Intro To Musculoskeletal Diseases Flashcards
What are bursa?
Synovial membrane lined pockets that allow free movement to adjacent structures where friction would be
Enthesitis?
Inflammation. Where tendons ligaments join onto bone e.g Achilles
Oliogoarthritis?
2-4 joints
Poly arthritis?
More than 5 joints
Example of non inflammatory problems?
Osteoarthritis
Immune mediators and conditions?
IL 1 - gout and autoinflammatory
IL 17- seronegative spondyloarthritis
TNF a- rheumatoid arthritis
Auntoantibodies- connective tissue disease and vascularised
Rheumatoid arthritis doesn’t affect spine but?
Atlanta-axial joint
Clinical measurements for rheumatoid arthritis?
Positve autoantibodies-rheumatoid factor
And or anti-cyclic citrullinated peptide antibodies in around 70%
Seronegative spondyloarthropathy is…
Don’t have autoantibodies
Can Affect spine
Associated with HLA B27 gene
Seronegative spondyloarthropathy includes?
PEAR
Ankylosis spondylitis
Psoriatic arthritis
Reactive arthritis- STI bacterial diarrhoea illness
Enteropathic arthritis- IBD
Most common connective tissue disease?
Lupus
Connective tissue diseases associated with anti nuclear antibodies
MSK disorders are the …… most common cause of disability?
Second
How much pop see GP about MSK problems?
20%
How much does NHS spend each year of treating MSK problems?
10 billion
Osteoarthritis affects how many males and females over 60?
10% males
18% females
Rheumatoid arthritis affects how much of UK pop?
1%
Rheumatoid arthritis is how much more common in women than men?
2-4 times
How many people with rheumatoid arthritis stop work within 2 years of its onset?
1/3
Prevalence/ mean age of seronegative spondyloarthropathy?
1 in 200, 0.5%
Mean age of onset- 24
Gout affects how much of UK population?
2.5%
For septic arthritis what should you do?
Joint aspiration
Check: clarity, colour viscosity
What will you send joint aspirate for?
Gram stain
Bacterial culture
Crystals
White cell differential
Mortality rate for septic arthritis?
11%
Polyarticular disease with sepsis has a mortality rate of?
5O%
Commonest organism for septic arthritis is ?
Staph and strep
Sepsis 6?
Take:
Cultures
Lactate
Urine output
Give:
High flow oxygen
Fluids
IV antibiotics
What causes gout?
Mono sodium urate crystals
Needle shaped, in cooler area
What is pseudo gout?
Calcium pyrophosphate crystals
Many people have high urate but only what percent actually have clinical gout?
10%
What do MSU crystals do?
Activate inflammasome causing IL-1B production and initiation of an intense inflammatory response
What causes hyperuricaemia ?
Age Fam history Mostly men Renal disease, reduced excretion Obesity Diuretics, thiazides Alcohol excess Sweetened soft drinks High dietary purine intake High cell turnover, psoriasis and high grade lymphoma
Protective for hyperuricaemia?
Weight loss
Dairy intake
Coffee
Cherries
Treatment of gout?
Colchine
NSAIDs
Steroids
Acute flares last?
2-7 days
What is first line for gout?
Allopurinol
Less than 300micromol/L
12% patients have properly titrated dose
Chondrocalcinosis?
Deposition of calcium pyrophosphate, pseudo gout
What happens in osteoarthritis?
Thinneing of articular cartilage
Mild thickened inflamed synovium
Ostephytes
Thickened stretched capsule
What happens in osteoarthritis?
Inflammatory factors activate chondrocytes and subchondral osteoblasts
Risk of osteoarthritis?
Obesity Joint injury Genetic Gender, more women Previous joint disease Biomechanical stress Metabolic processes Age
Osteoarthritis nodes?
PIPS- Bouchards nodes
DIPS- heberdens nodes
Clinical features of PIPS and DIPS nodes?
Over 50 Crepitus Bony enlargement and tenderness Morning stiffness less than 30 mins Persistent joint pain aggravated on use
RA occurs usually at what age?
Peaks at 30-50
Septic arthritis classic signs?
Hot red knee painful cant move it and generally poorly
Treatment for osteoarthritis?
Education Strengthening exercises Weight loss Paracetamol Topical NSAIDs
