Joint disease

Question 1

What is the role of osteoblasts?

Answer 1

Build new bone

Question 2

What is the role of osteoclasts?

Answer 2

Break down old bone

Question 3

What is osteoporosis caused by?

Answer 3

An imbalance of osteoblast and osteoclast levels.

Reduced osteoblast activity and increased osteoclast activity leading to low bone mass

Question 4

What is the first sign/symptom of osteoporosis?

Answer 4

Fracture

Question 5

How is bone mass density determined?

Answer 5

DXA scan

Question 6

DXA scans usually measure bone density at hip/lower back to get a T score. What score is indicative of osteoporosis?

Answer 6

Score less than or equal to 2.5

Question 7

What is the pathogenesis of osteoarthritis?

Answer 7

Cartilage gradually roughens and becomes thin.
Thickening of underlying bone 
Formation of osteophytes 
Thickening and inflammation of synovium
Thickening and contraction of ligament

Question 8

What are some of the non-pharmacological management options for osteoarthritis?

Answer 8

Weight reduction
Physiotherapy
Exercise plan
Heat packs

Question 9

What are some of the pharmacological management options for osteoarthritis?

Answer 9

Simple analgesics
NSAIDs
Corticosteroids

Question 10

What is the difference between osteoarthritis and rheumatoid arthritis?

Answer 10

Osteoarthritis usually affects one joint only whereas rheumatoid is more systemic and affects multiple joints

Question 11

Why is there a likely reduced life expectancy in rheumatoid arthritis?

Answer 11

Due to risk of developing other diseases e.g. CVD

Question 12

Early morning stiffness is more common in osteoarthritis rather than rheumatoid arthritis. True or false?

Answer 12

False

Question 13

What is the pathogenesis of rheumatoid arthritis?

Answer 13

Lymphocytes infiltrate the synovial membrane, causing inflammation and thickening
Formation of pannus over cartilage causes erosion into bone
Eventual degeneration of cartilage joint

Question 14

DMARDs are used in the management of which joint disease?

Answer 14

Rheumatoid arthritis

Question 15

Why do women have accelerated bone loss around menopause?

Answer 15

Because of the loss of the protective effect of oestrogen - due to decreased levels

Question 16

How can peak bone mass be optimised?

Answer 16

By having healthy balanced diet and doing weight bearing exercises e.g. aerobics and running early on in life

Question 17

List 6 risk factors for developing osteoporosis?

Answer 17

Smoking
Oestrogen deficiency
History of fractures
Increasing age
Female
Excess alcohol consumption
History of fracture in first degree relative
Corticosteroid use

Question 18

What are the pre-screening checks before starting biologic DMARDs?

Answer 18

FBC
LFT
TB
HIV/Hep A/B
Diabetes
MS
History of heart disease

Question 19

Which cDMARD doesn’t require regular blood monitoring?

Answer 19

Hydroxychloroquine

Question 20

Which cDMARD causes urine discolouration?

Answer 20

Sulfasalazine

Question 21

Which cDMARD requires folic acid?

Answer 21

Methotrexate as it is a folate antagonist

Question 22

Which drugs can cause skin rash?

Answer 22

Hydroxychloroquine and sulfasalazine