gout and osteoarthritis

Question 1

signs & symptoms of joint disease

Answer 1

Symptoms of Joint Disease
PAIN
IMMOBILITY STIFFNESS
LOSS OF FUNCTION

Signs of Joint Disease
Swelling (fluctuant, bony, synovial)
Deformity
Redness = infection due to inflammation
Crepitus

LOSS OF FUNCTION

Question 2

investigations of joint disease

Answer 2

Radiography
Plain
MRI (soft tissue and inside the joints), Arthrography (dye injected in)

Blood
C-reactive protein (CRP)
Rheumatoid factors (RF)
Extractable Nuclear Antigens (ENA’s)
Anti DS-DNA, Anti-Nuclear Antibody (ANA)
Arthroscopy (look inside the joint) & Biopsy (joint swelling)

Question 3

acute monoarthropathies

Answer 3

acute arthritis of a single joint

common causes:
infection - septic arthritis
crystal arthropathy - gout

can be initial stage of polyarthritis

Question 4

what is gout

Answer 4

Uric acid crystal deposition in joints


Significant pain from reactive inflammation


hyperuricaemia - high uric acid levels

Drug induced = thiazide diuretics
genetic predisposition
nucleic acid breakdown post chemotherapy cancer treatment = nuclei floating will be repositioned myeloma

obesity and alcohol enhance


Less common in women until menopause - then equalises

Question 5

gout symptoms

Answer 5

acute inflammation of SINGLE joint
usually great toe
usually a precipitating event = trauma, surgery, illness, diet/alcohol excess

rapid onset - hours
NSAIDs to treat
excruciating pain

Question 6

dental aspects of gout

Answer 6

avoid aspirin !
interferes with uric acid removal


drug treatments may give oral ulceration (allopurinol)

Question 7

what is osteoarthritis

Answer 7

symptomatic in 10% population BUT 60% show degenerative changes on XR


DEGENERATIVE joint disease

weight bearing joints/joint damage
HIPS AND KNEES MOSTLY

NOT wear and tear
problem is cartilage repair dysfunction

Question 8

symptoms and signs of osteoarthritis

Answer 8

Symptoms of Osteoarthritis
PAIN
improves with rest
worse with activity

BRIEF morning stiffness

SLOWLY progressive over years

Signs of Osteoarthritis
Radiographs
loss of joint space & subchondral sclerosis
osteophyte lipping at joint edge

radiographs may show ASYMPTOMATIC changes - is OA the cause of symptoms?

Joint swelling & deformity

Question 9

treatment of osteoarthritis

Answer 9

CAN’T STOP DISEASE PROGRESSION

Pain improved by
increasing muscle strength around the joint
weight loss
walking aids
role of NSAIDs
Prosthetic replacement for PAIN
Joint Replacement

Question 10

dental aspects of osteoarthritis

Answer 10

TMJ can be involved
symptoms RARE!
Difficulty in accessing care
chronic NSAID use
oral ulceration possible
bleeding tendency - anti-platelet
Joint replacements - AB prophylaxis?
Usually not needed