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Year 2 Medicine > Introduction to Diseases of the Musculoskeletal System > Flashcards

Introduction to Diseases of the Musculoskeletal System Flashcards

1
Q

Nomenclature - MSK

  • To describe problems with bones, use the prefix …
  • To describe problems with muscle, use the prefix …/…
  • To describe problems with joints, use the prefix …
  • The prefix … describes cartilage
  • To denote inflammation, use the suffix -…
  • To denote pain, use the suffix -…
A
  • To describe problems with bones, use the prefix OSTEO
  • To describe problems with muscle, use the prefix MY/MYO
  • To describe problems with joints, use the prefix ARTH
  • The prefix CHOND describes cartilage
  • To denote inflammation, use the suffix -ITIS
  • To denote pain, use the suffix -ALGIA
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2
Q

… – Tendon problem (inflammation)

A

Tendonitis – Tendon problem (inflammation)

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3
Q

Bursae are … membrane lined pockets that serve to allow free movement of adjacent structures where otherwise, there could be …

A

Bursae are synovial membrane lined pockets that serve to allow free movement of adjacent structures where otherwise, there could be friction.

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4
Q

… – Inflammation of bursa

A

Bursitis – Inflammation of bursa

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5
Q

… – Inflammation of an enthesis.

A

Enthesitis – Inflammation of an enthesis.

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6
Q

… are the points where tendons, ligaments or joint capsules insert into bone. The largest site is the Achilles insertion.

A

Entheses are the points where tendons, ligaments or joint capsules insert into bone. The largest site is the Achilles insertion.

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7
Q

Entheses are the points where tendons, ligaments or joint capsules insert into bone. The largest site is the … insertion

A

Entheses are the points where tendons, ligaments or joint capsules insert into bone. The largest site is the Achilles insertion.

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8
Q

Osteoporosis – Reduced bone …

A

Osteoporosis – Reduced bone density

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9
Q

… – Poor bone mineralisation

A

Osteomalacia – Poor bone mineralisation

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10
Q

Osteomyelitis – Bone …

A

Osteomyelitis – Bone infection

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11
Q

Osteosarcoma – An example of … bone …

A

Osteosarcoma – An example of malignant bone tumour

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12
Q

Which word would you use to describe muscle inflammation?

  • 1) Myopathy
  • 2) Myositis
  • 3) Myalgia
A

2) Myositis

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13
Q

Muscle conditions

  • … - Pain in muscles.
    • Very common.
    • Commonly associated with viral infections.
    • Can be drug induced (eg by statins).
  • … - Inflammation of the muscles.
    • Far less common than … and can be autoimmune
A
  • Myalgia - Pain in muscles.
    • Very common.
    • Commonly associated with viral infections.
    • Can be drug induced (eg by statins).
  • Myositis - Inflammation of the muscles.
    • Far less common than myalgia and can be autoimmune
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14
Q

Myalgia - Pain in muscles.

  • Very ….
  • Commonly associated with … infections.
  • Can be … induced (eg by ..).
A
  • Very common.
  • Commonly associated with viral infections.
  • Can be drug induced (eg by statins).
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15
Q

Myositis - Inflammation of the muscles

  • Far … common than myalgia and can be …
A
  • Far less common than myalgia and can be autoimmune
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16
Q

What is a joint?

A
  • A joint is formed where two or more bones meet each other
  • This is an example of a normal joint
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17
Q

Approach to a patient with musculoskeletal disorder

  • Full history & Physical examination - Often enough to make a diagnosis
  • … tests – help to support the diagnosis
A
  • Full history & Physical examination - Often enough to make a diagnosis
  • Serological tests – help to support the diagnosis
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18
Q

Some ways of classifying rheumatic disease

A
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19
Q

Joint pain - Articular or Periarticular?

A
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20
Q

Periarticular joint pain

  • Point … over the involved structure, Pain reproduced by … involving that structure
  • Which structure?
    • Bursa?
    • Tendon?
    • Tendon …?
    • Ligament?
    • Others?
A
  • Point tenderness over the involved structure, Pain reproduced by movement involving that structure
  • Which structure?
    • Bursa?
    • Tendon?
    • Tendon sheath?
    • Ligament?
    • Others?
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21
Q

Periarticular joint pain

  • … tenderness over the involved structure, Pain reproduced by movement involving that structure
  • Which structure?
    • …?
    • …?
    • Tendon sheath?
    • …?
    • Others?
A
  • Point tenderness over the involved structure, Pain reproduced by movement involving that structure
  • Which structure?
    • Bursa?
    • Tendon?
    • Tendon sheath?
    • Ligament?
    • Others?
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22
Q

Articular Joint pain

  • … … tenderness, pain at the … range of movement in any direction
  • Inflammatory/…?
    • Any signs of inflammation?
    • Features of … problem?
      • Locking, catching etc
A
  • Joint line tenderness, pain at the end range of movement in any direction
  • Inflammatory/mechanical?
    • Any signs of inflammation?
    • Features of mechanical problem?
      • Locking, catching etc
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23
Q

