Conditions - UKMLA Flashcards
what are other names of osteoarthritis?
Degenerative arthritis
what are the differential diagnoses of osteoarthritis?
Reactive arthritis
Rheumatoid arthritis
Ankylosing spondylitis
Gout
Pseudogout
Psoratic arthritis
Septic arthritis
Bursitis
Baker’s cyst
Popliteal DVT
what is the prognosis of osteoarthritis?
Can be restrictive and progression can vary, but it is not usually disabling.
can lead to functional restrictions
Impact on psychosocial health, as bony deformities and fucntional restriction are likely to affect self-confidence, sleep and mood.
what joints does osteoarthritis most commonly affect?
Distal interphalangeal joints (herberden’s nodes)
Proximal interphalangeal joints (Bouchard’s nodes)
Base of thumb (first capometacarpal joint)
Weight bearing joints such as hips, knees and spine.
what is primary vs secondary arthritis?
primary: localised (one principle site) or generalised.
Secondary: variety of causes including inherited dysplastic disorders, mechanical damage, metabolic causes, or previous inflammation such as seen in gout or rheumatoid.
what are the risk factors of osteoarthritis?
Age
Obesity
wear and tear
what is the pathophysiology of osteoarthritis?
The basic premise is that repair processes intended to repair damage lead to structural changes within a joint.
Excessive weight bearing and stress on a joint is the cause of this.
Cartilage is lost on the site that undergoes this stressful contact
what are signs and symptoms of osteoarthritis?
Joint pain typically related to activity and has developed over months or years.
Morning stiffness may be present but does not last longer than 30 minutes
On examination, joint deformities, joint effusions, joint warmth or tenderness, and crepitus may be felt on passive joint movement.
what is the diagnostic criteria of osteoarthritis?
can be diagnosed clinically without investigations if a person:
- 45 years+
- Activity related joint pain
- Morning stiffness that lasts up to 30 minutes or no stiffness at all
what may be seen on X-Ray of someone with osteoarthritis?
A plain X-Ray film
- Loss of articulating cartilage is seen through narrowing of the joint space
- Osteophytes may be seen
- Subchondral bone thickening occurs due to remodelling following injury
what is the management of osteoarthritis?
Weight loss if over weight
TENS
Walking devices
Analgesia
Intra-articular corticosteroid injections may be required and last for several weeks
May need a joint replacement
what is another name for rheumatoid arthritis?
Inflammatory arthritis
give a brief description of rheumatoid arthritis.
Chronic, symmetrical inflammatory polyarthrtitis.
Involves small joints but may involve soft tissues and extra auricular structures.
symmetrical MCP, PIP joints and wrist.
what are risk factors of rheumatoid arthritis?
Genetic and enviornmental
Smoking
HLA-DR4 gene
what is the pathophysiology of rheumatoid arthritis?
Exclusive to synovial joints.
Inflammatory of the synovial membrane due to the presence of immune complexes in these joints, which leads to activation of the immune system and synovitis
what are signs and symptoms of rheumatoid arthritis?
Symmetrical MCP, PIP and wrist synovitis is characterised, but any synovial joint may be affected.
characteristic deformities:
- Ulnar deviation of MCP fingers
Boutnonniere deformities of fingers
swan0neck deformities of fingers
z-deformity of thumbs
what may be seen in radiology and lab investigations for rheumatoid arthritis?
Radiology: soft-tissue swelling, juxta-auricular osteoporosis, osteopenia, joint space narrowing, bone and joint destruction.
Lab: rheumatoid factor present
ESR and CRP
what is the management of rheumatoid arthritis?
Explain the importance of stopping smoking.
NSAID for pain, stiffness and swelling.
DMARDs which reduce pain, swelling and stiffness, reduce ESR and CRP, correct anaemia and slow disease progression (methtrexate.
Rarely surgical
what is the differential diagnoses of rheumatoid arthritis?
Fibromyalgia
Gout
Reactive arthritis
Polymyalgia rheumatica
Septic arthritis
Sarcoidosis
Lupus
Seronegative spondyloarthropathies
