MSK Flashcards
What is Osteoarthritis?
Loss of articular cartilage
Wear & tear of joints
MC type of arthritis
RF OA
Elderly
After 55 years, females (menopause increases risk)
Previous joint trauma
Genetics
Obesity
RA
Gout
Obesity - low-grade inflam state, not mechanical RF
Joint hypermobility
Occupation! - manual labour (small joints of hands), farming (hips), football (knees)
OSTEOPOROSIS = ↓OA RISK !
Signs / Symptoms OA
Typical Px : Elderly patient w/ hip or knee pain (weight-bearing joints) or carpometacarpal joint (base of thumb)
Asymmetrical!
LESS THAN 30 mins morning stiffness
↓Pain with rest
Pain at end of day
↑Pain with activity
Crepitus
Bony swellings - DIP (Heberden’s) and PIP (Bouchard’s)
Effusion
Synovitis
Functional impairment
Tenderness
Deformities
DDx OA
RA
Gout
Pseudogout
Causes OA
Most - 1º (idiopathic)
2º - caused by other diseases e.g. obesity, haemochromatosis,
??
Ix OA
XR - LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
CRP might be elevated
Rheum factor + ANA = NEG
MRI - shows early articular cartilage injury and subchondral BM changes
Aspiration of synovial fluid - if painful effusion, shows viscous fluid w few leucocytes
Main pathological features of OA
Loss of cartilage
Disordered bone repair
Tx OA
Conservative :
Px ed
Exercise
↓weight
Physio
Footwear
Occupational therapy
Walking aid
Medical
> Topical - NSAIDs, Capsaicin
> Oral - NSAIDs (caution!) w/ PPI if long term, paracetamol
Opioids - if above hasnt worked
not rlly gonna offer unless rllyyy bad and nothing else works ->
Intra-articular steroid injections (only short term relief - 2-10 weeks) - hyaluronic acid
Surgery
Remove osetophytes
Joint replacement - if VERY severe
Arthroscopy - ONLY if loose bodies (lasts only 10-15 years)
What is a loose body?
When small pieces of articular cartilage break off and “floats” in synovial fluid
Causes joints to lock
What are some indications of a loose body?
Uncontrollable pain (esp at night)
Significant limitations
What is Rheumatoid Arthritis?
A chronic, autoimmune, inflammatory symmetrical polyarthritis
RF RA
Female BEFORE menopause (After menopause, incidence is equal between M and F)
Family history
Smoking!!
Autoimmune conditions
Stress
Infection
Signs / Symptoms RA
Joint pain worse in mornings/with cold
Morning stiffness > 30 mins
Loss of function
Fatigue + malaise
Pain decreases with use
Warm, red, tender joints
Joints : SYMMETRICAL!
Small = MCP + PIP (not DIP usually)
Large (as disease progresses) = wrists, elbows, shoulders, knees, ankles
HAND DEFORMITIES : usually at IP joints
1. Ulnar deviation
2. Swan neck (or Z thumb)
3. Boutonniere deformity
Rheumatoid nodules at pressure points - elbow
Carpal tunnel syndrome
Popliteal cyst
What happens in a swan neck deformity?
PIP hyperextension
DIP flexion
What happens in a Boutonniere deformity?
PIP flexion
DIP hyperextension
Extra-Articular symptoms RA
Soft tissue :
Nodules! - usually at pressure points
Bursitis
Tenosynovitis
Muscle wasting
Haematological
Palpable lymph nodes
Splenomegaly
Anaemia
Felty’s triad (rare)
Eyes
Sicca
Sjogren’s
Episcleritis
Scleritis
Neuro
Mild sensory neuropathy (peripheral - legs>arms)
Cord compression
Myelopathy
Skin
Vasculitis
Lungs
Pleural effusion
Rheum nodules
Diffuse fibrosing alveolitis
Diagnostic criteria RA
Needs 4/7 of following
- Morning stiffness > 30 mins
- Arthritis of 3 or more joints
- Arthritis of hand joints
- Symmetrical
- Rheumatoid nodules
- Rheumatoid factor pos
- Radiographic changes - LESS
DDx RA
SLE
Psoriatic arthritis
Symmetrical seronegative spondyloarthropathies
Ix RA
XR - LESS
Loss of joint space
Erosions (peri-articular)
Soft tissue swelling
Soft bones (osteopenia)
Bloods
> Rheum factor = POS in 70% patients (but not specific)
> Anti-CCP = POS, vvv specific but not routinely done (If pos = worse prognosis)
> FBC - ↑ platelets, ↑ ESR, ↑ CRP, normochromic normocytic anaemia
MRI/US - erosions at joint margins and bones
If effusion present, then aspiration of joint = CLoudy bc ↑↑WBC
Tx RA
Upon diagnosis : 1st Line :
DMARDs - Methotrexate, Leflunomide
+
5-asa - Sulfasalazine
2nd Line:
Biologic - TNF-inhibitor
–
Symptom control - NSAID
–
If acute exacerbations, steroids (IM methyprednisolone)
MDT management - Rheum, OT, physio, GP
What is Osteoporosis?
Low bone mass
∴ bone fragility + ↑ fracture risk
What is osteopenia?
Precursor to osteoporosis
T score between -1 and -2.5
What is Osteomalacia?
Poor bone mineralisation
bc lack of calcium (adult form of rickets)
∴ soft bones
Causes Osteoporosis
1º - post-menopause & age
2º - ↑bone turnover, SHATTERED
Steroid use (prednisolone)
Hyperthyroidism/Hyperparathyroidism
Alcohol/smoking
Thin (low BMI)
Testosterone low
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease e.g. RA, myeloma
Dietary calcium low