Articular Joint pain

  • Joint line tenderness, pain at the end range of … in any direction
  • …/mechanical?
    • Any signs of …?
    • Features of mechanical problem?
      • Locking, catching etc
A
  • Joint line tenderness, pain at the end range of movement in any direction
  • Inflammatory/mechanical?
    • Any signs of inflammation?
    • Features of mechanical problem?
      • Locking, catching etc
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24
Q

Articular Joint pain

  • Joint line tenderness, pain at the end range of movement in … direction
  • Inflammatory/mechanical?
    • Any signs of inflammation?
    • Features of mechanical problem?
      • …, catching etc
A
  • Joint line tenderness, pain at the end range of movement in any direction
  • Inflammatory/mechanical?
    • Any signs of inflammation?
    • Features of mechanical problem?
      • Locking, catching etc
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25
_Joint inflammation nomenclature_ * MonoARTHRITIS – arthritis affecting ... joint * OligoARTHRITIS – arthritis affecting .... or fewer joints * PolyARTHRITIS – arthritis affecting ... or more joints
* MonoARTHRITIS – arthritis affecting **1** joint * OligoARTHRITIS – arthritis affecting **4** or fewer joints (2-4) * PolyARTHRITIS – arthritis affecting **5** or more joints (\>=5)
26
_Joint inflammation nomenclature_ * ...ARTHRITIS – arthritis affecting 1 joint * ...ARTHRITIS – arthritis affecting 4 or fewer joints (2-4) * ...ARTHRITIS – arthritis affecting 5 or more joints (\>=5)
* **MonoARTHRITIS** – arthritis affecting 1 joint * **OligoARTHRITIS** – arthritis affecting 4 or fewer joints (2-4) * **PolyARTHRITIS** – arthritis affecting 5 or more joints (\>=5)
27
_Joint inflammation nomenclature_ * MonoARTHRITIS – arthritis affecting ... joint * OligoARTHRITIS – arthritis affecting ... or fewer * PolyARTHRITIS – arthritis affecting ... or more joints
* **MonoARTHRITIS – arthritis affecting 1 joint** * **OligoARTHRITIS – arthritis affecting 4 or fewer joints (2-4)** * **PolyARTHRITIS – arthritis affecting 5 or more joints (\>=5)**
28
_Rheumatology Terms_
29
Main differential diagnoses for polyarticular condition (4)
RA, SLE, crystal induced, infectious
30
You are asked to review a patient presenting with thenar eminence atrophy. Which nerve do you think is affected? * 1)Ulnar nerve * 2)Radial nerve * 3)Median nerve
* 1)Ulnar nerve * 2)Radial nerve * **3)Median nerve**
31
Which epicondyle is affected in tennis elbow? * 1)Medial * 2)Lateral
* 1)Medial * **2)Lateral**
32
_Soft tissue conditions_ * Problems with radiolucent moving tissues * Very common, part of everyday life * Some examples: * tennis elbow (... epicondylitis) * golfers elbow (... epicondylitis) * carpal tunnel (... nerve compression as it passes through the carpal tunnel in the wrist)
* Problems with radiolucent moving tissues * Very common, part of everyday life * Some examples: * tennis elbow (**lateral** epicondylitis) * golfers elbow (**medial** epicondylitis) * carpal tunnel (**median** nerve compression as it passes through the carpal tunnel in the wrist)
33
_Soft tissue conditions_ * Problems with radiolucent moving tissues * Very common, part of everyday life * Some examples: * ... elbow (lateral epicondylitis) * ... elbow (medial epicondylitis) * ... tunnel (median nerve compression as it passes through the ... tunnel in the wrist)
* Problems with radiolucent moving tissues * Very common, part of everyday life * Some examples: * **tennis** elbow (lateral epicondylitis) * **golfers** elbow (medial epicondylitis) * **carpal** tunnel (median nerve compression as it passes through the **carpal** tunnel in the wrist)
34
_Soft tissue conditions_ * Problems with ... moving tissues * Very ..., part of everyday life * Some examples: * tennis elbow (... epicondylitis) * golfers elbow (... epicondylitis) * carpal tunnel (median nerve compression as it passes through the carpal tunnel in the wrist)
* Problems with **radiolucent** moving tissues * Very **common**, part of everyday life * Some examples: * tennis elbow (**lateral** epicondylitis) * golfers elbow (**medial** epicondylitis) * carpal tunnel (median nerve compression as it passes through the carpal tunnel in the wrist)
35
_Importance of rheumatic disease_ * 4 features
36
_Worldwide Impact of rheumatic disease - World Health Organization_
37
MSK disorders are the ... most common cause of disability worldwide, measured by years lived with disability (YLDs)
MSK disorders are the **second** most common cause of disability worldwide, measured by years lived with disability (YLDs)
38
Low ... pain is the single leading cause for disability globally
Low **back** pain is the single leading cause for disability globally
39
Disability due to MSK disorders is estimated to have increased by ...% from 1990 to 2010, in particular OA, and is expected to continue to rise with an increasingly obese, sedentary and ageing population.
Disability due to MSK disorders is estimated to have increased by **45**% from 1990 to 2010, in particular OA, and is expected to continue to rise with an increasingly obese, sedentary and ageing population.
40
_UK Impact - Rheumatic diseases_ * ... greatest impact on the health of the UK population, considering both death and disability (Lancet 9 March 2013) * Musculoskeletal disorders account 15.6% * Low back pain accounts for over ... of this * Ranking of major causes of death and disability
