HD 5- Clinico-pathology of Musculoskeletal Disorders

Question 1

What are the main features of joint disease that should ask your patient?

Answer 1

•	Timing	= Acute vs. chronic
•	Inflammation = Yes/No
•	Deformity = Yes/No (mild/mod/severe)
•	Pattern	 = Mono (1 joint)/ Oligo (2-4 joints)/ Polyarthritis (>5 joints)
•	Impact	= Impairment e.g. bent knee
Activity ↓ - can’t walk

Question 2

Key features of osteoarthritis?

Answer 2

Non-inflammatory, no swelling compared to RA
Happens later in life
A degenerative joint disease. Wear and tear.

Localised pain- increased on weight bearing.
Night pain + early morning stiffness.

Question 3

Management of osteoarthritis?

Answer 3

NSAIDS, steroid injections.
Quads exercises, weight loss.
Total knee/ hip replacements.

Question 4

Key features of rheumatoid arthritis?

Answer 4

Chronic, Inflammatory disease that can happen at any age.

Affects hand joints symmetrically.
Ulner deviation- towards pinky, can affect OH.

Radiographic change- joints fused together

Question 5

Management of rheumatoid arthritis?

Answer 5

•	Education
•	Joint protection
•	Support
•	Painkillers
•	NSAIDs
•	DMARDs (disease modifying anti-rheumatic therapy) eg methotrexate
Can be triple therapy- Methotrexate/sulphasalazine/hydroxychloroquine triple
•	Surgery

Question 6

Dental relevance of rheumatoid arthritis management?

Answer 6

Patients can be on ANTI TNF agents aka biologics.
eg Infliximab

Look harder/more extensively – if pt on biologics less likely to notice symptoms of disease i.e. abscess

Question 7

Key features of ankylosing spondylitis?

Answer 7

•	Chronic
•	Inflammatory 
•	Deforming
•	Axial +/- oligoarthritis
•	↓ spinal movement
o	Difficulty driving car
o	Can’t go shopping

Question mark posture

Question 8

Treatment for ankylosing spondylitis?

Answer 8

• Daily exercises to maintain spinal mobility and posture, maintained with regular physiotherapy input
• Education
• Support
• NSAIDs/coxibs
• Disease Modifying Anti-Rheumatic Drugs (DMARDs): for peripheral arthritis
• Anti-TNF drugs: for peripheral & spinal disease
• Surgery- for spinal complications

Question 9

Key features of Psoriatic arthritis?

Answer 9

Clinically undisguisable from RA.

Affects those with psoriasis. Dactylitis – inflammation of whole finger – sausage like fingers/toes

Red patches on skin

Question 10

Key features of reactive arthritis and Reiter’s syndrome?

Answer 10

Joint pain triggered from an infection else where in body.

Commonly effects young people.

Onset peaks 10-14 days after a distant infection:
o	Gastrointestinal 
(campylobacter, yersinia, salmonella)
o	Urogenital
o	(chlamydia)

Reiter’s syndrome= reactive arthritis + conjunctivitis

Question 11

Key features of Sjogren’s syndrome?

Answer 11

• Fatigue/malaise
• Dry eyes
• Xerostomia
• Dyspareunia- dry fanny
• Arthralgia, arthritis
• Raynaud’s phenomenon (with hyperviscosity)
• Lung: interstitial lung disease
• Renal: renal tubular acidosis

Chronic incurable disease

Question 12

Treatment of Sjogren’s syndrome?

Answer 12

• Eye drops, ointments
• Oral sprays, gels, lozenges
• Vaginal lubricants