Joint Disease

Question 1

When is peak bone mass?

Answer 1

25-40 years

Question 2

What rate is bone mass lost?

Answer 2

1% a year

Question 3

What is osteoporosis?

Answer 3

Generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture

Question 4

What are the signs of osteoporosis?

Answer 4

Fracture
Reduced bone density on DXA scan
Pain
Reduced mobility
Kyphosis
Reduced height

Question 5

Why do women have accelerated bone loss around menopause?

Answer 5

Protective effect of oestrogens

Question 6

What T score on a DXA scan indicated OP?

Answer 6

< 2.5 (or equal)

Question 7

Where do DXA scanners scan?

Answer 7

Hip/lower spine

Question 8

What are the risk factors for OP?

Answer 8

History of fracture in self of 1st degree relative
Smoking
Low weight
Female
Oestrogen deficiency
Corticosteroid use
White
Age 
Low calcium intake
Alcohol
Lack of exercise
Recurrent falls
Dementia
Impaired eyesight
Poor health/fragility

Question 9

What are primary preventions of OP?

Answer 9

Lifestyle changes:
Ca and Vit D
Weight baring exercise
Reduced alcohol intake
Stop smoking
Reduce falls risk

Question 10

What are secondary preventions of OP?

Answer 10

Drugs:

Ca, Vit D, Calcitrol, HRY, SERMS, Bisphosphonates, Calcitonin, Strontium, PTH, Denosumab

Question 11

What are the clinical features of Osteoarthritic?

Answer 11

Joint pain - worse on movement and at the end of the day
May be swelling
Most common in knee, hands, lumbar and cervical spine
Early morning stiffness - up to 30 mins

Question 12

What is the pathogenesis of OA?

Answer 12

Cartilage gradually roughens and thins
Underlaying bone thickens
Osteophytes form
Synovium thickens and inflames
Ligament thickens and contracts
Some joints repair themselves and some don't

Question 13

What are the non-pharmacological managements of OA?

Answer 13

Loose weight
Physio
Exercise
Heat pack
Occupational therapy
Psychological support
Surgery

Question 14

What are the pharmacological managements of OA?

Answer 14

Analgesics - paracetamol and codeine
NSAIDs - if inflammatio
Corticosteroid injection to joints
Chondroprotective agents

Question 15

What are the clinical features of Rheumatoid arthritis?

Answer 15

Slow progressive symmetrical polyarthritis
Pain and stiffness in small joints of hands and feet
Involvement of wrists, shoulders, elbows, knees and ankles
Early morning stiffness - can take up to lunch time to get comfortable

Question 16

What are the extra-articular symptoms of RA?

Answer 16

Sjorgen's (fluids)
Vasculitis (inflam blood vessels)
Neuropathy (=circulation problems)
Subcutaneous nodules 
Lymphadenopathy
CVD
Depression
Respiratory disease

Question 17

What is the pathogenesis of RA?

Answer 17

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

Question 18

What are the pharmacological managements of RA?

Answer 18

Analgesics
NSAIDs
Conventional DMARDs - Methotrexate, sulfasalazine
Biological DMARDs - injection
Steroids - tablet/inject to joint/ im injection