Lecture 5- Intro to disease of MSK

Question 1

What is polyarthiritis?

Answer 1

an arthritis affecting 5 or more joints

Question 2

OligoARTHRITIS

Answer 2

-an arthritis affecting 4 or fewer joints

Question 3

To describe problems with bones

Answer 3

use the prefix OSTEO

Question 4

To describe problems with muscle

Answer 4

use the prefix ‘MY’

Question 5

Tendonitis

Answer 5

inflammation of Tendons

Question 6

Bursitis

Answer 6

Inflammation of bursa

Question 7

what is bursae?

Answer 7

Bursae are synovial membrane lined pockets that serve to allow free movement of adjacent structures where otherwise, there could be friction.

Question 8

what is Entheses?

Answer 8

. Entheses are the points where tendons, ligaments or joint capsules insert into bone. The largest site is the achilles insertion.

Question 9

what is the largest entheses insertion site?

Answer 9

The largest site is the achilles insertion.

Question 10

what does the prefix CHOND describe?

Answer 10

cartilage

Question 11

Explain the muscle conditions:
Myalgia:
Myositis

Answer 11

Myalgia:Pain in muscles. Very common. Commonly associated with viral infections. Can be drug induced (eg by statins).

Myositis– Inflammation of the muscles. Far less common than myalgia and can be autoimmune

Question 12

what is a joint?

Answer 12

A joint is formed where two or more bones meet each other

Question 13

Ways to classify rheumatic disease?

Answer 13

Inflammatory VS Degenerative

Question 14

Rheumatoid arthritis affects?

Answer 14

affects the SYNOVIUM

Question 15

osteoarthritis affects?

Answer 15

affects the CARTILAGE

Question 16

what is cause of gout?

Answer 16

If serum urate levels consistently exceed the physiological saturation point (around 380 μmol/L), monosodium urate crystals form and deposit, particularly in cartilage, bone, and periarticular tissues of peripheral joints

Question 17

describe the presentation of gout?

Answer 17

• presents in the early morning
• usually affects a single joint- 1st metatarsopharyngeal joint or knee
• Affected joint is
  1) warm
  2) tender
  3) swollen
  4) most cases- skin overlaying erythematous

Question 18

who gets gout?

Answer 18

• men over 40 and women over 65
• incidence increases with age
• metabolic syndrome are strongly associated with gout

Question 19

Risk factors for gout?

Answer 19

Male, older, genetic
metabolic syndrome, Obesity, hypertension, hyperlipidaemia, loop and thiazide diuretic, CKD, osteoarthiritis, dietary factors

Question 20

Management of Gout?

Answer 20

-NSAIDS with colcichine- acute phase
Long term:
Allopurinol- lower serum rate level

Question 21

what is the differential diagnosis for hot swollen joint?

Answer 21

Septic arthritis

Question 22

what are the commonest organism for septic arthritis?

Answer 22

Staph and strep

Question 23

describe the pathophysiology of RA?

Answer 23

• More common in women onset 30-40 years

- affects synovium -involves early invasion of by lymphocytes with an acute inflammatory reaction

Question 24

what are the characteristics of RA?

Answer 24

acute inflammatory reaction characterised by oedema, hypertrophy and increased vascular permeability.

Question 25

what are the symptoms and signs of RA?

Answer 25

onset varies; can be acute or chronic
-symmetrical pain and boggy swelling and the small joints of the hands and feet
-Early morning stiffness
-malaise and fatigue are common
examinations looks for pain, swelling and restriction of movement
-important to examine other organs

Question 26

Extra-articular manifestations of RA

Answer 26

0Nodules (20%) ; Sero positive
-Bursitis / Tenosynovitis
-Eyes: Sjogren’s syndrome (secondary) / Scleritis / Scleromalacia
-Lymphadenopathy (Felty’s)
-Anaemia of chronic disease
-Lung fibrosis /effusion /Nodules (Caplan’s)
-Pericarditis
-Neurological: -Atlanto-axial subluxation / Carpal tunnel syndrome / –Mononeuritis -multiplex
-Renal amyloidosis (AA)
-Leg ulcers / Pyoderma gangenosum
Vasculitis

Question 27

what are the investigations of RA?

Answer 27

-ESR+CRP
-Anaemia
-Rheumatoid factor positive
-Anti CCP antibodies
X-rays

Question 28

Management of RA?

Answer 28

Early aggressive treatment to reduce inflammation and joint damage

• NSAID
• Corticosteriods: into joints only if 1 or 2 joints
• Systemic if many joints

Question 29

Management of RA?

Answer 29

DMARDS: methotrexate, sulfasalazine and hydrixychloroquine
Biologic agents: Anti-TNF : etanercept, adalimumab
-anti B cell- Rituximab
Anti-interleukin-6 Tocilzumab
-Anti T cell- Abata cept

Question 30

Explain Osteroarthiritis?

Answer 30

Degenerative- prevelance increases with age-
joint pain and varying degree of functional limitation
-common sites, knee,hips and small joints

Question 31

Pathophysiology of OA?

Answer 31

• All joint tissue affected : cartlidge, bone, synovium, capsule, ligaments or muscles

Question 32

what is main site of destruction in OA?

Answer 32

articular cartilage

Question 33

what are the clinical features of OA?

Answer 33

Age. 50 years
moning stiffness <30mins
persistent joint pain aggravated in use
crepitus
no inflammation

Question 34

OA investigation?

Answer 34

clinical diagnosis

x-rays do not correlate with symptoms

Question 35

management of OA?

Answer 35

Exercise, 
weight loss
Appropriate footwear- insoles
analgesics and Topical analgesics
-corticosteriods injection
-surgery