Locomotor Flashcards
What is osteoarthritis and how much of the joint capsule is involved?
Most common arthritis and the whole capital is involved. Osteoarthritis is characterised by cartilage loss followed by Periarticular a response.
Who is most commonly affected by osteoarthritis?
Over 60s
Females three times more likely than men
Some familial patterns of inheritance?
What joints are most commonly affected by osteoarthritis? (Two)
Hip and knee
What are some the rest factors of osteoarthritis?(7)
Obesity Lots and lots of sport Congenital joint dysplasia Hypermobility Gender Occupation Joint congruity
What are the primary and secondary causes of osteoarthritis?
Primary cause is idiopathic/wear and tear
Secondary causes include metabolic disease,prexisting joint damage and systemic disease
Summarise the pathophysiology of osteoarthritis?
Normal balance of degradation and regeneration of cartilage is damaged.
Repair is attempted but disordered creating a surface which is fibrillated and fissured.
This exposes underlying bone to stress and microfractures and when the bonetried to repair itself it does so in a disorganised way
What are bony overgrowths at the joint margins called?
Osteophytes
in osteoarthritis what is a atrophied disease and what is hypertrophic disease?
Atrophic is cartilaginous destruction without any bony growth
Hypertrophic is cartilagineous destruction with massive new bone information.
What are the symptoms of osteoarthritis?
Primary joint pain
Morning stiffness lesson 30 minutes
Pain of stiffness better with rest worse at exercise
What the signs osteoarthritis?
Joint tenderness
Practice
Decreased range of movement
Joint instability
What are the hand signs of osteoarthritis?
Heberdens nodes at distal interphalyngeal joint
Bouchard nodes at proximal interphalangeal joint
Give some differentials for osteoarthritis
Rheumatoid arthritis Septic arthritis Doubt Anklyosing spondylitis Bursitis
What investigations should you do for osteoarthritis?
X-ray
Bloods (crp may be up) negative ra
Joint aspiration
NB diagnosis often clinical
What would you see on x-ray on osteoarthritis?
Loss Loss of joint space Osteophytes Subchondral cyst's Sub articular sclerosis
What is the go to besting treatment wise you can do for a joint with osteoarthritis?
Poor question but joint replacement
What is the overall management plan for osteoarthritis?
Education Exercises Ànalgesia Decrease BMI Walking aids Steroid injections intra-articular for short-term relief
What is the prognosis of osteoarthritis?
Most do not become completely disabled but hand and knee are bad joints to have involved
What is rheumatoid arthritis?
Auto immune disease causing chronic symmetrical polyarthritis with systemic involvement due to signovial information
Risk factors? For rheumatoid arthritis
Gender, females more likely
Genetic’s (60% of the disease susceptibility)
Immunology (V complicated) ‘immune dysregulation plays a big part on the pathophysiology of RA’
Tough question which two genes are heavily involved with rheumatoid arthritis?
HLA DR4
HLA DRB
Describe the pathophysiology of rheumatoid arthritis?
Widespread synovitis
Cause by production of rheumatoid factor and immune complexes
Synovium proliferates into folds and fronds
Vascular proliferation and increase in permeability lead to joint effusion
Panus of inflamed Sino VM damages under Lyne cartilage
Cartilage becomes thinned and underlying bone exposed
Juxtarticular bone erosions on x-ray
Bone erosions, deformities, long Term disability
What are the symptoms of rheumatoid arthritis?
Joint pain
Worse with rest better on exercise
Morning stiffness lasting longer than 30 minutes
Symmetrical pattern
Mainly hands and feet then progress to larger joints
Fatigue and weakness
What are the signs fairly early on the rheumatoid arthritis?
Muscle wasting
Slightly warmer joints
Tenderness and joint swelling
Limitation of movement
What are the hand signs of rheumatoid arthritis?
Squaring of the hands Ulnar deviation of the fingers Boutienere deformity Swan neck deformity Z thumb deformity And extensor tendons may rupture
Differentials of rheumatoid arthritis?
Osteoarthritis Gout Septic arthritis Polymyalgia rheumatica Viral arthritis
You can get extra articular signs of rheumatoid arthritis what are they?
Rheumatoid nodules Albert/4 on Vasculitis Fibrosing Alveolitis Plural and pericardial if fusion Raynolds Carpal tunnel
What investigations you do for rheumatoid arthritis?
