MSJ Flashcards
Myalgia
Muscle pain
Can be due to
- Viral infection
- Drugs (e.g statins)
Tennis elbow
Golfer’s elbow
Tennis elbow
- Lateral epicondylitis
Golfer’s elbow
- Median epicondylitis
Worldwide impact of MSK disorders
MSK
- 2nd cause of disability worldwide
Lower back pain
- Leading cause of disability
Financial cost of MSK problem
10 billion cost on NHS
- 20% of GP complaints is MSK problem
Septic arthritis
Presentation
- Monoarthritis
- Hot, swollen joint
Diagnosis
- Joint aspiration
- Gram staining for infection–> mainly Strep. infection
Mortality rate- 11% mortality rate, 50% if polyarticular
Gout
- Cause
- Risk factors
Most common inflammatory arthropathy worldwide
Cause:
- High serum urate levels (>408)–> precipitation of monosodium rate crystals (negatively birefringent rods)
- 10% with hyperuricaemia develop it
Risk factors
- Men, >40
- Women >65
- Genetics
- CKD
- Metabolic syndrome
- Oestoarthritis
- Dietary factors (alcohol, red meat, cauliflower, spinach, shellfish, muscles)
- Loop and thiazide diuretics use
Pseudogout
Precipitation of calcium pyrophosphate crystal in joints. (positively birefringent rods)
Management of gout
Acute attacks
- NSAIDs (naproxen)
- Colchicine
- Steroids [intrarthticular, systemic)
Long term treatment
- Urate-lowering therapy: allopurinol, febuxostat
Rheumatoid arthritis epidemiology
0.5-1% word
More common in women (3:1)
- Peak 45-65
30% genetic susceptibility w/ environmental factors
RA pathophysiology
Changes first occur in synovial
Smoking is the most important triggering environmental factor.
- Triggers generation of ACPA (Ab) which triggers RA
Mechanism
- Lymphocyte invade synovium–> acute inflammation
- Vascular permeability increases= synovial proliferation, panes formation
- Cartilage destruction and bone erosion
RA signs and symptoms
Symmetrical pain
Swelling of small joints of the hands and feet
- MCP, PIP, wrist, MTP, not DIPs
Early morning stiffness (>1 hour)
Systemically unwell
Malaise, fatigue
Extra-articular manifestation of RA
Nodules
Bursitis/ tenosynovitis
Eye problems: secondary Sjogren’s syndrome, scleritis
Splenomegaly
Atlanto-axial subluxation
Carpal tunnel syndrome
Renal amyloidosis
Increases risk of CVD
Anaemia
Lung fibrosis
RA investigations
FBC- anaemia of chronic disease
- Normocytic normochromic
Rheumatoid factor positive
- IgM ab against Fc component of IgG (1 in 20 is raised in normal population)
Anti CCP Ab
- 98% specific
ESR and CRP
X-ray of hands and feet
- initially periarticular osteoporosis and reduced joint space
- Cysts
RA management
NSAIDs for short peroids
Corticosteroids
- 1/2 joints infected= intra-articular injection
- Systemic if more joints affected (tablet/ intramuscular)
DMARDs (disease modifying Anti-Rheumatic drugs)
- Methotrexate
- Sulfasalazine
- Hyrdoxychloroquine
- Leflunomide
If not responding to DMARDs= biologic agents
- Anti-TNF agents
- Anti-B cell
- Anti-IL-6R blocker
- Anti-T cells
- JAK-2 inhibitor (tablet)
Physiotherapy, occupation therapy, podiatry
Osteoarthritis
- Epidemiology
70% of people >65
common joints affected
- 1st carpometacarpal joint
- PIP, DIP
Osteoarthritis pathophysiology
Metabolically active, starting in the cartilage
- Articular cartilage focally destroyed
Remodelling of adjacent bone causes formation of osteophytes
Further remodelling and repair
Secondary synovial inflammation and crystal deposits.
Osteoarthritis clinical features
Clinical diagnosis, blood test and imaging not very helpful
Morning stiffness, <30 minds
Persistent joint pain aggravated on use
Crepitus
Bony enlargement and tenderness
No clinical correlation in X-rays with symptoms
SLE epidemiology
97:100k
More common in females (10-20 times more than males)
More common in afro-carribeans
SLE pathophysiology
Genetic susceptibility and UV light exposure= abnormal immune response
- Immune complexes attack many tissues in the Body.
SLE presentation
Malar rash
Inflammation of lung and heart
- Pericarditis
- Serositis
- Endocarditis
Arthritis
Glomerulonephritis
Anaemia, thrombocytopenia
SLE investigations
Urinanlaysis
- protein: creatinine ratio
FBC
ESR high
Not high CRP (unless serositis)
Antibodies
- Anti-nuclear
- Lupus anticoagulant
C3, C4 (low)