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Patient Sem 1 > Joints > Flashcards

Joints Flashcards

1
Q

What is osteoporosis?

A
  • disease of old age
  • primarily affects women but affects men as well
  • results in fractures of mainly the wrist, spine and hip
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2
Q

What are the consequences of a hip fracture?

A
  • prolonged hospital admission
  • death from complications
  • hospital acquired infections
  • VTE
  • significant mobility problems
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3
Q

What is the pathophysiology of osteoporosis?

A
  • trabecular bone becomes weaker, more porous, low bone density and mass
  • reduced osteoblast activity
  • increased osteoclast activity
    bone is being broken down quicker than it can be formed
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4
Q

How does a low peak bone mass increase the risk of developing osteoporosis?

A
  • peak bone mass age 25 - 40

- lose bone density at a rate of 1% / year

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5
Q

What is defined as being susceptible to fractures?

A

fractures occurring from falling from standing height or less

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6
Q

What is the bone remodelling cycle?

A
  • 100 days (3 months)
  • resting phase
  • activation phase (a small hole will trigger the activity of osteoclasts), triggers resorption
  • reversal phase, triggers osteoblasts
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7
Q

What are the signs and symptoms of osteoporosis?

A
  • fracture
  • reduced bone density on DXA scan
  • pain
  • reused mobility
  • kyphosis (curving of the spine, causing indigestion)
  • reduction in height
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8
Q

What are the consequences of spine fractures?

A
  • often goes unnoticed, put down to old age with back pain
  • reduced mobility
  • height reduction (10 - 20cm)
  • indigestion
  • neck weakness
  • back pain
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9
Q

DXA Scans

A
  • scans the hip/spine to calculate a T score
  • T score of -2.5 or below = osteoporosis
  • only for high risk patients OR those with established osteoporosis
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10
Q

What are the risk factors for developing osteoporosis?

A
  • history of fractures
  • history of fractures in first degree relative
  • smoking
  • low body weight (underweight)
  • female
  • oestrogen deficiency (lower than menopause levels)
  • corticosteroid use (prednisolone)
  • white race
  • increase in age
  • low calcium intake
  • exces alcohol
  • recurrent falls
  • dementia
  • impaired eyesight
  • poor health/frailty
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11
Q

What is the primary prevention for osteoporosis?

A
  • adequate calcium and vitamin D
  • weight bearing exercise
  • reduced alcohol intake
  • stop smoking
  • reduce risk of falls (e.g. medications in elderly)
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12
Q

What is the secondary prevention for osteoporosis?

A
  • Calcium
  • Vitamin D
  • Calcitriol
  • Calcitonin
    THEN
  • Bisphosphonates
  • HRT/SERMS
  • Strontium
  • Parathyroid Hormone
  • Denosumab
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13
Q

What is osteoarthritis?

A
  • disease of wear and tear
  • affects 1 or 2 joints
  • onset most common 40 - 60
  • more common in women
  • obesity increases the risk
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14
Q

What are the signs and symptoms of osteoarthritis?

A
  • joint pain, worsened on movement
  • gradually gets worse over the course of the day
  • early morning stiffness 30 mins, but joints remain painful
  • swelling IF inflammation present
  • knee, hands, lumbar, cervical spine
  • some joints repair themselves, some don’t
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15
Q

What is the pathogenesis of osteoarthritis?

A
  • cartilage gradually roughens and becomes thin
  • causes thickening of the underlying bone
  • bones move closer together and may touch
  • formation of osteophytes
  • MAY get thickening and inflammation of synovium
  • thickening and contraction of ligament (bone - bone attachment) which makes if painful to move
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16
Q

What are the non-pharmacological treatments for osteoarthritis?

A
  • weight reduction
  • physiotherapy
  • exercise plan
  • heat packs/cold packs
  • occupational health - optimise mobility
  • surgery
17
Q

What are the pharmacological treatments for osteoarthritis?

A
  • simple analgesics
  • NSAIDS IF INFLAMMATION IS PRESENT
  • corticosteroid injections into the joint
  • chondroprotective agents glucosamine
18
Q

What is rheumatoid arthritis?

