Lecture 5- Intro to disease of MSK Flashcards
What is polyarthiritis?
an arthritis affecting 5 or more joints
OligoARTHRITIS
-an arthritis affecting 4 or fewer joints
To describe problems with bones
use the prefix OSTEO
To describe problems with muscle
use the prefix ‘MY’
Tendonitis
inflammation of Tendons
Bursitis
Inflammation of bursa
what is bursae?
Bursae are synovial membrane lined pockets that serve to allow free movement of adjacent structures where otherwise, there could be friction.
what is Entheses?
. Entheses are the points where tendons, ligaments or joint capsules insert into bone. The largest site is the achilles insertion.
what is the largest entheses insertion site?
The largest site is the achilles insertion.
what does the prefix CHOND describe?
cartilage
Explain the muscle conditions:
Myalgia:
Myositis
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
what is a joint?
A joint is formed where two or more bones meet each other
Ways to classify rheumatic disease?
Inflammatory VS Degenerative
Rheumatoid arthritis affects?
affects the SYNOVIUM
osteoarthritis affects?
affects the CARTILAGE
what is cause of gout?
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
describe the presentation of gout?
- 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
who gets gout?
- men over 40 and women over 65
- incidence increases with age
- metabolic syndrome are strongly associated with gout
Risk factors for gout?
Male, older, genetic
metabolic syndrome, Obesity, hypertension, hyperlipidaemia, loop and thiazide diuretic, CKD, osteoarthiritis, dietary factors
Management of Gout?
-NSAIDS with colcichine- acute phase
Long term:
Allopurinol- lower serum rate level
what is the differential diagnosis for hot swollen joint?
Septic arthritis
what are the commonest organism for septic arthritis?
Staph and strep
describe the pathophysiology of RA?
- More common in women onset 30-40 years
- affects synovium -involves early invasion of by lymphocytes with an acute inflammatory reaction
what are the characteristics of RA?
acute inflammatory reaction characterised by oedema, hypertrophy and increased vascular permeability.
what are the symptoms and signs of RA?
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
Extra-articular manifestations of RA
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
what are the investigations of RA?
-ESR+CRP
-Anaemia
-Rheumatoid factor positive
-Anti CCP antibodies
X-rays
Management of RA?
Early aggressive treatment to reduce inflammation and joint damage
- NSAID
- Corticosteriods: into joints only if 1 or 2 joints
- Systemic if many joints
Management of RA?
DMARDS: methotrexate, sulfasalazine and hydrixychloroquine
Biologic agents: Anti-TNF : etanercept, adalimumab
-anti B cell- Rituximab
Anti-interleukin-6 Tocilzumab
-Anti T cell- Abata cept
Explain Osteroarthiritis?
Degenerative- prevelance increases with age-
joint pain and varying degree of functional limitation
-common sites, knee,hips and small joints
Pathophysiology of OA?
- All joint tissue affected : cartlidge, bone, synovium, capsule, ligaments or muscles
what is main site of destruction in OA?
articular cartilage
what are the clinical features of OA?
Age. 50 years moning stiffness <30mins persistent joint pain aggravated in use crepitus no inflammation
OA investigation?
clinical diagnosis
x-rays do not correlate with symptoms
management of OA?
Exercise, weight loss Appropriate footwear- insoles analgesics and Topical analgesics -corticosteriods injection -surgery
