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204: The Musculoskeletal System > Introduction to diseases of the musculoskeletal system > Flashcards

Introduction to diseases of the musculoskeletal system Flashcards

1
Q

Tendonitis

A

Tendon problem

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2
Q

Bursitis

A

Inflammation of bursa

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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3
Q

Enthesitis

A

Inflammation of an enthesis

Entheses are the points where tendons, ligaments or joint capsules insert into bone

The largest site is the achilles insertion

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4
Q

Osteoporosis

A

Reduced bone density

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5
Q

Osteomalacia

A

Poor bone mineralisation

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6
Q

Osteomyelitis

A

Bone infection

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7
Q

Osteosarcoma

A

An example of malignant bone tumour

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8
Q

Myalgia

A

Pain in muscles

Very common

Commonly associated with viral infections

Can be drug induced

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9
Q

Myositis

A

Inflammation of the muscles

Far less common than myalgia and can be autoimmune

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10
Q

Ways of classifying rheumatic disease

A

Articular vs non-articular/ periarticular

Inflammatory vs non-inflammatory/ degenerative/ mechanical

Number of joints affected

Duration of onset

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11
Q

Joint pain

A

Periarticular

  • point tenderness over the involved structure
  • pain reproduced by movement involving that structure

Articular

  • joint line tenderness
  • pain at the end range of movement in any direction
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12
Q

Joint inflammation nomenclature

A

Monoarthritis- affecting 1 joint

Oligoarthritis- affecting 2-4 joints

Polyarthritis- affecting 5 of more joints

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13
Q

Importance of rheumatic disease

A

Common and getting more common

Expensive

Important

Leading cause of disability

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14
Q

UK impact

A

Third greatest impact on the health of the UK population, considering both death and disability

  • MSK disorders account 15.6%
  • low back pain accounts for over half of this
  • ranking of major causes of death and disability
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15
Q

MSK disorders and work

A

Poor musculoskeletal health is a major barrier to workplace participation

People with MSK conditions are less likely to be employed than people in good health and more likely to retire early

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16
Q

Septic arthritis

A

Always think about it in a patient with a (usually) single, hot and swollen joint

Mortality rates are of 11%, increases to 50% in polyarticular disease with sepsis

Commonest organisms are staph and strep

Do not have to be systemically unwell and they may be able to weight bear

17
Q

Gout

A

Crystal deposition is often clinically silent

About 10% of people with hyperuricaemia develop clinical gout

UK GP studies show the prevalence of gout per 1000 has been steadily increasing from 2.6 in 1975 to 3.4 in 1987, and 9.5 in 1993

Clinical cure is achievable with treatment which is cheap, widely available, and under prescribed

18
Q

Who gets gout?

A

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

Epidemiology studies show that the metabolic syndrome and its components are strongly associated with gout

19
Q

Risk factors for gout

A 
Male sex
Older age
Genetic factors
Chronic kidney disease
Metabolic syndrome
Osteoarthritis 
Dietary factors
20
Q

Crystals

A

Gout is caused by negatively birefringment rods- monosodium urate

Pseudogout by positively birefringent rhomboids- calcium pyrophosphate

21
Q

Management of gout

A

Acute attacks

  • NSAIDs
  • colchine
  • steroids

Long term

Urate lowering therapy

22
Q

Rheumatoid arthritis

A

Common, chronic, multisystem inflammatory condition affecting up to 0.5-1% of the world

More common in women (3:1)

Peak onset is 45-65 years

Unknown cause with around 30% genetic susceptibility and the rest environmental

23
Q

Main problem with inflammatory arthritis

A

Synovium

24
Q

Main problem with osteoarthritis

A

Cartilage

25
Q

Rheumatoid arthritis pathophysiology

A

Early lymphocyte invasion of the synovium

Acute inflammatory reaction- swelling and increased vascular permeability

Synovial proliferation

Pannus formation

Cartilage destruction and bone erosion

26
Q

Symptoms and signs of pathophysiology

A

Onset varies, can be acute or chronic

Symmetrical pain and boggy swelling of the small joints of the hands and feet

Early morning stiffness > 1 hour

Malaise and fatigue

Systemically unwell

Examination- look for pain, swelling and restriction of movement

Also really important to examine other organ systems as RA is a systemic disease

27
Q

Extra-articular manifestations of RA

A

Nodules

Bursitis/ tenosynovitis

Eyes: dry eyes/ scleritis/ scleromalacia

Splenomegaly

Anaemia of chronic disease

Lung fibrosis/ effusion

Pericarditis

Neurological: atlanto-axial sublaxation/ carpal tunnel syndrome

Renal amyloids

Lef ulcers/ pyoderma gangenosum

Vasculitis

Increased risk of CV disease

28
Q

Rheumatoid arthritis invesitgations

A

ESR and CRP

FBC: anaemia of chronic disease

Rheumatoid factor positive- IgM antibody against the FC portion of human IgG antibodies

Anti CCP antibodies

X-rays: normal in early disease… erosion/ peri-articular osteoporosis and reduced joint space/ cysts

29
Q

RA principles of management 1

A

Early and aggressive treatment to reduce inflammation and joint damage

Non-steroidal anti-inflammatory drugs for short periods

Corticosteroids

  • intra-articular joint injections if only 1 or 2 troublesome
  • systemic if many joints are a problem
30
Q

RA principles of management 2

A

Disease modifying anti-rheumatic drugs

Synthetic DMARDs

  • methotrexate
  • hydroxychloroquine
  • leflunomide

Biological agents

  • anti TNF agents
  • anti B cell
  • anti interleukin 6 receptor blockers
  • anti T cell- selective co-stimulation modulator
  • janus kinase inhibitor
31
Q

RA principles of management 3

A

Multidisciplinary team input

  • nurse specialist (education and disease monitoring)
  • physiotherapy (improve strength and stamina)
  • occupational therapy (work, home environments)
  • podiatry
32
Q

Osteoarthritis

A

Common, degenerative disease of which the prevalence increases with age

Affects 70% of over 65 year olds

Most commonly clinically affects the knees, hips and small joints of the hands

Characterised by joint pain and very variable degrees of functional limitation

33
Q

Pathophysiology of osteoarthritis

A

Metabolically active, dynamic process, involving all joint tissue (cartilage, bone, synovium, capsule, ligaments/ muscles)

Focal destruction of articular cartilage

Remodelling of adjacent bones- hypertrophic reaction at joint margins

Remodelling and repair process (efficient but slow)

Secondary synovial inflammation and crystal deposition

34
Q

Clinical features of arthritis

A

Age > 50 years

Morning stiffness < 30 minutes

Persistent joint pain aggravated on use

Crepitus

No inflammation

Bony enlargement and/ or tenderness

35
Q

Systemic lupus erythematosus

A

Chronic, relapsing, remitting disease

Broad spectrum of clinical features involving almost all organs and tissues

Prevalence in the UK 97 per 100000

F:M is 10-20:1

Peak onset between 15-40 years

More common and severe in those of Afro-Caribbean, Indian, Hispanic and Chinese origin living in USA and Europe

36
Q

SLE investigations

A

Urinalysis- urinary protein: creatine ratio

Full blood count

Urea and electrolytes

ESR

CRP

Liver function test

Antibodies: ANA; ENA; Anti-dsDNA; lupus anticoagulant; anti C1q; C3, C4

204: The Musculoskeletal System (23 decks)

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