Diseases of musculoskeletal system - joint and bone Flashcards

1
Q

What are Arthritides?

A

Pain and stiffness of a joint

Inflammation of the joint

Not one single disease but hundreds of diseases

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2
Q

Acute vs. Chronic arthritis

A

Acute is pain, heat, redness and swelling

Chronic types include:
Rheumatoid and Osteo

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3
Q

Osteoarthritis

A

Commonest type of joint disease

  • degenerative joint disease
  • Progressive erosion of articular cartilage
  • formation of bony spurs and cysts at the margins of joints
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4
Q

Epidemiology of OA - Who gets it and why?

A

Ageing phenomenon

No apparent initiating cause

Secondary OA- knee in basket ball players and elbow in baseball players

Underlying systemic diseases such as diabetes and marked obesity

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5
Q

In men and women, where are most common places of OA seen?

A

Knees and hands in women and hip in men

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6
Q

Pathogenesis of OA

A

Chondrocytes-
cellular basis of OA

Chondrocytes produce interleukin-1 – initiates matrix breakdown

Prostaglandin derivatives induces the release of lytic enzymes – prevents matrix synthesis

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7
Q

What is primary OA?

A

Abnormal stresses in weight bearing joints

Affects fingers, knees and cervical and lumbar spines

Involvement of fingers- Herberden’s or Bouchard’s nodes

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8
Q

What is rheumatoid arthritis?

A

Chronic systemic disorder-principally affecting the joints

Producing a non suppurative proliferative synovitis- destruction of articular cartilage and ankylosis of joints

Also affects skin, muscles, heart, lungs and blood vessels

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9
Q

Clinical features of RA

A

Malaise, fatigue and generalised musculoskeletal pain to start off

joints are swollen, warm, painful and stiff in the morning or after activity

slow or rapid disease course over 4-5 years

small joints of the hands and feet are affected - leads to a deformed joint

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10
Q

Pathogenesis of RA

A

Genetic susceptibility-65-80%-
HLA- DR4 &DR1 or both

Primary exogenous arthritogen- EBV,other viruses, Borrelia

Autoimmune reaction within the synovial membranes- CD4 positive T-cells

Mediators of joint damage: e.g.

Cytokines-
IL-1-6 and TNF

-alpha&beta

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11
Q

Criteria for rheumatoid arthritis diagnosis

A
Morning stiffness
Arthritis in 3 or more joint areas
Arthritis of hand joints
Symmetric arthritis
Rheumatoid nodules
Serum Rheumatoid factor

(4 of the above)

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12
Q

What is rheumatoid factor?

A

Present in most but not all RA patients

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13
Q

In RA diagnosis the analysis of synovial fluid - confirms presence of…

A

Neutrophils

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14
Q

How does RA present in the skin?

A

Rheumatoid nodules

Commonest cutaneous manifestation in areas of pressure

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15
Q

RA affects which other organs?

A

Lung
Spleen
Heart

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16
Q

Which 4 arthritides lack the rheumatoid factor?

A

Ankylosing spondylitis

Reiter’s syndrome

Psoriatic arthritis

Enteropathic arthritis

17
Q

What is gout?

A

A group of disorders producing hyperuricemia

Uric acid is the end product of purine metabolism

Deficiency of the enzymes involved

18
Q

Clinical features of Gout

A

Acute arthritis
Chronic arthritis
Tophi in various sites
Gouty nephropathy

19
Q

Transient attacks of acute arthritis crystallization of urates within and about joints leads to what?

A

chronic gouty arthritis and deposition of masses of urates in joints and other sites- tophi

20
Q

What is pyogenic osteomyelitis and how does it present?

A
Systemic illness-fever
Presents:
malaise 
chills
marked pain
21
Q

Diagnosis tools for pyogenic osteomyelitis

A

X-ray lytic focus of bone destruction surrounded by zone of sclerosis

Blood cultures are positive

Biopsy- if needed shows sheets of neutrophils

22
Q

What is pyogenic osteomyelitis caused by and how does it spread?

A

Caused by bacteria
Hematogenous spread
Extension from a contiguous site
Direct implantation

23
Q

What is infective arthritis?

A

Acutely painful and swollen joints with restricted movements

24
Q

What is infective arthritis caused by?

A

Bacterial-
Staphylococcus, Streptococcus,
Gonococcus,
Mycobacteria

25
How does infective arthritis present?
Fever, leucocytosis and elevated ESR
26
What is osteoporosis? Where does it affect?
Increased porosity of the skeleton Reduction in bone mass Localised or entire skeleton Primary or secondary
27
When is onset of osteoporosis usually?
Primary-age and postmenopausal
28
What are risk factors of osteoporosis?
Physical activity Muscle strength Diet Hormonal status
29
Clinical features of osteoporosis?
Vertebral factures Kyphosis Scoliosis
30
What causes secondary osteoporosis?
Endocrine disorders- Hyperparathyroidism, Type1 diabetes Neoplasia-Multiple myeloma Malnutrition
31
What is Paget's disease?
Osteoclast dysfunction | Caused by Paramyxovirus
32
What is the clinical presentation of Paget's disease?
Pain is most common symptom Chalk stick type fractures
33
When does Paget's disease first present?
Begins in the 5th decade More common in males Axial skeleton and proximal skeleton is most commonly involved
34
Types of tumours due to Paget's disease
Giant cell tumours are benign Malignant: Osteosarcoma Chrondrosarcoma Malignant fibrous histiocytoma
35
What is Osteomalaica? How does it present clinically?
Defects in matrix mineralization Related to lack of Vit D Decreased bone density - too little bone-osteopenia Skeletal deformities are not seen
36
What is renal osteodystrophy?
Skeletal changes of chronic renal disease
37
Clinical symptoms and presentation of renal osteodystrophy
Increased osteoclastic bone resorption Delayed matrix mineralization Osteosclerosis Growth retardation Osteoporosis