MSK Flashcards
What are the symptoms of osteoarthritis (OA)?
Joint pain that is exacerbated by exercise and relieved by rest
Joint stiffness in the morning or after rest (brief, rare)
Functional difficulties
Knee, hand, hip, or spine involvement
Bouchard’s nodes (PIP joints)
Heberden’s nodes (DIP joints)
Joint swelling/synovitis
Crepitus
What are the 1st line investigations for OA?
X-ray of affected joints (osteophytes, narrowing of joint spaces, subchondral sclerosis, cysts)
Normal CRP (exclude RA)
Normal ESR (exclude RA)
When do investigations not need to be considered for OA?
Patient is >45 years old, has activity-related joint pain, and has either no morning joint-related stiffness or has stiffness that lasts <30 minutes
What is the management plan for OA?
Topical NSAIDs and oral paracetamol (if not enough, oral NSAID and PPI)
Weight loss and exercise
Intra-articular corticosteroid injections
POTENTIAL JOINT REPLACEMENT THERAPY
What are the risk factors for OA?
Age >50 years
Female sex
Obesity
Family history
Physically demanding occupation/sport
Post-trauma/injury
What are the symptoms of SLE?
Photosensitive malar rash
Discoid rash
Raynaud’s phenomenon
Pericarditis/myocarditis
Fatigue, fever, mouth ulcers, lymphadenopathy
Arthralgia and non-erosive arthritis
Pleurisy
Proteinuria and glomerulonephritis
anxiety, depression, psychosis, seizures
What are the risk factors for SLE?
women
Afro-Caribbean
What are the first-line investigations for SLE?
Urinalysis (assess renal involvement)
FBC (normocytic anaemia of chronic disease, haemolytic anaemia)
APTT (prolonged in patients with antiphospholipid antibodies)
ANAs (less specific)
Anti-dsDNA antibodies, Smith antigen (more specific)
ESR and CRP (ESR elevated, CRP normal unless infection)
Complement (low C3 and C4)
How is SLE treated?
- Hydroxychloroquine
NSAID (naproxen)
Corticosteroid (prednisolone)
Immunosuppressant (methotrexate/azathioprine)
Belimumab/Rituximab (biologic)
What are the key diagnostic factors for rheumatoid arthritis (RA)?
Active symmetrical arthritis lasting >6 weeks
Joint pain and swelling (MCP, PIP, MTP)
Morning stiffness
Ulnar deviation
Rheumatoid nodules
Pleuritic chest pain (pleuritis/pericarditis)
Scleritis/uveitis
How is RA investigated?
Rheumatoid factor
Anti-CCP antibodies
X-ray (bony erosions, osteopenia, joint space narrowing)
Differentiate between radiographs of osteoarthritis and rheumatoid arthritis
Both have joint space narrowing (primary in OA, secondary to synovitis in RA)
OA has subchondral sclerosis and osteophytes
RA has bony erosions and osteopenia
How is RA treated?
Hydroxychloroquine or methotrexate (DMARD)
Consider corticosteroid (prednisolone)
Consider NSAID (ibuprofen or naproxen)
Consider biologic agent (infliximab, rituximab)
What are the key diagnostic factors for reactive arthritis?
Previous chlamydial or GI infection
Painful, swelling of joint (asymmetrical monoarthritis)
Spinal inflammation (non-specific lower back pain)
Fever, fatigue, weight loss
Enthesitis
Keratoderma blenorrhagia
Conjunctivitis, anterior uveitis
What are the risk factors for reactive arthritis?
Male sex
HLA-B27 genotype
Preceding chlamydial or GI infection
How is reactive arthritis treated?
analgesia, NSAIDs, intra-articular steroids
sulfasalazine and methotrexate for persistent disease
How is reactive arthritis investigated?
ESR and CRP (elevated)
ANA and Rheumatoid factor (negative)
X-ray (sacroiilitis, enthesitis)
Joint aspiration and gram staining to exclude septic arthritis
What are the key diagnostic factors for septic arthritis?
Hot, swollen, painful joint with restricted movement
Acute presentation
Fever
Large, single joint
Erythema migrans
How is septic arthritis investigated?
Joint aspiration and synovial fluid analysis (culture and sensitivities, microscopy, Gram stain, polarising microscopy)
ESR and CRP
How is septic arthritis treated?
Surgical lavage and IV antibiotics
Immobilise joint in acute phase
Physiotherapy once acute phase over
What are the key diagnostic factors for ankylosing spondylitis?
Inflammatory back pain >3 months
Early morning back stiffness, improvement with exercise
Enthesitis
Presentation in late teens/early 20s
Fatigue and sleep disturbance
Tenderness at sacroiliac joint
Dyspnoea
Loss of lumbar lordosis and kyphosis
What are the risk factors for ankylosing spondylitis?
HLA-B27 gene
Family history
Male sex