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Y3 Core Conditions > Locomotor > Flashcards

Locomotor Flashcards

1
Q

What is osteoarthritis?

A

A disorder of synovial joints, characterised by:

  1. focal areas of damage to the articular cartilage
  2. Remodelling of underlying bone and formation of osteophytes - new bone at joint margins
  3. Mild synovitis
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2
Q

Which areas of the body are most commonly affected by osteoarthritis?

A

Knees, hips and small joints of the hands (but any synovial joint can be affected)

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3
Q

How many people are affected by osteoarthritic joint pain in the UK?

A

8.5 million

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4
Q

What are the risk factors for osteoarthritis? (10)

A
  1. Genetic factors - heritability is around 40-60%, and the responsible genes are unknown
  2. Ageing
  3. Female sex
  4. Obesity
  5. High bone density - risk factor for development
  6. Low bone density - risk factor for progression
  7. Joint injury
  8. Occupational/recreational stressed on joints
  9. Joint laxity
  10. Joint malalignment
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5
Q

What are the complications associated with osteoarthritis?

A

Depending on the progression of the disease:

  1. Disability
  2. Inability to work
  3. Falls
  4. Psychosocial impact
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6
Q

What are the symptoms associated with osteoarthritis? (10)

A 
Cardinal complaints:
1. Pain - worse at end of day 
2. Restricted function/stiffness
Others:
3. Gelling - pain/stiffness caused by inactivity 
4. Bony swellings and joint deformity
5. Crepitus
6. Restricted ROM
7. Joint tenderness
8. Muscle wasting/weakness
9. Joint effusions
10. Instability
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7
Q

What symptoms would NOT indicate osteoarthritis?

A
  1. Symptoms occurring before middle age
  2. Symptoms that are related to inflammation rather than joint damage
  3. Many joints are problematic rather than a few
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8
Q

What are the differential diagnoses for all forms of osteoarthritis? (12)

A
  1. Inflammatory arthritis
  2. Rheumatoid arthritis
  3. Psoriatic arthritis
  4. Gout
  5. Reactive arthritis
  6. Arthritis associated with SLE
  7. Fibromyalgia
  8. Septic arthritis
  9. Fractured bone
  10. Ligament damage
  11. Bursitis
  12. Cancer
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9
Q

What are the signs associated with osteoarthritis?

A
  1. Bouchards (proximal) and Heberden’s (distal) nodes

2. Fixed flexion deformity

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10
Q

What are the conservative ways of managing osteoarthritis?

A
  1. Lose weight
  2. Do less sport and rest more
  3. Physiotherapy
  4. Walking aids, supportive footwear, adapt home
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11
Q

What are the medical treatments for osteoarthritis? (4)

A
  1. Paracetamol
  2. NSAIDs - arthrotec - diclofenac and misoprostol
  3. Tramadol
  4. Joint injection of anaesthetic/steroids
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12
Q

What are the surgical options for treating osteoarthritis? (4)

A
  1. Arthroscopic washout
  2. Arthroplasty
  3. Osteotomy
  4. Arthrodesis
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13
Q

How will osteoarthritis appear on X-ray, and what is the acronym used to remember the signs?

A

LOSS
Loss of joint space (asymmetrical) - reflects thinning of the hyaline cartilage
Osteophytes
Subchondral sclerosis
Subchondral cysts - fluid filled micro-fractures

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14
Q

What is the pathophysiology of rheumatoid arthritis (RA)?

A

It is an autoimmune disease, in which:

  • IgG forms against cartilage and rheumatoid factor (RF) (an IgM antibody) - forms against that IgG, leading to synovitis
  • This eventually leads to pannus (deposits in the synovial membrane) and joint destruction
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15
Q

What is the definition of RA?

A

A chronic systemic inflammatory disease characterised by a symmetrical, deforming, peripheral polyarthritis

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16
Q

What is the typical presentation of RA?

A

There is an onset of symmetrical polyarthritis over weeks to months, then relapsing-remitting course. It affects MCPs and PIPs of hands and feet leading to pain, swelling and deformity.
It is associated with morning stiffness and improves with exercise.