* **Third** greatest impact on the health of the UK population, considering both death and disability (Lancet 9 March 2013) * Musculoskeletal disorders account 15.6% * Low back pain accounts for over **half** of this * Ranking of major causes of death and disability
41
_UK Impact - Rheumatic diseases_ * Third greatest impact on the health of the UK population, considering both death and disability (Lancet 9 March 2013) * Musculoskeletal disorders account ...% * Low back pain accounts for over half of this * Ranking of major causes of death and disability
* Third greatest impact on the health of the UK population, considering both death and disability (Lancet 9 March 2013) * Musculoskeletal disorders account **15.6**% * Low back pain accounts for over half of this * Ranking of major causes of death and disability
42
_How much do you estimate the NHS in the UK spends in a year on treating musculoskeletal conditions?_ * 1)50 million * 2)1 billion * 3)10 billion
* 1)50 million * 2)1 billion * **3)10 billion**
43
_UK Impact - Rheumatic diseases_ * Each year ...% of the general population sees a GP about an MSK problem (mostly due to back pain and OA) * The NHS in the UK spends £... billion per year on treating musculoskeletal conditions * The prevalence of MSK conditions rises with age. For example, of people aged 45-64 years, 27% have sought treatment from their GP for osteoarthritis, rising to 45.5% among those aged over 75 years.
* Each year **20**% of the general population sees a GP about an MSK problem (mostly due to back pain and OA) * The NHS in the UK spends £**10** billion per year on treating musculoskeletal conditions * The prevalence of MSK conditions rises with age. For example, of people aged 45-64 years, 27% have sought treatment from their GP for osteoarthritis, rising to 45.5% among those aged over 75 years.
44
_UK Impact - Rheumatic diseases_ * Each year ...% of the general population sees a GP about an MSK problem (mostly due to back pain and OA) * The NHS in the UK spends £10 billion per year on treating musculoskeletal conditions * The prevalence of MSK conditions ... with age.
* Each year **20**% of the general population sees a GP about an MSK problem (mostly due to back pain and OA) * The NHS in the UK spends £10 billion per year on treating musculoskeletal conditions * The prevalence of MSK conditions **rises** with age. For example, of people aged 45-64 years, 27% have sought treatment from their GP for osteoarthritis, rising to 45.5% among those aged over 75 years.
45
_MSK disorders and Work_ * Poor musculoskeletal health is a major barrier to workplace participation. * People with musculoskeletal conditions are ... likely to be employed than people in good health, and ... likely to retire early.
* Poor musculoskeletal health is a major barrier to workplace participation. People with musculoskeletal conditions are **less** likely to be employed than people in good health, and **more** likely to retire early.
46
Poor musculoskeletal health is a major barrier to workplace participation. Give 2 examples
**People with musculoskeletal conditions are less likely to be employed than people in good health, and more likely to retire early.**
47
_Inflammatory v.s non-inflammatory joint pain_
48
_Inflammatory v.s non-inflammatory joint pain_
49
_Inflammatory v.s non-inflammatory joint pain_
50
_Inflammatory v.s non-inflammatory joint pain_
51
30 year old female, who presents with a three month history of painful, swollen MCPs and wrists. The pain is worse in the mornings and EMS lasts 3 hours. Heat and movement help the pain but when she stops moving her hands the pain returns. * 1) Non-inflammatory * 2) Inflammatory
* 1) Non-inflammatory * **2) Inflammatory**
52
50 year old ex-rugby player presents with 3 years of painful swollen right knee and painful left hip. He works as builder and by the end of the day the pain is worse. Rest and elevation of the knee helps the pain. EMS lasts 30 minutes. * 1) Non-inflammatory * 2) Inflammatory
* **1) Non-inflammatory** * 2) Inflammatory
53
You are asked to review a 35 year old male, who presents with a 2 days history of a painful, swollen right knee. What are your differential diagnosis? * 1) Post-traumatic hemarthrosis * 2) Gout * 3) Septic arthritis * 4) All of the above
* 1) Post-traumatic hemarthrosis * 2) Gout * 3) Septic arthritis * **4) All of the above**
54
_Septic Arthritis_
Beware the diabetic or immunosuppressed patients! - often not normal inflammatory response
55
_Septic Arthritis Aspiration_ * Differential diagnosis of ... ... joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * ... * Viscosity * Send for: * Gram stain * ... Culture * Crystals * White cell differential
* Differential diagnosis of **hot swollen** joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * **Colour** * Viscosity * Send for: * Gram stain * **Bacterial** Culture * Crystals * White cell differential
56
_Septic Arthritis Aspiration_ * Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * ... * Colour * ... * Send for: * ... stain * Bacterial Culture * Crystals * White cell differential
* Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * **Clarity** * Colour * **Viscosity** * Send for: * **Gram** stain * Bacterial Culture * Crystals * White cell differential
57
_Septic Arthritis Aspiration_ * Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * ... * ... * ... * Send for: * Gram stain * Bacterial Culture * ... * White cell differential
* Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * **Clarity** * **Colour** * **Viscosity** * Send for: * Gram stain * Bacterial Culture * **Crystals** * White cell differential
58
_Septic Arthritis Aspiration_ * Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * Colour * Viscosity * Send for: * ... stain * Bacterial ... * Crystals * ... cell differential
* Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * Colour * Viscosity * Send for: * **Gram** stain * Bacterial **Culture** * Crystals * **White** cell differential
59
_Septic Arthritis Aspiration_ * Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * Colour * Viscosity * Send for: * Gram stain * Bacterial Culture * Crystals * White cell differential
* Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * Colour * Viscosity * Send for: * Gram stain * Bacterial Culture * Crystals * White cell differential
60
_Septic Arthritis Aspiration_ * Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * Colour * ... * Send for: * Gram ... * Bacterial Culture * Crystals * White cell ...
* Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * Colour * **Viscosity** * Send for: * Gram **stain** * Bacterial Culture * Crystals * White cell **differential**
61
_Septic Arthritis Aspiration_ * Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: (3) * Send for: (4)
* Differential diagnosis of hot swollen joint is wide: * ALWAYS do joint aspiration * Check: * Clarity * Colour * Viscosity * Send for: * Gram stain * Bacterial Culture * Crystals * White cell differential
62
_Septic Arthritis_ * Always think about it in a patient with a (usually) ..., ... and swollen joint. * Mortality rates are of ...%. This increases to 50% in polyarticular disease with sepsis. * The commonest organisms are staph and strep * They do not have to be systemically unwell and they may be able to weight bear. * Seek senior advice. Do not delay antibiotic therapy.
* Always think about it in a patient with a (usually) **single, hot** and swollen joint. * Mortality rates are of **11**%. This increases to 50% in polyarticular disease with sepsis. * The commonest organisms are staph and strep * They do not have to be systemically unwell and they may be able to weight bear. * Seek senior advice. Do not delay antibiotic therapy.
63
_Septic Arthritis_ * Always think about it in a patient with a (usually) single, hot and swollen joint. * Mortality rates are of 11%. This increases to ...% in polyarticular disease with sepsis. * The commonest organisms are ... and strep * They do not have to be systemically unwell and they may be able to weight bear. * Seek senior advice. Do not delay antibiotic therapy.
* Always think about it in a patient with a (usually) single, hot and swollen joint. * Mortality rates are of 11%. This increases to **50**% in polyarticular disease with sepsis. * The commonest organisms are **staph** and strep * They do not have to be systemically unwell and they may be able to weight bear. * Seek senior advice. Do not delay antibiotic therapy.
64
_Septic Arthritis_ * Always think about it in a patient with a (usually) single, hot and swollen joint. * Mortality rates are of 11%. This increases to 50% in polyarticular disease with sepsis. * The commonest organisms are staph and strep * They do not have to be ... unwell and they may be able to ... ... * Seek senior advice. Do not delay ... therapy.
* Always think about it in a patient with a (usually) single, hot and swollen joint. * Mortality rates are of 11%. This increases to 50% in polyarticular disease with sepsis. * The commonest organisms are staph and strep * They do not have to be **systemically** unwell and they may be able to **weight bear.** * Seek senior advice. Do not delay **antibiotic** therapy.
65
_Septic Arthritis_ * Always think about it in a patient with a (usually) single, hot and ... joint. * Mortality rates are of 11%. This increases to 50% in ... disease with sepsis. * The commonest organisms are staph and strep * They do not have to be systemically unwell and they may be able to weight bear. * Seek ... ... Do not delay antibiotic therapy.
* Always think about it in a patient with a (usually) single, hot and **swollen** joint. * Mortality rates are of 11%. This increases to 50% in **polyarticular** disease with sepsis. * The commonest organisms are staph and strep * They do not have to be systemically unwell and they may be able to weight bear. * Seek **senior advice.** Do not delay antibiotic therapy.
66
_Septic Arthritis Management - Sepsis 6_
67
_Gout_ * ... common inflammatory arthropathy worldwide * Serum ... levels \> physiological saturation point (around 408 μmol/L) * Monosodium ... crystals - form and deposit (Cartilage, bone and periarticular tissues of peripheral joints)
* **Most** common inflammatory arthropathy worldwide * Serum **urate** levels \> physiological saturation point (around 408 μmol/L) * Monosodium **urate** crystals - form and deposit (Cartilage, bone and periarticular tissues of peripheral joints)
68
_Gout_ * Most common inflammatory arthropathy worldwide * Serum urate levels \> physiological saturation point (around 408 μmol/L) * Monosodium urate crystals - form and deposit (..., ... and ... tissues of peripheral joints)
* Most common inflammatory arthropathy worldwide * Serum urate levels \> physiological saturation point (around 408 μmol/L) * Monosodium urate crystals - form and deposit (**Cartilage, bone and periarticular tissues of peripheral joints)**
