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Introduction to joint disease Flashcards

1
Q

when does oesteoperosis start?

A

disease of old age but starts early on in life

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2
Q

osteoporosis is more common in….

A

women

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3
Q

OP results in what?

A

fractures

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4
Q

what are the most common fractures associated with OP?

A

hip, wrist and spine

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5
Q

which fractures go largely unnoticed? why?

A

spine

dont report to health professionals

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6
Q

__% die from complications from hip fractures. such as….?

A

20

prolonged hospital stay- infections

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7
Q

1 in __ women over 50

1 in ___ men over 50

A

2

5

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8
Q

TF: bone is the same your entire life

A

FALSE

is constantly turned over and remodelled

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9
Q

how long does the turnover of bone take

A

3 months

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10
Q

what do oestoblasts do?

A

BUILD new bone

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11
Q

what do oesteoclasts do?

A

break down old bone

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12
Q

what is breaking down old bone by oestoclasts also known as?

A

resorption

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13
Q

OP is caused by reduced _____ activity

A

oestoblast

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14
Q

what is the cortex?

A

which outer shell of bone

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15
Q

what is trabecular bone?

A

meshwork of bone inside cortex

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16
Q

what happens to trabecular bone in OP

A

BECOMES HOLEY AND WEAKER

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17
Q

when does your bone density decrease

A

1% per year after you reach peak bone mass

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18
Q

TF: putting stress on skeleton when younger is good to prevent OP?

A

TRUE

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19
Q

what is the WHO definition for OP

A

osteoporosis is a generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture (middle bit of bone becomes weaker), causing susceptibility to fracture.

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20
Q

bone takes about ____ days to be remodelled

A

100

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21
Q

what is bone turnover influenced by?

A

hormones- oestrogen, testosterone, cytokines, PGs

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22
Q

if oestrogen and testosterone is low, you are ____ likely to develop OP

A

MORE

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23
Q

what happens when insult activated osteoclasts

A

in response to insult activation is triggered
osteoclasts will start the resorption process
then the reversal phase- holes that need filling
oestroblasts are triggered to fill the hole

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24
Q

signs and symptoms of OP?

A

fracture is usually the first presentation
DXA scan shows reduced bone density
pain
reduced mobility
Kyphosis where the spine starts curving- in vertebral fractures:
Reduction in height
Indigestion (more pressure on stomach)