17
Q

In long standing RA, particularly if left untreated, what deformities may develop? (5)

A
  1. Ulnar deviation
  2. Dorsal wrist subluxation
  3. Boutonniere and swan neck deformities
  4. Muscle wasting
  5. Baker’s cysts
18
Q

What systemic symptoms are associated with RA? (3)

A
  1. Fatigue
  2. Weight loss
  3. Fever
19
Q

What dermatological syndromes/symptoms are associated with RA? (2)

A
  1. Sjorgren’s

2. Raynaud’s

20
Q

What is gout?

A

Gout is a disorder of purine metabolism characterised by a raised uric acid level in the blood (hyperuricaemia) and the deposition of urate crystals in joints and other tissues, such as connective tissues or the urinary tract

21
Q

What is gout arthritis?

A

Arthritis due to urate crystals in the joints

22
Q

What is the single most important risk factor for developing gout?

A

Hyperuricaemia

23
Q

What is hyperuricaemia usually due to?

A

Impaired renal excretion of urate

24
Q

What are the other causes (secondary causes) of hyperuricaemia? (11)

A
  1. Hypertension
  2. Hyperparathyroidism
  3. Down’s syndrome
  4. Lead nephropathy
  5. Sarcoidosis
  6. Medication
  7. Chronic renal disease
  8. Volume depletion
  9. Glycogen storage diseases
  10. Lymphoproliferative/myeloproliferative disorders
  11. Carcinomatosis
25
Q

Aside from hyperuricaemia, what are the other risk factors for gout? (10)

A
  1. Age
  2. Male gender
  3. Menopausal status in women
  4. Renal disease
  5. Obesity (dietary intake of red meat/seafood too)
  6. Metabolic syndrome
  7. Dyslipidaemia
  8. Drugs - e.g. diuretics
  9. Genetic factors
  10. Trauma
26
Q

What occurs in approximately 50% of people with untreated gout, after 10 years?

A

Tophi (tophaceous material)

27
Q

What conditions is gout an independent risk factor for? (3)

A
  1. CKD
  2. MI
  3. Cardiovascular disease mortality
28
Q

Where does gout tend to occur?

A

Gout tends to attack joints in the extremities, because temperatures in the feet and hands can be low enough to precipitate urate from plasma. This tophi typically form in the helix of the ear, finger tips, olecranon bursae.

29
Q

Which joint does gout typically affect?

A

First metatarsophalangeal joint (big toe) : 56-78% of people at first presentation

30
Q

How does gout typically present?

A

Severe pain with associated swelling, redness, warmth and tenderness. Usually reaches maximum intensity within 24 hours.

31
Q

Which drugs can raise plasma urate levels, and cause gout? (7)

A
  1. ACE inhibitors
  2. Beta-blockers
  3. Ciclosporin
  4. Diuretics
  5. Pyrazinamide
  6. Ritanovir
  7. Tacrolimus
32
Q

What is the gold standard for diagnosing gout?

A

Demonstration by microscopy of urate crystals in synovial fluid or tophi.

33
Q

What are the differentials to consider for gout? (9)

A
  1. Septic arthritis (important to consider if patient is systemically unwell)
  2. Bursitis, cellulitis, tenosynovitis
  3. Non-urate crystal-induced arthropathy
  4. Osteoarthritis
  5. Psoriatic arthritis
  6. Reactive arthritis
  7. Rheumatoid arthritis
  8. Haemochromatosis
  9. Trauma
34
Q

What is the management of acute gout? (4)

A
  1. Self-care: rest/elevate limb, avoid trauma to area, keep joint exposed and in cool environment (consider ice pack)
  2. Pharmacological:
    -NSAIDs (+PPI if necessary)
    -Oral colchicine
    (aspirin is not indicated in gout)
  3. Joint aspiration
  4. In people who cannot tolerate NSAIDs or colchicine - consider oral/IM corticosteroids
35
Q

What is the management to prevent gout?

A

Urate-Lowering therapy (ULT)

  • Allopurinol (first-line)
  • Febuxostat (second-line)

Y3 Core Conditions (19 decks)

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