GP- MSK and rheumatology Flashcards
Risk factor for OA
obesity, age, occupation, trauma, being female and family history.
definition and pathophysiology of OA
“wear and tear” in the joints.
It occurs in the synovial joints and results from genetic factors, overuse and injury.
Osteoarthritis is thought to result from an imbalance between cartilage damage and the chondrocyte response, leading to structural issues in the joint
Commonly Affected Joints OA
Hips
Knees
Distal interphalangeal (DIP) joints in the hands
Carpometacarpal (CMC) joint at the base of the thumb
Lumbar spine
Cervical spine (cervical spondylosis)
X ray changes on OA
OA presentation and general signs
OA signs in the hands
TOM TIP: Patients may present with referred pain, particularly in the adjacent joints. For example, consider osteoarthritis in the hip in patients presenting with lower back or knee pain.
- OA NICE diagnosis criteria
The NICE guidelines (2022) suggest that a diagnosis can be made without any investigations if the patient is over 45, has typical pain associated with activity and has no morning stiffness (or stiffness lasting under 30 minutes).
OA management
Chronic fatigue syndrome definition
Diagnosed after at least 3 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease which may explain symptoms
Chronic fatigue syndrome epidemiology
Epidemiology
more common in females
past psychiatric history has not been shown to be a risk factor
Chronic fatigue syndrome features
Fatigue is the central feature, other recognised features include
* sleep problems, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep-wake cycle
* muscle and/or joint pains
* headaches
* painful lymph nodes without enlargement
* sore throat
* cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding
* physical or mental exertion makes symptoms worse
* general malaise or ‘flu-like’ symptoms
* dizziness
* nausea
* palpitations
Chronic fatigue syndrome investigations
Investigation
NICE guidelines suggest carrying out a large number of screening blood tests to exclude other pathology e.g. FBC, U&E, LFT, glucose, TFT, ESR, CRP, calcium, CK, ferritin, coeliac screening, HbA1C and also urinalysis
Chronic fatigue syndrome diagnosis
Diagnosis
NICE publish diagnostic criteria NICE
a diagnosis is typically made if the symptoms persist for 3 months
Chronic fatigue syndrome management
Fibromyalgia definition
Fibromyalgia is a chronic, complex, and widespread pain syndrome. Patients experience body pain that occurs on both sides, front and back, and above and below the diaphragm for a duration of at least three months. This pain is often accompanied by fatigue, mood disturbances, and sleep issues.
Fibromyalgia epidemiology
women are around 5 times more likely to be affected
typically presents between 30-50 years old
Fibromyalgia features
The cardinal symptom of fibromyalgia is chronic, widespread body pain, often described as a constant dull ache. This is accompanied by:
- Fatigue, often waking up tired despite sufficient sleep
- Cognitive disturbances, such as problems with focus and memory, known as ““fibro fog””
- Mood disorders, particularly depression and anxiety
- Sleep disturbances, including insomnia
- headaches and dizziness
Fibromyalgia differentials
- Rheumatoid arthritis: Characterized by joint pain, swelling, and redness
- Chronic fatigue syndrome: Marked by severe, unexplained fatigue
- Lupus: Presents with rash, joint pain, and kidney problems
- Hypothyroidism: Accompanied by weight gain, constipation, and cold sensitivity
Fibromyalgia diagnosis and investigations
Diagnosis of fibromyalgia is primarily clinical, based on the patient’s history and physical examination. The American College of Rheumatology (ACR) criteria, which include widespread pain for at least three months and tenderness at 11 or more of the 18 specific tender points, are commonly used.
Fibromyalgia management
another term for low back pain
Lumbago is another term for low back pain
majority of patients who do not have a specific disease causing their lower back pain, have what type of back pain?
Non-specific or mechanical lower back pain
Another term for lower back pain
lumbago
Acute low back pain should improve within …
Acute low back pain should improve within 1-2 weeks