonly affected by osteoarthritis?

A
  • Hips
  • Knees
  • Distal interphalangeal (DIP) joints in the hands
  • Carpometacarpal (CMC) joint at the base of the thumb
  • Lumbar spine
  • Cervical spine (cervical spondylosis)
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4
Q

What are the X-ray findings in OA?

A
  • Loss of joint space
  • Osteophytes (bone spurs)
  • Subarticular sclerosis (increased bone density along the joint line)
  • Subchondral cysts (fluid-filled holes in the bone)
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5
Q

Do x-ray changes in osteoarthritis correlate with symptoms?

A

No, significant x-ray findings may not correlate with symptom severity.

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6
Q

How does osteoarthritis typically present?

A

JOINT PAIN AND STIFFNESS- worse with activity and at end of day

Morning stiffness lasting <30 mins

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7
Q

What are the general signs of osteoarthritis?

A
  • Bulky, bony enlargement of the joint
  • Restricted range of motion
  • Crepitus on movement
  • Joint effusions
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8
Q

What are specific signs of osteoarthritis in the hands?

A

Specific signs in the hands include:
- Heberden’s nodes (DIP joints)
- Bouchard’s nodes (PIP joints)
- Squaring at the base of the thumb (CMC joint)

  • Weak grip
  • Reduced range of motion
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9
Q

Why is the carpometacarpal (CMC) joint prone to osteoarthritis?

A

The CMC joint at the base of the thumb is a saddle joint subjected to high use, making it prone to wear.

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10
Q

What is the criteria for diagnosing OA without investigations? (NICE 2022)

A

MADE VIA HISTORY

criteria includes the patient being over 45, having typical activity-related pain, and having no morning stiffness or stiffness lasting under 30 minutes.

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11
Q

What are non-pharmacological management options for OA?

A
  • Therapeutic exercise
  • Weight loss if overweight
  • Occupational therapy (e.g., walking aids, home adaptations)
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12
Q

What is the first-line pharmacological treatment for knee OA?

A

topical NSAIDs

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13
Q

When are oral NSAIDs recommended for OA, and what should they be co-prescribed with?

A

recommended when necessary, and should be co-prescribed with a proton pump inhibitor for gastroprotection

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14
Q

Further medical management for OA

A

Intra-articular steroid injections for up to 10 weeks

Hip and knee replacement in severe cases

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15
Q

What are the potential adverse effects of NSAIDs?

A
  • Gastrointestinal: Gastritis, peptic ulcers, upper GI bleeding
  • Renal: Acute kidney injury, chronic kidney disease
  • Cardiovascular: Hypertension, heart failure, myocardial infarction, stroke
  • Exacerbating asthma
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16
Q

Why should NSAIDs be used cautiously in patients with hypertension?

A

NSAIDs block prostaglandins, reducing vasodilation and potentially increasing blood pressure.

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17
Q

Why are opiates not helpful for chronic pain in osteoarthritis?

A

due to their association with side effects, dependence, and withdrawal without objective benefits

18
Q

What is rheumatoid arthritis?

A

Autoimmune chronic symmetrical peripheral inflammatory polyarthritis

19
Q

What joints do RA affect?

A

Synovial joints, including tending sheathe

Hence increases risk of tendon rupture

20
Q

What are the consequences of untreated RA

A

Erosion and destruction- permanent damage and disability

21
Q

RA risk factors

A

Anyone, but most at risk:
Middle aged women
Smokers
Obese

HLA DR4 family history

22
Q

What causes RA?

A

Some have a genetic predisposition
Environmental trigger such as smoking activates it

23
Q

How does RA present?

A

Pain, swelling, and prolonged morning stiffness

24
Q

What is palindromic rheumatism?

A

Self limiting episodes of inf arthritis, that last a few days then resolve

May be a precursor to RA

25
Q

How does RA present differently from OA?

A

RA is worst with rest and better with activity
RA is worst in the morning

Whereas OA is better with rest and in the morning, and worse with activity

RA typically does not affect DIPs

26
Q

What joints are most commonly affected by RA?

A

MCPs, PIPs, wrists, and MTP tenderness

27
Q

Systemic symptoms of RA

A

Fatigue, weight loss, flu like illness

28
Q

What are the hand signs of RA?

A

Z shaped thumb
Swan neck- flexed DIP
Boutonnière- flexed PIP
Ulnar deviation of metacarpals

29
Q

What is Feltys syndrome?

A

RA x neutropenia x splenomegaly

30
Q

Extra articular signs of RA

A

Feltys

Anaemia

Cardio disease

Lymphadenopathy

Bilateral carpal tunnel syndrome

Amyloidosis

Bronchiolitis

Eye conditions

31
Q

How is RA diagnosed?

A

Rheumatology referral for persistent synovitis and other symptoms

Antibodies, CRP, ESR, imaging

Squeeze test

32
Q

What are the RA antibodies

A

Rf- present in about 70% of RA patients, but can be present in other conditions

AntiCCP- positive in about 80% of RA patients- often shows up before condition has been developed too

33
Q

What are the scoring systems used for rheumatoid conditions?

A

ACR/EULAR

DAS28

HAQ

34
Q

Management for RA

A

Lifestyle interventions, short term steroids for quick symptom control

Long term:
DMARDs

NSAIDs for pain but watch for side effects

35
Q

Complications of RA

A

since it can increase fat metabolism it may lead to adverse cardiovascular effects

Atlantoaxial subluxation- c2 synovitis causing spinal cord compression

36
Q

What is septic arthritis?

A

Acute joint infection -> can cause rapid joint destruction

37
Q

What organisms can cause septic arthritis?

A

staph aureus

Neisseria gonorrhoea (if sexually active)
Strep A
Haemophilus influenza
E.coli

38
Q

How does septic arthritis usually present?

A

Only affects one joint, commonly the knee

Rapid onset of:
Hot swollen red painful joint
Stiffness and reduced motion
Systemic features (inc. sepsis)

39
Q

What can septic arthritis be confused with upon presentation?

A

Gout and pseudogout
Severe RA flare
Haemarthrosis

40
Q

Septic arthritis management plan

A

Joint aspiration -> gram stain and culture, crystal microscopy

Meanwhile treat empirically with IV antibiotics until sensitivities known

Important to have low threshold for suspecting it, as it is very dangerous

41
Q

What medication is used to treat septic arthritis?

A

Antibiotics normally continued for 4-6 weeks after

Flucloxacillin
Clindamycin if penicillin allergic
Vancomycin for MRSA
Ceftriaxone for gonnorhoea

MSK Diseases (16 decks)

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