69
_Gout Epidemiology_ * Crystal deposition is often clinically ... * About ...% of people with hyperuricaemia develop clinical gout * UK GP Studies show the prevalence of gout per 1,000 has been steadily increasing from 2.6 in 1975, to 3.4 in 1987, and 9.5 in 1993 * 1 in 40 adults in the UK is affected by gout= 2.5% - 15 years analysis (2014) * Clinical cure is achievable with treatment which is cheap, widely available, and under-prescribed
* Crystal deposition is often clinically **silent** * About **10**% of people with hyperuricaemia develop clinical gout * UK GP Studies show the prevalence of gout per 1,000 has been steadily increasing from 2.6 in 1975, to 3.4 in 1987, and 9.5 in 1993 * 1 in 40 adults in the UK is affected by gout= 2.5% - 15 years analysis (2014) * Clinical cure is achievable with treatment which is cheap, widely available, and under-prescribed
70
_Gout Epidemiology_ * Crystal deposition is often clinically silent * About 10% of people with hyperuricaemia develop clinical gout * UK GP Studies show the prevalence of gout per 1,000 has been steadily increasing from ... in 1975, to 3.4 in 1987, and ... in 1993 * 1 in ... adults in the UK is affected by gout= 2.5% - 15 years analysis (2014) * Clinical cure is achievable with treatment which is cheap, widely available, and under-prescribed
* Crystal deposition is often clinically silent * About 10% of people with hyperuricaemia develop clinical gout * UK GP Studies show the prevalence of gout per 1,000 has been steadily increasing from **2.6** in 1975, to 3.4 in 1987, and **9.5** in 1993 * 1 in **40** adults in the UK is affected by gout= 2.5% - 15 years analysis (2014) * Clinical cure is achievable with treatment which is cheap, widely available, and under-prescribed
71
_Gout Epidemiology_ * ... deposition is often clinically silent * About 10% of people with hyperuricaemia develop clinical gout * UK GP Studies show the prevalence of gout per 1,000 has been steadily increasing from 2.6 in 1975, to 3.4 in 1987, and 9.5 in 1993 * 1 in 40 adults in the UK is affected by gout= 2.5% - 15 years analysis (2014) * Clinical cure is achievable with treatment which is ..., ... available, and ...-prescribed
* **Crystal** deposition is often clinically silent * About 10% of people with hyperuricaemia develop clinical gout * UK GP Studies show the prevalence of gout per 1,000 has been steadily increasing from 2.6 in 1975, to 3.4 in 1987, and 9.5 in 1993 * 1 in 40 adults in the UK is affected by gout= 2.5% - 15 years analysis (2014) * Clinical cure is achievable with treatment which is **cheap, widely available, and under-prescribed**
72
_Who gets gout?_ * ... aged 40 years and over, ... over 65 years * It increases with age, affecting 15% of men aged over 75 in the United Kingdom * Epidemiological studies show that the ... syndrome and its components (insulin resistance, obesity, hyperlipidaemia, and hypertension) are strongly associated with gout
* **Men** aged 40 years and over, **Women** over 65 years * It increases with age, affecting 15% of men aged over 75 in the United Kingdom * Epidemiological studies show that the **metabolic** syndrome and its components (insulin resistance, obesity, hyperlipidaemia, and hypertension) are strongly associated with gout
73
_Who gets gout?_ * Men aged ... years and over, Women over ... years * It increases with age, affecting ...% of men aged over 75 in the United Kingdom * Epidemiological studies show that the metabolic syndrome and its components (insulin resistance, obesity, hyperlipidaemia, and hypertension) are strongly associated with gout
* Men aged **40** years and over, Women over **65** years * It increases with age, affecting **15**% of men aged over 75 in the United Kingdom * Epidemiological studies show that the metabolic syndrome and its components (insulin resistance, obesity, hyperlipidaemia, and hypertension) are strongly associated with gout
74
_Who gets gout?_ * Men aged 40 years and over, Women over 65 years * It increases with age, affecting 15% of men aged over 75 in the United Kingdom * Epidemiological studies show that the metabolic syndrome and its components (... resistance, obesity, hyper..., and ...) are strongly associated with gout
* Men aged 40 years and over, Women over 65 years * It increases with age, affecting 15% of men aged over 75 in the United Kingdom * Epidemiological studies show that the metabolic syndrome and its components (**insulin** resistance, obesity, **hyperlipidaemia**, and **hypertension**) are strongly associated with gout
75
_Risk factors for gout (7)_
76
_Risk factors for gout_ * .... sex * Older age * ... factors (mainly reduced excretion of urate) * Chronic ... disease (reduced excretion of urate) * Metabolic syndrome * Obesity * ...tension * Hyperlipidaemia * Loop and thiazide diuretics (reduce excretion of urate) * Osteoarthritis (enhanced crystal formation) * Dietary factors (increased production of uric acid
* **Male** sex * Older age * **Genetic** factors (mainly reduced excretion of urate) * Chronic **kidney** disease (reduced excretion of urate) * Metabolic syndrome * Obesity * **Hypertension** * Hyperlipidaemia * Loop and thiazide diuretics (reduce excretion of urate) * Osteoarthritis (enhanced crystal formation) * Dietary factors (increased production of uric acid
77
