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Musculoskeletal > Arthritis and soft tissue rheumatism > Flashcards

Arthritis and soft tissue rheumatism Flashcards

1
Q

What is generalised OA?

A

OA in three or more sites

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2
Q

When is OA pain worse?

A

During activity, relieved by rest

usually morning stiffness lasting 30 mins

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3
Q

What will you hear in an OA joint?

A

Crepitus

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4
Q

Why is an OA joint enlarged?

A

Osteophytes

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5
Q

OA joint distribution?

A

foot, knee, hip, cervical spine, lumbar spine, hand

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6
Q

Which joints does OA affect in hand?

A

DIP, PIP, and 1st CMC joints

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7
Q

Heberdens nodes

A

DIP

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8
Q

Douchards nodes

A

PIP

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9
Q

What might the thumb look like in OA?

A

Squared off

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10
Q

What kind of cyst might you find in the knee in OA?

A

Bakers cyst

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11
Q

Where might you feel OA hip pain?

A

may feel in groin
may radiate to knee
may feel in lower back

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12
Q

Intra-articular pharmacological management of OA?

A

Steroids

Hyaluronic acid

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13
Q

Surgical management of OA

A

Arthroscopic washout
Loose body
Soft tissue trimming
Joint replacement

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14
Q

Which condition are urate crystals found in?

A

Gout

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15
Q

Which type of crystals are found in gout?

A

Urate

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16
Q

Birefringent in gout?

A

Negative

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17
Q

How does the body respond to gout?

A

Acute inflammatory response with phagocytosis of crystals

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18
Q

Psoriasis and hyperuricemia?

A

Psoriasis can cause hyperuricemia

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19
Q

Which foods are high in purine?

A

Red meat
Seafood
Corn syrup

20
Q

Causes of reduced urate excretion

A 
Chronic renal impairment
Volume depletion eg heart failure
Hypothyroidism
Diuretics
Cytotoxics eg cyclosporin
21
Q

Which cytotoxics can cause reduced urate excretion?

A

Ciclosporin

22
Q

Ciclosporin and renal function

A

Ciclosporin causes a reduced renal blood flow and glomerular filtration rate

23
Q

Causes of increased urate production

A

Inherited enzyme defects
Myeloproliferative/Lymphoproliferative disorders
Psoriasis
Haemolytic disorders
Alcohol (beer, spirits)
High dietary purine intake (red meat, seafood, corn syrup

24
Q

How would you treat hydroxyapatite?

A

NSAID
Intra-articular steroid injection
Physiotherapy
Partial or total arthroplasty

25
Q

Prophylactic treatment for gout and when you should start it

A

Allopurinol
Febuxstat
-Start 2-4 weeks after acute attack
-Provide cover with NSAIDS etc

26
Q

Treatment for acute attacks of gout?

A

NSAIDs
Allopurinol
Colchicine
Steroids

27
Q

Calcium pyrophosphate deposition disease

A

Commoner in elderly
Chondrocalcinosis increases with age
Related to osteoarthritis
Affects fibrocartilage - knees, wrists, ankles
Acute attacks related to shedding of calcium pyrophosphate crystals (pseudogout)
Calcium pyrophosphate crystals-envelope shaped, mildly positively birefringent

28
Q

Inflammatory markers in CPPD

A

Raised inflammatory markers in CPPD

29
Q

Hydroxyapatite

A

“Milwaukee shoulder”
Hydroxyapatite crystal deposition in or around the joint.
Release of collagenases, serine proteinases and IL-1
Acute and rapid deterioration.
Females, 50-60 years

30
Q

Which mediators are released in hydroxyapatite?

A

Collagenases
Serine proteases
IL-1

31
Q

CPDD crystal deposition disease associations

A 
Hyperparathyroidism
Familial hypocalciuric hypercalcemia
Hemochromatosis
Hemosiderosis
Hypophosphatasia
Hypomagnesia
Hypothyroidism
Gout
Neuropathic joints
Aging
Amyloidosis
Trauma
32
Q

Treatment for CPDD

A

NSAIDS
Steroids
Colchicine
Rehydration

33
Q

Causes of pseudogout

A 
Lack of fluid (dehydration).
An attack of any severe illness.
Overactivity of the parathyroid glands (hyperparathyroidism).
Long-term use of steroid medicine.
Underactive thyroid gland (hypothyroidism).
Any cause of arthritis.
Haemochromatosis
Wilson's disease
Acromegaly
Kidney dialysis.
Surgery or injury.
Low magnesium level in the blood (hypomagnesaemia).
34
Q

Hydroxyapatite

A

Hydroxyapatite (HA) crystal deposition disease (HADD) is a well-recognized systemic disease of unknown etiology that is caused by para-articular and/or intra-articular deposition of HA crystals. The disease is clinically manifested by localized pain, swelling, and tenderness about the affected joint along with variable limitation of joint motion, although not all patients are symptomatic. Plain radiographs may show calcifications of varying size and shape in the para-articular tendons, bursae, and capsule. The disease may be mono- or polyarticular in distribution. The shoulder is most commonly involved with calcification in the supraspinatus tendon. When intra-articular, HA crystals can cause joint destruction. Any joint can be involved; the shoulder is most commonly affected, resulting in “Milwaukee shoulder.” Treatment of HADD usually requires use of analgesics, local heat, needling with or without aspiration of the calcific deposits, steroid injections, and, at times, even surgery for relief of pain.

35
Q

Soft tissue rheumatism vs fibromyalgia

A

Pain should be confined to a specific site e.g. shoulder, wrist etc.

More generalised soft tissue pain – consider fibromyalgia

36
Q

Some patients with reactive arthritis may suffer from a triad of symptoms (Reiters), what is the triad?

A

Urethritis
Uveitis
Arthritis

37
Q

Where does enteropathic arthritis affect?

A

Spine and peripheral joints

38
Q

Nail changes often seen in psoriatic arthritis

A

Pitting and oncholyitis (lifting of the nail from the nail bed)

39
Q

Common sites for enthesitis

A 
Common sites for enthesitis are:
at the top of the shin bone
behind the heel (Achilles tendon)
under the heel
where the ribs join to the breast bone
If your ribs are affected, you may experience chest pain, and you may find it difficult to expand your chest when breathing deeply.
40
Q

Dactylitis

A

Sausage digit

41
Q

Common first sign of scleroderma/systemic sclerosis

A

Swelling of the fingers

42
Q

Common enthsopathies in reactive seronegative autoimmune arthritis

A
  • Plantar fasciitis

- Achilles insertional tendonitis

43
Q

Bamboo spine in which condition?

A

Ankylosing spondylitis

44
Q

Which kind of arthritis may someone with ankylosing spondylitis develop?

A

Knee or hip

45
Q

Conditions associated with ankylosing spondylitis

A

Associated conditions include aortitis, pulmonary fibrosis and amyloidosis.

46
Q

Treatment for ankylosing spondylitis

A

Treatment consists of physiotherapy, exercise, simple analgesia and DMARDs for more aggressive disease. Surgery is mainly reserved for hip and knee arthritis and kyphoplasty to straighten out the spine is controversial and carries considerable risk.

Musculoskeletal (44 decks)

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