Joint Disease Flashcards
When is peak bone mass?
25-40 years
What rate is bone mass lost?
1% a year
What is osteoporosis?
Generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture
What are the signs of osteoporosis?
Fracture Reduced bone density on DXA scan Pain Reduced mobility Kyphosis Reduced height
Why do women have accelerated bone loss around menopause?
Protective effect of oestrogens
What T score on a DXA scan indicated OP?
< 2.5 (or equal)
Where do DXA scanners scan?
Hip/lower spine
What are the risk factors for OP?
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
What are primary preventions of OP?
Lifestyle changes: Ca and Vit D Weight baring exercise Reduced alcohol intake Stop smoking Reduce falls risk
What are secondary preventions of OP?
Drugs:
Ca, Vit D, Calcitrol, HRY, SERMS, Bisphosphonates, Calcitonin, Strontium, PTH, Denosumab
What are the clinical features of Osteoarthritic?
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
What is the pathogenesis of OA?
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
What are the non-pharmacological managements of OA?
Loose weight Physio Exercise Heat pack Occupational therapy Psychological support Surgery
What are the pharmacological managements of OA?
Analgesics - paracetamol and codeine
NSAIDs - if inflammatio
Corticosteroid injection to joints
Chondroprotective agents
What are the clinical features of Rheumatoid arthritis?
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
What are the extra-articular symptoms of RA?
Sjorgen's (fluids) Vasculitis (inflam blood vessels) Neuropathy (=circulation problems) Subcutaneous nodules Lymphadenopathy CVD Depression Respiratory disease
What is the pathogenesis of RA?
Lymphocytes infiltrate synovial membrane causing inflammation and thickening
Formation of pannus over cartilage causes erosion into bone
Eventual degeneration of cartilage and joint
What are the pharmacological managements of RA?
Analgesics
NSAIDs
Conventional DMARDs - Methotrexate, sulfasalazine
Biological DMARDs - injection
Steroids - tablet/inject to joint/ im injection