Rheumatoid factor
Anti-CCP
Joint aspiration
X-ray
What two serology tests are good ish for monitoring treatment/Progression?
ESR
CRP
What is the main treatment for rheumatoid arthritis?
Dmards
First line Sulphasalazine methotrexate leflunomide
Second line TNF A blockers. Ciclosporin
How do you DMARDS work against rheumatoid arthritis?
Through cytokines inhibition reduce inflammation reduce swelling and reduce development of joint erosions and irreversible damage
They are slow and their beneficial effect is not immediate
What are some of the symptomatic treatment for rheumatoid arthritis?
NSAIDs and toxins
Intra-articular injections – powerful but short lived
What is gout?
Inflammatory condition of joints due to deposition of mono sodium urate crystals. These and cause acute inflammation and eventual tissue damage.
How is uric acid formed?
The metabolism of purines by xanthene oxidase enzyme.
Can’t break down Uric acid it is excreted by the kidneys
Causes of gout?
Things which prevent the excretion: (anything affecting kidney) Chronic renal disease Hypertension Diuretics Hyper or hypo parathyroidism Increase lactic acid G6P deficiency
Increased Eurich acid production:
Increased purines synthesis
Increased turnover purines
Risk factors of gout?
Mail Alcohol seafood Kidney problems Anything cause kidney problems Family history
What is your typical presentation of gout?
Pain in the first metatarsal joint
9/10 pain
Often precipitated by alcohol dehydration diuretics
Signs of gout?
Red swollen tender joint
Tophi
Florid Synovitis
Investigations for gout?
Joint aspiration microscopy is the best
Serum uric acid
Serum uric acid and creatinine looking for signs of renal failure
Treatment for acute gout?
NSAIDS/Coxibs
Corticosteroids if needed
Ice and elevate
Prevention of gout?
Allopurinol
Lose weight
Avoid fatty foods and alcohol access
What is septic arthritis?
Acute inflammation of a joint or Prosthetic join caused by an infection
What are the risk factors for septic arthritis?
Trauma Surgery Elderly IVDU Immunosuppressant Obesity Age
Symptoms of setting of septic arthritis?
Very selfish pantry Joint pain Swollen and read tender joint Normally monoarticular Irritation of movement System upset fevers chills nice swets
Investigation for septic arthritis?
Joint aspiration from sign over your fluid for MCNS Blood culture Bloods wcc esr crp X ray Swab
Treatment for septic arthritis?
Empirical antibiotics e.g. flucloxacillin
Directed abx
Infected prosthesis = remove
What to do with an infected prosthetic joint?
It’s got to go
Maybe put in an antibiotic spacer for 3 to 6 weeks
Put another one in
What actually is a prolapsed disc?
Nucleus pulposis herniating through annular fibrosis
Is come place for a prolapse disk?
L5 S1
Cause of prolapsed disc?
Trauma
Age related degeneration
What is sciatica?
Pain tingling numbness that arise due to nerve entrapment of the lumbosacral spine
Symptoms and signs of lumbosacral disc prolapse?
Unilateral pain down one leg past knee Pain often worse in leg than back Pain better online down Loss of tendon reflexes Pain leg raise
What’s in them do you need to be careful of in prolapsed disc’s?
Cauda equina syndrome
Red flags for back pain?
Less than 20 yo Night pain Supine pain Thoracica pain Saddle Anaesthesia Incontinenence Babinski or clonus reflex
Investigations for back pain?
None if less than six week
MRI very specific for disc herniations
Treatment for prolapsed disc?
Analgesia e.g. paracetamol ibuprofens
Add week opioid if pain continues e.g. codeine
Add amitriptyline/gabapentin if sciatic pain
Think of using diazepam if muscle spasms
If more pain go to pain clinic
What is osteoporosis?
Lobo mass and deterioration of microstructure of bone. Increase bone fragility and increased risk of fractures
Symptoms of osteoporosis?
Only symptom is osteoporotic fracture
Pathogenesis of osteoporosis?
Increase breakdown of bone by osteoclasts
Decrease formation of osteoplast
Decrease bone density
Risk factors for osteoporosis?
Postmenopausal woman lack of oestrogen
Elderly people vitamin d deficiency and consequent hypoparathyroidism
Glucocorticoids
What are the investigations for osteoporosis?
X-ray
DEXA scan
Management and treatment of osteoporosis?
Vitamin D and calcium supplements Exercise Smoking cessation Reduce falls Bisphosphonates (alendronate)- lots side effects
