Lower MSK Conditions

Question 1

Which genes are associated with psoriatic arhtritis?

Answer 1

B27 and B7

Question 2

What are common symptoms of psoriatic arthritis?

Answer 2

DIP joint pain
pain, swelling and stiffness in 1 or more joints
swollen fingers or toes.
your nails changing from their usual colour, or tiny dents or pits developing in your nails.
feeling drained of energy

Question 3

Common presentation of polymyalgia rheumatica?

Answer 3

bilateral shoulder/pelvic girdle pain
worsens over days/weeks
morning stiffness -causing difficulty turning over in bed
malaise

bloods: raised ESR

Question 4

What condition is characterised by inflammation and pain in the tibial tuberosity and is common in male adolescents?

Answer 4

Osgood Schlatter disease
(jumpers knee)

Question 5

What condition is known as clergyman’s knee and how may it present?

Answer 5

infrapatellar bursitis - due to kneeling
knee pain, redness, swelling below kneecap

Question 6

What does a + Thomas test show?

Answer 6

Thomas Test Interpretation For Hip Flexibility
A positive test indicates a decrease in flexibility in the rectus femoris or iliopsoas muscles or both

Question 7

What does Trendelenburg test for?

Answer 7

weakness in hip abductor muscles c

Question 8

What is osteomyelitis and how does it present?

Answer 8

infection of bone tissue

pain
nausea
fever
redness/swelling in area

Question 9

OSD Management?

Answer 9

The primary treatment for OSD is symptom management.

Analgesia can help manage the pain and applying ice packs for 10-15 minutes can reduce the swelling.

As symptoms resolve, reintroducing sport at a reduced intensity is appropriate.

Question 10

What may be some exam findings of OSD?

Answer 10

swelling/tenderness over tibial tuberosity
pronounced knee pain during knee flexion

Question 11

What is pathophysiology of polymyalgia rheumatica?

Answer 11

PMR is a chronic, systemic inflammatory disease characterised by discomfort and morning stiffness of the chest, shoulder, and pelvic girdle in people over the age of 50 years.
There is a strong association with giant cell arteritis and the two conditions often occur together

Question 12

Risk factors of PMR

Answer 12

Female, 50+, Caucasian

Question 13

What is 1st line management of PMR?

Answer 13

15mg until symptoms are fully controlled then
12.5mg for 3 weeks then
10mg for 4-6 weeks then
Reduce by 1mg every 4-8 weeks

Question 14

What disease most commonly associated with PMR?

Answer 14

Giant cell arteritis (GCA) is the most commonly associated disease with polymyalgia rheumatica (PMR).

Polymyalgia rheumatica is an inflammatory disorder that is closely related to GCA and occurs in 40% to 60% of patients with GCA. Conversely, 15%-20% of persons with PMR will also have GCA. Due to the potential complications of GCA, such as blindness, it is crucial to recognize and manage promptly.

Question 15

What is the initial investigation of suspected PMR and what would blood tests show?

Answer 15

ESR Blood test initial investigation
blood tests would show raised CRP, ESR

Question 16

What is the pathophysiology of ankylosing spondylosis (AS)?

Answer 16

FUSION OF JOINTS

AI disease type of arthritis mainly affects back, causing inflammation of the spine, starts in teens/20s
As the disease progresses it destroys the nearby articular tissues or joint tissues - inflammation
body makes extra calcium around the bones of the spines
This causes fusion or joining up of the joint bones and stiffness and immobility.
This is the hallmark symptom in the spine in ankylosing spondylitis

s

Question 17

How does AS present?

Answer 17

symptoms:
Back pain and stiffness are inflammatory (rather than mechanical) and worse in the morning (lasting more than 30 minutes), improving with movement.

back pain/stiffness

thoracic/cervical spine stiffness

enthesitis - inflammation of the area where tendon/ligaments connect to bone - Typically in ankylosing spondylitis this enthesis is inflamed at the vertebrae.

Question 18

How to investigate AS?

Answer 18

Bloods - ESR/CRP (dont rule out AS if ESR/CRP are normal)

X-Ray Findings:
changes to sacroiliac joints + spine
sclerosis (abnormal hardening of bone)
partial or total ankylosis (joint fusion)

Question 19

What treatment should I start for someone with suspected ankylosing spondylitis while waiting for referral?

Answer 19

Consider NSAID while waiting for referral
If contraindicated then try standard analgesic (Eg para w or w/o codeine)

Question 20

When should I refer with AS to rheumatology?

Answer 20

Pts under 45 with low back pain lasting more than 3/12 PLUS 4 of the following:

Low back pain starting before the age of 35 years.
Symptoms which wake them during the second half of the night.
Buttock pain.
Improvement when moving
Improvement within 48 hours of taking a NSAID
Spondyloarthritis in a first-degree relative
Current or past arthritis
Current or past enthesitis
Current or past psoriasis

if 3 criteria are present then arrange HLA-B27 test (If positive then refer to rheumatology for a spondyloarthritis test)

If axial spondyloarthritis is suspected, but the person does NOT meet the criteria for referral, advise them to return for further assessment if they develop new signs, symptoms, or risk factors (particularly if there is a history of current or past inflammatory bowel disease, psoriasis, or uveitis).

Question 21

What is axial sponyloarthritis?

Answer 21

INFLAMMATION OF JOINTS OF SPINE
a type of arthritis that affects the joints in your axial skeleton (head, neck, chest, back)

Question 22

What are symptoms of axial sponyloarthritis?

Answer 22

enthesitis - inflammation of area where tnedons/ligaments meet bone

anterior uveitis - eye inflammation (occurs in 25% of AS pts)

stiffness of ribs - can cause sob

plantar fasciitis

achilles tendonitis

kyphosis (advanced stages)

Question 23

What is a typical x-ray finding of AS?

Answer 23

Bamboo spine - due to joint fusions of spinal joints - suggest late stages of disease progression

Question 24

What are complications of ankylosing spondylitis?

Answer 24

a) Pulmonary fibrosis: Patients with ankylosing spondylitis can develop pulmonary complications including upper lobe fibrosis and restrictive lung disease.

b) Fracture : Due to a combination of spinal rigidity and osteoporosis, individuals with ankylosing spondylitis are at an increased risk of vertebral and other fractures.

c) Osteoporosis : Chronic inflammation and prolonged immobilisation associated with ankylosing spondylitis can lead to decreased bone mineral density or osteoporosis.

d) Anterior uveitis: This is a common extra-articular manifestation of ankylosing spondylitis. It presents as acute, painful red eye and is associated with inflammation of the uveal tract.

Question 25

What are symptoms of anterior uveitis?

Answer 25

Painful red eye (typically a dull, aching pain)
Reduced visual acuity
Photophobia (due to ciliary muscle spasm)
Excessive lacrimation (tear production)

Question 26

What are exam findings of anterior uveitis?

Answer 26

Ciliary flush - ring of red spreading from the cornea outwards)
Miosis - constricted pupil due to sphincter muscle contraction
Abnormally shaped pupil - due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
Hypopyon - inflammatory cells collected as a white fluid in the anterior chamber