A

an autoimmune SYSTEMIC condition that affects any age, and many joints

  • common onset 30 - 50 years
  • reduced life expectancy as more likely to have other conditions
  • more women affected than men
19
Q

What are the signs and symptoms of rheumatoid arthritis?

A
  • slow progressive symmetrical poly arthritis (small joints affected)
  • pain and stiffness in the joints of the hands and feet
  • wrists, shoulders, elbows, knees, ankles
  • early morning stiffness, stiffness worsens throughout the day whilst pain improves
  • most people have remitting and relapsing disease (flares)
20
Q

What are the extra-articular symptoms of rheumatoid arthritis?

A
  • Sjorgens syndrome
  • Vasculitis
  • Neuropathy
  • Subcutaneous nodules (build up of tissue over the joint)
  • Lymphadenopathy
  • CVD
  • Depression
  • Respiratory Disease
21
Q

What is the pathogenesis of Rheumatoid Arthritis?

A
  • lymphocytes infiltrate synovial membrane
  • inflammation and thickening
  • formation of panes over cartilage causes erosion into bone
  • degeneration of cartilage and joint
22
Q

What is are the pharmacological treatment options for Rheumatoid Arthritis?

A
  • Analgesics
  • NSAIDs
  • Conventional DMARDs
  • Biological DMARDs
23
Q

What is the gold standard treatment for rheumatoid arthritis?

A

methotrexate + hydroxycholorquine

24
Q

bisphosphonates counselling points

A

poorly absorbed by the body:
- take on an empty stomach
- take with a whole glass of water
- don’t eat for 30 minutes after
- sit upright for 30 mins - hour afterwards to prevent heartburn
- long term treatment
- falls with no fractures
indicates it’s working
- if not tolerated can switch to a different bisphosphonate
- take calcium containing medicines 3 - 4 hours before

25
Q

What are the side effects of bisphosphonates?

A
  • headaches
  • muscle pain, bone pain
  • itchy rashes/photosensitivity
26
Q

What are the counselling points for hydroxychloroquine?

A
  • eyesight testing - visual problems
  • takes 12 weeks or longer to see effects
  • rash - stop taking immediately
  • nausea/indigestion
  • diarrhoea
  • headaches
  • bleaching of hair/mild hair loss
  • indigestion remedies interact
  • cannot be taken during pregnancy
27
Q

What are the counselling points for methotrexate?

A 
- up to 3 months before you see benefits
do not take if:
- pregnant/breastfeeding
- you have a current infection
- liver or kidney disease
- you've had a recent vaccination
- take it once a week, on the same day
- blood tests before and regularly during
- liver tests before and during
28
Q

What are the side effects of methotrexate?

A
  • feeling sick
  • headaches
  • vomiting
  • diarrhoea
  • shortness of breath
  • mouth ulcers
  • minor hair loss and hair thinning
  • rashes - stop taking immediately
29
Q

What are the counselling points for sulfasalazine?

A
  • won’t start working immediately, takes up to 12 weeks
  • swallowed with a whole glass of water, not crushed or chewed
  • increases risk of infection
  • causes urine to change colour
  • stains contact lenses
  • blood tests needed regularly
30
Q

What are the side effect of sulfasalazine?

A
  • feeling sick
  • diarrhoea
  • stomach pain
  • dizziness
  • headache
  • rashes - stop taking immediately
31
Q

What are the biologics available for rheumatoid arthritis?

A
  • Etanercept

- Adalinumab

32
Q

When is a biologic indicated?

A

if the disease activity score is above 5.1

33
Q

What pre-screening checks does a patient need before a biologic?

A
  • TB
  • Hep B/C
  • HIV
  • Cancer Pre Screening
  • LFTs
  • Blood Count
  • Chest X Ray
  • Travel Abroad
  • Heart Disease History
  • Exclude pregnancy
34
Q

What are the advantages of a biologic?

A
  • better response rate
  • generally better tolerated as they are more specific
  • may reverse joint damage
  • works quicker than a conventional DMARD
  • can try a different biologic that works on a different part of the pathway if response is not good
35
Q

What are the disadvantages of a biologic?

A
  • more expensive
  • increased risk of cancer
  • increased infection dis
  • injections - patient acceptability

Patient Sem 1 (8 decks)

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