_Risk factors for gout_ * Male sex * ... age * Genetic factors (mainly reduced ... of urate) * Chronic kidney disease (reduced ... of urate) * Metabolic syndrome * Obesity * Hypertension * ...lipidaemia * Loop and ... diuretics (reduce excretion of urate) * Osteoarthritis (enhanced crystal formation) * Dietary factors (increased production of uric acid
* Male sex * **Older** age * Genetic factors (mainly reduced **excretion** of urate) * Chronic kidney disease (reduced **excretion** of urate) * Metabolic syndrome * Obesity * Hypertension * **Hyperlipidaemia** * Loop and **thiazide** diuretics (reduce excretion of urate) * Osteoarthritis (enhanced crystal formation) * Dietary factors (increased production of uric acid
78
_Risk factors for gout_ * Male sex * Older age * Genetic factors (mainly reduced excretion of urate) * Chronic kidney disease (reduced excretion of urate) * Metabolic syndrome * o... * Hypertension * Hyperlipidaemia * Loop and thiazide diuretics (reduce excretion of urate) * ... (enhanced crystal formation) * Dietary factors (increased ... of ... acid)
* Male sex * Older age * Genetic factors (mainly reduced excretion of urate) * Chronic kidney disease (reduced excretion of urate) * Metabolic syndrome * **Obesity** * Hypertension * Hyperlipidaemia * Loop and thiazide diuretics (reduce excretion of urate) * **Osteoarthritis** (enhanced crystal formation) * Dietary factors (increased **production** of **uric** acid
79
_Risk factors for gout_ * Male sex * Older age * Genetic factors (mainly reduced excretion of urate) * ... ... disease (reduced excretion of urate) * Metabolic syndrome * Obesity * Hypertension * ... * ... and thiazide diuretics (reduce excretion of urate) * Osteoarthritis (enhanced crystal formation) * ... factors (increased production of uric acid
* Male sex * Older age * Genetic factors (mainly reduced excretion of urate) * **Chronic kidney** disease (reduced excretion of urate) * Metabolic syndrome * Obesity * Hypertension * **Hyperlipidaemia** * **Loop** and thiazide diuretics (reduce excretion of urate) * Osteoarthritis (enhanced crystal formation) * **Dietary** factors (increased production of uric acid
80
What crystals are you expecting to find in the knee fluid aspirated from our previous patient if you suspect clinically that he has gout? * 1)Monosodium urate * 2)Calcium pyrophosphate * 3)Hydroxyapatite
* **1)Monosodium urate** * 2)Calcium pyrophosphate * 3)Hydroxyapatite
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_Crystals - Gout_ * Gout is caused by ... birefringent rods – ... urate * Calcium pyrophosphate crystal deposition (CPPD) by positively birefringent rhomboids – calcium pyrophosphate
* Gout is caused by **negatively** birefringent rods – **monosodium** urate * Calcium pyrophosphate crystal deposition (CPPD) by positively birefringent rhomboids – calcium pyrophosphate
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_Crystals - Gout_ * Gout is caused by ... birefringent rods – monosodium urate * Calcium pyrophosphate crystal deposition (CPPD) by ... birefringent rhomboids – calcium pyrophosphate
* Gout is caused by **negatively** birefringent rods – monosodium urate * Calcium pyrophosphate crystal deposition (CPPD) by **positively** birefringent rhomboids – calcium pyrophosphate
83
_Gout Management_ * Conservative: * Reduce ... and high ... foods * Diabetic control * Acute attacks: * ... e.g. naproxen * Colchicine * ... * Long term: * Urate-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * Anakinra (IL-1 antagonist)
* Conservative: * Reduce **alcohol** and high **purine** foods * Diabetic control * Acute attacks: * **NSAIDS** e.g. naproxen * Colchicine * **Steroids** * Long term: * Urate-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * Anakinra (IL-1 antagonist)
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_Gout Management_ * Conservative: * Reduce alcohol and high purine foods * ... control * Acute attacks: * NSAIDs e.g. naproxen * ... * Steroids * Long term: * ...-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * Anakinra (IL-1 antagonist)
* Conservative: * Reduce alcohol and high purine foods * **Diabetic** control * Acute attacks: * NSAIDs e.g. naproxen * **Colchicine** * Steroids * Long term: * **Urate**-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * Anakinra (IL-1 antagonist)
85
_Gout Management_ * Conservative: * Reduce alcohol and high ... foods * Diabetic control * Acute attacks: * NSAIDs e.g. naproxen * Colchicine * Steroids * Long term: * Urate-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * ... (IL-1 antagonist)
* Conservative: * Reduce alcohol and high **purine** foods * Diabetic control * Acute attacks: * NSAIDs e.g. naproxen * Colchicine * Steroids * Long term: * Urate-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * **Anakinra** (IL-1 antagonist)
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_Gout Management_ * Conservative: * Reduce alcohol and high purine foods * .. control * Acute attacks: * NSAIDs e.g. .. * ... * Steroids * Long term: * Urate-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * Anakinra (IL-1 antagonist)
* Conservative: * Reduce alcohol and high purine foods * **Diabetic** control * Acute attacks: * NSAIDs e.g. **naproxen** * **Colchicine** * Steroids * Long term: * Urate-lowering therapy e.g. allopurinol or febuxostat or benzbromarone * Anakinra (IL-1 antagonist)
