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Bones and Joints > Bone and Joint Disease > Flashcards

Bone and Joint Disease Flashcards

1
Q

What are the aims of treatment for RA?

A 
Control of pain 
Early treatment to prevent joint destruction and consequent deformity/disability 
Monitor disease progression 
Prevention of disease complications
Improving quality of life
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2
Q

What are the treatment options?

A 
Pain relief - NSAIDs 
Physiotherapy 
DMARDs e.g. TNF inhibitors 
Steroids 
Methotrexate 
Immunosuppression = steroids, DMARDs, methotrexate
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3
Q

What is osteomyelitis?

A

Inflammation of bone marrow

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4
Q

What causes osteomyelitis?

A

Pyogenic bacterial infection = PYOGENIC OSTEOMYELITIS

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5
Q

What is the main causative organism of osteomyelitis?

A

Staph aureus - 80-90% of cases

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6
Q

Name other bacteria which can cause osteomyelitis.

A

Ecoli, group B strep, Salmonella, M TB

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7
Q

How do organisms gain entry into the bone?

A

Haematogenous dissemination
Spread to bone from adjacent site
Trauma
Surgical - Iatrogenic

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8
Q

Where does pus originally form in osteomyelitis and how does it spread?

A

Pus originally forms in the bone shaft. The increasing pressure compresses the blood supply leading to necrosis of the medullary bone.

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9
Q

What happens to pus after it has formed and caused necrosis of the medullary bone?

A

Pus is then forced through the bone cortex to under the periosteum.

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10
Q

What is sequestrum?

A

Lifting of the periosteum due to pus impacts on further blood loss for the cortical bone. In response the cortical bone becomes necrotic and is trapped, forming the sequestrum.

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11
Q

What is involucrum?

A

Periosteum lays down new bone ontop of the sequestrum.

Involcrum on surface with sequestrum beneath.

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12
Q

How does an abscess form and what can it lead to?

A

Abscesses are formed when pus breaks into soft tissues.

Abscesses can form a sinus when it opens into the skin surface.

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13
Q

What is pus formed of under the microscope (histology)?

A

Necrotic tissue debris, neutrophils and dead fragmented neutrophils

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14
Q

What are the treatment options for osteomyelitis?

A

Antibiotics according to culture and sensitivity.
Inadequate treatment with antibiotics can lead to chronic infection and features of chronicity e,g, sequestrum.
Surgical debridement also an option to remove pus and necrotic tissue (usually only after 24-28hrs with no improvement from antibiotics)

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15
Q

What is gout?

A

Arthritis initiated by deposition of urate crystals within and around joints. Caused by excess uric acid in the tissues and plasma = hyperuricaemia

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16
Q

What is primary gout?

A

90% of cases, cause is unknown, probably due to unknown enzymatic defect

17
Q

What is secondary gout?

A

Caused by another condition that leads to a increase in production of uric acid (leukaemia, chronic renal disease)

18
Q

What causes acute arthritis gouty attack?

A

Monosodium urate (MSU) precipitates (crystalizes) within joints, triggering an acute inflammatory reaction. (infiltration by neutrophils)

19
Q

What are the preferences for an acute gout attack?

A

Peripheral joints of the body where the synovial fluid is a poor solvent and temperature is low

20
Q

Which joint is commonly affected in acute gout attacks and what symptoms appear?

A

Joint of the big toe, signs of acute inflammation - red, hot, pain, swelling, loss of function

21
Q

Describe how chronic gout occurs.

A

Repeated attacks of acute gouty arthritis. Results in urate crystal deposition in the synovial membrane.

22
Q

What are urate crystal deposition fragments called in chronic gout and what is the condition?

A

Tophi, chronic tophaceous gout

23
Q

What happens in chronic gout?

A

An intense chronic inflammatory pathway in the synovium leading to pannus formation and cartilage/bone destruction.

24
Q

Name treatment options for gout.

A

NSAIDS - anti-inflammatory, pain relief
Colchicine - inhibits neutrophil mobility and activity
Hydration
Low dose steroids - if NSAIDS unsuccessful
Medical assessment to reduce risk factors

25
Q

What is septic arthritis?

A

Infection in joint leading to acute inflammation and pus accumulation in joint cavity (replaces normal clear synovial fluid)

26
Q

How do organisms gain entry for septic arthritis?

A

Bacteraemia (Hematogenous spread)
Surgery (Iatrogenic)
Trauma

27
Q

What is the most common causative organism for septic arthritis?

A

Staph Aureus

28
Q

What is a classic picture/case of septic arthritis?

A

Haematogenous septic arthritis - young child with fever and severe localized joint pain, swelling and limitation in ROM.

29
Q

What is the treatment for septic arthritis?

A

Surgical and irrigation of affected joint and treatment with systemic antibiotic therapy

Bones and Joints (2 decks)

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