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25
what is a DXA scan?
high intensity X-ray calculates bone density to see if you are progressing to OP compares to what you should be at that age
26
are DXA scans commonly used?
NO very expensive only high risk patients
27
what is kyphosis?
Kyphosis where the spine starts curving- in vertebral fractures: Reduction in height Indigestion (more pressure on stomach)
28
vertebral fractures can result in a height reduction of....
10-20cm
29
what problems can vertebral fractures cause?
indigestion neck weakness back pain loss of mobility
30
TF: bone density changes throughout life
true
31
when do you peak in bone mass?
25-40
32
what happens at menopause for women? why
steep decline in bone density due to loss of protective effect of oestrogens
33
what can you do in life to optimise peak bone mass?
healthy balanced diet- Ca and Vitamin D | weight bearing exercise early on in life
34
what about a DXA scan tells us you have OP?
get a T score | if the T score is <2.5
35
what is the most reliable part of the body to scan in DXA scans?
hip/ lower spine
36
risk factors for OP
``` history of fracture smoking low body weight female oestrogen deficiency (e.g. menopause) corticosteroid use white age Ca intake low alcohol no exercise falls dementia poor health ```
37
primary prevention for OP?
lifestyle changes | try to reduce fall risks- chair lift
38
secondary prevention for OP
``` pharmacological management: Calcium Vitamin D Calcitriol HRT SERMS Bisphosphonates Calcitonin Strontium PTH Senosumab ```
39
what is osteoarthritis?
disease of ware and tare | limited to 1-2 joints due to damage and stress
40
TF: OA is a disease of all joints
FALSE- 1 or 2
41
how do you manage OA?
difficult | many need surgery
42
OA affects ___% of >65 year olds
12
43
onset of OA is common...
40-60 year olds
44
OA is more common in: | men or women
women
45
why can obesity increase OA risk?
carrying more weight | bigger strain on joints
46
do we know what triggers off OA?
no we only know the risks
47
clinical features of OA?
joint pain that's worse at the end of the day swelling- not always early morning stiffness for about 30 minutes
48
FT: OA is alway accompanied by swelling?
FALSE
49
pathogenesis of OA?
Cartilage which protects the ends of the bone at a joint gradually roughens and becomes thin Thickening of underlying bone Formation of osteophytes- bony spurts at the edge of a joint= uncomfortable Thickening & inflammation of synovium Thickening and contraction of ligament round the outside of the joint
50
can joints in OA repair themselves?
Some joints repair themselves, others don’t- if a little bit the body can manage
51
ligaments attach....
bone to bone
52
tendons attach...
bone to muscle
53
features of mild OA?
cartilage is starting to ware away formation of oestophytes inflammation
54
features of severe OA?
two bones dont have cartilage to cushion between them bones move closer together when bones touch opposing bone it rubs and is painful joint deformity
55
what is needed when someone has severe OA?
probably a joint replacement
56
goals of OA management?
reduce pain optimise mobility minimise joint deformity patient education
57
normal joint pathophysiology?
Cartilage protects the bone Round the side of the joint= capsule and synovium (membrane round the joint which protect everything) white space- synovial fluid which lubricates
58
non pharmacological management for OA?
``` weight reduction physiotherapy exercise plan heat or cold packs psychological support occupational therapy review ```
59
when will a patient get an occupational therapy review?
if mobility is limited | advice on how to independently manage is needed
60
pharmacological managements of OA?
ANALGESICS- codeine, paracetamol etc NSAIDS- if we know there inflammation corticosteroids- injections into the joints, never oral chondroprotective agents
61
TF: Oral corticosteroids can be used to treat OA?
NO | injected into joints
62
rheumatoid arthritis is a ______ condition
systemic
63
can arthritis occur in young children?
yes | juvenile arthritis
64
why are there more management options for RA than OA?
as we know RA is an autoimmune condition
65
RA affects ___% of the population
1-3
66
RA most common ones age?
30-50 years
67
what is key for RA?
Early intervention
68
why do people with RA have a reduced life expectancy?
not from the condition, from cardiac, liver and respiratory conditions
69
are females more likely to get RA than males
3:1
70
aetiology of RA?
unknown
71
clinical features of RA?
slow progressive symmetrical polyarthiritis pain and stifness in small joints of hands and feet nearly alway associated with early morning stiffness
72
extra-articular symptoms of RA?
Sjogren’s syndrome- reduced secretions- dry eyes and mouth Vasculitis- inflammatory condition of vessels Neuropathy- can cause circulation problems Subcutaneous nodules- painful build-up of tissue over joints effected- can need surgery to remove Lymphadenopathy- enlargement of lymph nodes Cardiovascular disease Depression Respiratory disease
73
What is sjogrens syndrome?
reduced secretions- dry eyes and mouth
74
what is vasculitis
inflammatory condition of the vessels
75
what are subcutaneous nodules?
painful build up of tissue over joints | need surgery to remove
76
what is lymphadenopathy
enlargement of lymph nodes
77
___% of patients have mild RA and respond well to first treatment
20
78
__% RA patients develop severe disease which can lead to being in a wheelchair
5
79
how many patients have relapsing remitting RA? what does this mean?
3/4 | flare up for a while and then settles with treatment
80
pathogenesis of RA?
Lymphocytes (inflammatory cytokines) infiltrate synovial membrane, causing inflammation & thickening- almost always Formation of pannus over cartilage causes erosion into bone which causes: Eventual degeneration of cartilage & joint Eventually permanent joint damage and deformity
81
What stage of RA does pharmacological intervention become hard
once there's already erosions in the joints
82
goals of RA management?
relief of pain and inflammation prevention of joint damage improvement in movement ability maintenance of lifestyle
83
pharmacological management of RA?
``` analgesics NSAIDs conventional DMARDs biological DMARDS steroid- po/ IM/ injection into joint ```
84
what are conventional DMARDs
disease modifying medicines e.g. methotrexate, sulfasalazine
85
when should conventional DMARDs be given?
ideally within 3 months of diagnosis
86
how are Biological DMARDs administered
self injection

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