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55 year old with sudden pain and swelling right knee. You are waiting for aspiration results to return but his observations are normal. Bloods come back and uric acid is normal but calcium is high. * What is the main differential diagnosis? * 1)Septic * 2)Gout * 3)Calcium Pyrophosphate Deposition * How do you expect the crystals under the microscope to appear? * 1)Positively birefringent * 2)Negatively birefringent
* What is the main differential diagnosis? * 1)Septic * 2)Gout * **3)Calcium Pyrophosphate Deposition** * How do you expect the crystals under the microscope to appear? * **1)Positively birefringent** * 2)Negatively birefringent
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_Chondrocalcinosis_ * Deposition of ... within knee joint
* Deposition of **calcium** within knee joint (radiological apperance of calcium in joint)
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_CPPD (Calcium Pyrophosphate Deposition) Management_ * Conservative: * ... / ... pack * Immobilisation * Acute attacks: * .. e.g. naproxen * Colchicine * Steroids * Long term: * Colchicine prophylaxis * Anakinra (IL-1 antagonist)
* Conservative: * **Hot / cold pack** * Immobilisation * Acute attacks: * **NSAIDs** e.g. naproxen * Colchicine * Steroids * Long term: * Colchicine prophylaxis * Anakinra (IL-1 antagonist)
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_CPPD (Calcium Pyrophosphate Deposition) Management_ * Conservative: * Hot / cold pack * Immobilisation * Acute attacks: * NSAIDs e.g. naproxen * C... * S... * Long term: * Colchicine prophylaxis * ... (IL-1 antagonist)
* Conservative: * Hot / cold pack * Immobilisation * Acute attacks: * NSAIDs e.g. naproxen * **Colchicine** * **Steroids** * Long term: * Colchicine prophylaxis * **Anakinra** (IL-1 antagonist)
91
_CPPD (Calcium Pyrophosphate Deposition) Management_ * Conservative: * Hot / cold pack * I... * Acute attacks: * NSAIDs e.g. naproxen * Colchicine * Steroids * Long term: * ... prophylaxis * Anakinra (IL-1 antagonist)
* Conservative: * Hot / cold pack * **Immobilisation** * Acute attacks: * NSAIDs e.g. naproxen * Colchicine * Steroids * Long term: * **Colchicine** prophylaxis * Anakinra (IL-1 antagonist)
92
_CPPD (Calcium Pyrophosphate Deposition) Management_ * Conservative: * Hot / cold pack * ... * Acute attacks: * NSAIDs e.g. naproxen * ... * ... * Long term: * Colchicine prophylaxis * Anakinra (IL-1 antagonist)
* Conservative: * Hot / cold pack * **Immobilisation** * Acute attacks: * NSAIDs e.g. naproxen * **Colchicine** * **Steroids** * Long term: * Colchicine prophylaxis * Anakinra (IL-1 antagonist)
93
_Osteoarthritis_ * Common, ... disease of which the prevalence ... with age * Affects 70% of over 65 years olds * Most commonly clinically affects the ..., hips and small joints of the hands (DIP, PIP, 1st CMCJ) * Characterised by joint pain and very variable degrees of functional limitation
* Common, **degenerative** disease of which the prevalence **increases** with age * Affects 70% of over 65 years olds * Most commonly clinically affects the **knees**, hips and small joints of the hands (DIP, PIP, 1st CMCJ) * Characterised by joint pain and very variable degrees of functional limitation
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_Osteoarthritis_ * Common, degenerative disease of which the prevalence increases with age * Affects ....% of over 65 years olds * Most commonly clinically affects the knees, ... and small joints of the hands (DIP, PIP, 1st ...) * Characterised by joint pain and very variable degrees of functional limitation
* Common, degenerative disease of which the prevalence increases with age * Affects **70**% of over 65 years olds * Most commonly clinically affects the knees, **hips** and small joints of the hands (DIP, PIP, 1st **CMCJ**) * Characterised by joint pain and very variable degrees of functional limitation
95
_Osteoarthritis_ * Common, degenerative disease of which the prevalence increases with age * Affects 70% of over 65 years olds * Most commonly clinically affects the knees, hips and small joints of the hands (..., PIP, 1st CMCJ) * Characterised by ... pain and very variable degrees of ... limitation
* Common, degenerative disease of which the prevalence increases with age * Affects 70% of over 65 years olds * Most commonly clinically affects the knees, hips and small joints of the hands (**DIP**, PIP, 1st CMCJ) * Characterised by **joint** pain and very variable degrees of **functional** limitation
96
_Osteoarthritis_ * ..., degenerative disease of which the prevalence increases with age * Affects ...% of over 65 years olds * Most commonly clinically affects the knees, hips and small joints of the hands (DIP, PIP, 1st CMCJ) * Characterised by joint pain and very variable degrees of functional limitation
* **Common**, degenerative disease of which the prevalence increases with age * Affects **70**% of over 65 years olds * Most commonly clinically affects the knees, hips and small joints of the hands (DIP, PIP, 1st CMCJ) * Characterised by joint pain and very variable degrees of functional limitation
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_Osteoarthritis Radiological Signs_
98
_Osteoarthritis Radiological Signs_
99
The gull-wing appearance, also known as seagull erosions or sawtooth appearance, is classically seen in erosive ..,
The gull-wing appearance, also known as seagull erosions or sawtooth appearance, is classically seen in erosive **osteoarthritis**,
100
_Osteoarthritis - Nodes - hands_
101
