MSK Flashcards
what is ankylosing spondylitis?
an inflammatory condition affecting the axial skeleton esp the spine and sacroiliac joints
what kind of disease is ankylosing spondylitis?
a seronegative spondylarthropathy
~90% of ankylosing spondylitis have which gene?
HLA-B27
is ankylosing spondylitis more common in men or women?
men
what is the typical ankylosing spondylitis pt?
a young man in 20s
what is the timeline for symptom development in ankylosing spondylitis?
symptoms develop gradually over at least 3 months
what are the main presenting symptoms in ankylosing spondylitis?
pain and stiffness in lower back
what is characterisitc about the pain and stiffness in ankylosing spondylitis?
it is worse w/ rest and improves w/ movement
worse at night
morning stiffness >30 mins
what are the 5 conditions assoc w/ ankylosing spondylitis?
anterior uveitis
aortic regurg
atrioventricular block
apical lung fibrosis
anaemia of chronic disease
what does schobers test assess?
spinal mobility
how is the schobers test carried out?
the pt stands straight and L5 is located and a point is marked 10cm above and 5cm below L5
the pt then bends forward as much as possible and the distance between the 2 points is measured
what result of schobers test supports a diagnosis of ankylosing spondylitis?
<20cm
what are the investigations for ankylosing spondylitis?
HLA-B27 genetic testing
inflammatory markers (CRP and ESR)
spine XR - bamboo spine (fusion of sacroiliac and spinal joints)
what is the first line management of ankylosing spondylitis?
NSAIDs
what is the second line management of ankylosing spondylitis?
anti TNF (adalimumab, etanercept, infliximab)
what are the two third line managements for ankylosing spondylitis?
monoclonal antibodies against IL-17 (secukinumab or ixekizumab)
JAK inhibitor (upadacitnib)
what is the difference between polymyositis and polymyalgia rheumatica?
polymyalgia rheumatica causes pain and stiffness
polymyositis causes pain and weakness
what is gout?
a type if crystal arthroparthy assoc w/ chronically high uric acid levels
what is the typical presentation of gout?
a single hot swollen and painful joint
what are the 3 joints most commonly affected by gout?
base of big toe
base of thumb
wrist
what does aspirated fluid show in gout?
monosodium urate crystals
needle shaped and negatively bifringent of polarised light
what does aspirated fluid in pseudo gout show?
calcium pyrophosphate crystals
rhomboid shaped and positively bifringent of polarised light
what is the first line management of an acute flare of gout?
NSAIDs e.g. naproxen w/ PPI
what is the second line management of an acute flare of gout?
colchicine
