Joint disease Flashcards
List the RFs for OA (7)
What is a protective factor for OA?
Age Gender (esp post-meno) FH Obesity H/o trauma Occupation (miners, farmers etc) Hypermobility
Osteoporosis is protective
List some causes of 2º OA (3; 11)
Pre-existing joint damage:
Septic / Inflamm / Crystal
Trauma / AVN
Metabolic:
Acromegaly
Haemochromatosis
Chondrocalcinosis
Systemic:
Neuropathies
Haemphilia
Haemoglobinopathies
What are the common features in the Hx for OA
Progressive pain
Activity related
Stiffness after rest (lasts <30mins)
Good/bad days
What may be seen O/E in OA
LOOK: Gait / Deformity / Swelling / Wasting
FEEL: Joint line tenderness / Crepitus / ± Effusion
MOVE: Reduced RoM
TEST: N/a
List some specific features O/E seen in Hip OA (4)
+ for Knee OA (5)
HIP: Trendelenberg +ve Fixed flexion (Thomas' test) Held in adduction/ext. rotation Leg shortening
KNEE: Obese Bilateral Varus deformity Moderate effusion Quadriceps wasting
How does Nodal Generalised OA typically present?
Post-menopausal women
With FH
One-by-one fingers (DIPs –> PIPs –> 1st CMC/MCP)
Pain / swelling / impaired func
What material is involved in pseudo gout?
Where does typically effect?
What Ix (2) / what is seen
Calcium pyrophosphate (deposits = CPPD) Knees/wrists
XR: Costocalcinosis
Polarised light microscopy: +ve biofringe rhomboids
What Ix are done into OA? (4)
Bloods:
FBC/ESR
RA/ANA
XR
CT/MRI if XR –ve but Hx suggestive
What are the surgical options for OA (5)
Arthroscopy/washout (young, h/o locking - delays replacement)
Realignment osteotomy (young pts w. intact surfaces)
Arthrodesis (ankle/spine/hand)
Total arthroplasty
One compartment arthroplasty
What are the CIs for joint replacement (3)
Relative:
Young
Co-morbid disease
Absolute:
Untreated joint sepsis
List the complications of Total Joint Replacement (4+3)
Length length discrepancy (15%)
Dislocation (3%)
Persistent pain (1-5% depends on joint)
Joint infection (0.5-1%)
Artificial joint polythene wear Periprosthetic fracture (peri-op) Neurovascular injury
List RFs for Gout (5) inc. assoc conditions (6)
Age Male (10:1) High protein diet High alcohol FH / Inherited defect (if <25 + renal urates) Metabolic syndrome
ASSOC CONDITIONS Impaired excretion: Hypothyroid HyperPTH CKD HTN NSAIDs/Thiazides
Increased prodn:
Myelo/lymphoproliferatives
Metabolic conditions
What is the main DDx for acute gout?
What are the differentiating features (4)
Septic arthritis: Systemic Sx More Subacute (days) Severity increases Reduced RoM
What Ix are done into Tophaceous Gout
Bloods: FBC / UEs / Urate (normal ≠ exclude)
Aspiration: –ve biofringe crystals / turbid fluid
XR: bony erosions (chronic)
More Ix when attack settled:
Urine dip / Glucose / BP / Lipids
FBC-ESR (myeloprolifs)
List the indications for Allopurinol (5)
Recurrent gout attacks Tophaceous gout Joint/bone damage High urate levels Renal disease
What lifestyle measures for management of gout?
Reduce alcohol / chol / cals
Avoid food grps (fish/spinach)
What alternative drugs can be used in gout?
Acute: Colcichine (CKD/CCF where NSAIDs CI)
Chronic: uricosurics (probenecid/sulfinpyrazone) These are CI in: High urate producers CKD H/o stones
What are some metabolic RFs for pseudogout (5)
HyperPTH
Wilson’s
Hypomag
Hypophos
How is Pseudogout managed?
Acute: same as gout
Chronic: joint injections
Which tissues can Apatite deposition occur in? (3)
Periarticular (e.g. calcific tendonitis) Hyaline cartilage (assoc w. OA) Subcut/mm (in CTDs)
What are the main causative organisms in joint infections (4)
S.aureus**
Gonococcal (young adults)
Haemophilus (children) Strep Pneumonia (children)
List some RFs for joint infections (5)
Age extremes Recent operative / injective procedure Pre-existing joint disease (esp RA) IVDU Immunosupp / DM
List common sites for acute / chronic osteomyelitis
Acute:
Growth plates (children)
Spine (immunosupp)
Chronic:
Post-open fracture site
Post-Op
What are the 6 S’s of Septic Arthritis
Subacute Single joint Swollen Still (held in loose pack) Screaming in pain Systemic sx