_Pathophysiology - Osteoarthritis_ * ... active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal ... of articular ... * ... of adjacent bone = hypertrophic reaction at joint margins (osteophytes) * ... and repair process (efficient but SLOW) * Secondary synovial inflammation and crystal deposition
* **Metabolically** active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal **destruction** of articular **cartilage** * **Remodelling** of adjacent bone = hypertrophic reaction at joint margins (osteophytes) * **Remodelling** and repair process (efficient but SLOW) * Secondary synovial inflammation and crystal deposition
102
_Pathophysiology - Osteoarthritis_ * Metabolically active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal destruction of articular cartilage * Remodelling of adjacent bone = ... reaction at joint margins (osteophytes) * Remodelling and ... process (efficient but SLOW) * Secondary synovial ... and crystal deposition
* Metabolically active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal destruction of articular cartilage * Remodelling of adjacent bone = **hypertrophic** reaction at joint margins (osteophytes) * Remodelling and **repair** process (efficient but SLOW) * Secondary synovial **inflammation** and crystal deposition
103
_Pathophysiology - Osteoarthritis_ * Metabolically active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal destruction of articular ... * Remodelling of ... bone = hypertrophic reaction at joint margins (osteophytes) * Remodelling and repair process (efficient but SLOW) * Secondary synovial inflammation and ... deposition
* Metabolically active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal destruction of articular **cartilage** * Remodelling of **adjacent** bone = hypertrophic reaction at joint margins (osteophytes) * Remodelling and repair process (efficient but SLOW) * Secondary synovial inflammation and **crystal** deposition
104
_Pathophysiology - Osteoarthritis_ * Metabolically active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal ... of articular cartilage * Remodelling of adjacent bone = hypertrophic reaction at joint ... (osteophytes) * Remodelling and repair process (... but SLOW) * ... synovial inflammation and crystal deposition
* Metabolically active, dynamic process involving all joint tissues (cartilage, bone, synovium, capsule, ligaments/muscles) * Focal **destruction** of articular cartilage * Remodelling of adjacent bone = hypertrophic reaction at joint **margins** (osteophytes) * Remodelling and repair process (**efficient** but SLOW) * **Secondary** synovial inflammation and crystal deposition
105
_Clinical Features of osteoarthritis_ * Age \> ... years * Morning stiffness \< ... minutes * Persistent joint pain aggravated on use * Crepitus * NO INFLAMMATION * Bony enlargement and/or tenderness
* Age \> **50** years * Morning stiffness \< **30** minutes * Persistent joint pain aggravated on use * Crepitus * NO INFLAMMATION * Bony enlargement and/or tenderness
106
_Clinical Features of osteoarthritis_ * Age \> 50 years * Morning stiffness \< 30 minutes * Persistent joint pain ... on use * Crepitus * NO ... * Bony enlargement and/or tenderness
* Age \> 50 years * Morning stiffness \< 30 minutes * Persistent joint pain **aggravated** on use * Crepitus * NO **INFLAMMATION** * Bony enlargement and/or tenderness
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_Clinical Features of osteoarthritis_ * Age \> 50 years * Morning stiffness \< 30 minutes * Persistent joint pain aggravated on use * C.. * NO INFLAMMATION * Bony ... and/or ...
* Age \> 50 years * Morning stiffness \< 30 minutes * Persistent joint pain aggravated on use * **Crepitus** * NO INFLAMMATION * Bony **enlargement** and/or **tenderness**
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_Clinical Features of osteoarthritis_ * Age \> ... years * Morning ... \< 30 minutes * Persistent joint ... aggravated on use * C... * NO INFLAMMATION * Bony enlargement and/or tenderness
* Age \> **50** years * Morning **stiffness** \< 30 minutes * Persistent joint **pain** aggravated on use * **Crepitus** * NO INFLAMMATION * Bony enlargement and/or tenderness
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Is there a clinical correlation between the radiological changes and the symptoms in osteoarthritis? * 1)Yes * 2)No
* 1)Yes * **2)No**
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_OA Investigations_ * Are Blood tests helpful? * A ... diagnosis * ... do not correlate well with symptoms
* **Blood** tests **not helpful** * A **clinical** diagnosis * **X-rays** do not correlate well with symptoms
111
_RA vs OA_
112
_RA vs OA_
113
_RA vs OA_
114
_RA vs OA_
115
_OA treatment_
116
_OA treatment_ * ... ... if overweight/obese * ... exercise aerobic fitness training * Education, advice, info access * Topical ...s * Paracetemol * Joint ... * Manual ... * Capsaicin * Opioids * Oral NSAIDS * Supports and braces * ...-absorbing shoes/insole * TENS * ... devices * Local ... and cold
* **Weight loss** if overweight/obese * **Strengthening** exercise aerobic fitness traininf * Education, advice, info access * Topical **NSAIDs** * Paracetemol * Joint **arthroplasty** * Manual **therapy** * Capsaicin * Opioids * Oral NSAIDS * Supports and braces * **Shock**-absorbing shoes/insole * TENS * **Assistive** devices * Local **heat** and cold

Year 2 Medicine (162 decks)

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