MSK Flashcards by Aimee Cunningham

What is meant by ‘wear and tear’ arthritis

Osteoarthritis

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What type of arthritis is worse at the end of the day?

Osteoarthritis

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What type of arthritis affects symmetrical, swollen, painful small joints?

Rheumatoid

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What type of arthritis causes pain with movement and background pain at rest?

Osteoarthritis

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What type of arthritis is worse in the morning?

Rheumatoid

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What is ‘joint gelling’ associated with osteoarthritis?

Stiffness after rest

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What joint deformities might be seen in osteoarthritis?

Heberden’s nodes distally
Bouchard’s nodes proximally
Tenderness, derangement, swelling
Mild synovitis

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What would be seen on an X ray of someone with osteoarthritis?

Loss of joint space
Osteophytes
Subarticular sclerosis
subchondral cysts

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How is osteoarthritis managed?

Exercise to improve strength and fitness
Weight loss
Analgesia inc steroid injections
Joint replacement

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What joint deformities can occurs in rheumatoid arthritis?

Early: swollen wrist, MCP, PIP & MTP
Later: ulnar deviation of fingers.
- Wrist sublaxation
- Boutonniere and swan neck finger deformity
- Z thumb
- Rupture of hand extensor tendons

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Systemic signs of rheumatoid arthritis?

Nodules: elbows, lungs
Lymphadenopathy
Vasculitis
Fibrosing alveolitis, obliterative bronchiolitis, pleural effusion
Raynauds
Splenomegaly
Carpal tunnel
Scleritis

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What gene is rheumatoid arthritis associated with?

HLA DR4/DR1

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What are specific blood markers of rheumatoid arthritis?

Rheumatoid factor
ANCA
Anti-CCP

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What would be seen on an X ray of someone with rheumatoid arthritis?

Soft tissue swelling
Osteopenia
Sublaxation
Reduced joint space
Bone erosions

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What is DAS28 Criteria?

For Rheumatoid Arthritis:

Joint involvement
Serology: RF & anti-CCP
Acute reactants: ESR & CRP
Symptoms for more than 6 weeks

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How is rheumatoid arthritis managed?

Aim for <3 Das 28
DMARDS: Methotrexate
Biologics: TNF alpha inhib
Steroids
NSAIDs
Manage CV risk factors
Surgery: reduce pain & deformity - increasing function

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What must be ruled out in a hot, swollen joint?

Septic arthritis

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What are risk factors for septic arthritis?

Joint disease
Recent joint surgery
Prosthetic
Immunosuppression
Diabetes
Chronic renal failure
Over 80
IV drug abuse

What signs would there be in septic arthritis?

Temperature over joint
Effusion
Very tender to move
Pyrexial, tachycardic

What are the differentials for a hot, swollen joint?

Osteoarthritis
Septic arthritis
Rheumatoid arthritis flare
Reactive arthritis
Vasculitis
Gout

What are the investigations for suspected septic arthritis?

Bloods: LFTs, clotting, CRP, FBC & CULTURES
X ray
URGENT joint aspiration: synovial microscopy and culture

How to managed septic arthritis?

Empirical ABx: flucloxacillin, vancomycin, cefotaxime
Analgesia & splint
Drain

What are the risk factors for osteoporosis?

Steroids
Hyperthyroidism
Alochol/tobacco
Thin <22 BMI
Testosterone low
Early menopause
Renal/liver failure
Erosive/inflammatory bone disease
Dietary Ca low/ malabsorption, Diabetes type 1

When would you not do DEXA scan in suspected osteoporosis?

If they are over 75

What does osteoporosis of trabecular bone put people at risk of?

Crushed vertebra

What is the bone mass density in osteoporosis?

Reduced: 2.5

What does osteoporosis of cortical bone put people at risk of?

- Long bone fractures

What is the medical management of osteoporosis?

- Bisphosphonates: Alendronate - Calcium & vit D - HRT - SC Denosumab

What changes in lifestyle can help managed osteoporosis?

- Quit smoking & alcohol - Weight bearing exercise - Balance exercises to reduce risk of falls - Diet rich in calcium and vit D - Fall prevention

What happens in a prolapsed disc?

Soft inner nucleus pulposus herniates through fibrous outer layer. Commonly lumbar

What are risk factors for a prolapsed disc?

- Natural weakness - Job: lifting/sitting - Sports - Obesity - Smoking - Age

What are the symptoms of a prolapsed disc?

- Sudden severe back pain - Eased by lying flat - Exacerbated by moving, coughing and sneezing - Nerve root pain/sciatica

When may surgery be considered for a prolapsed disc?

If symptoms don't improve over 6 weeks

What red flag must you check for in prolapsed disc history?

Cauda Equina: - Lower back pain - Saddle anaesthesia - Leg weakness - Bowel and bladder issues

How is a prolapsed disc managed?

- Exercise and live as normal - Pain relief/muscle relaxant: diazepam - Physio - Surgery

What is gout?

Deposition of monosodium urate crystals in joints

What can cause gout?

- Hereditary - Diuretics - Increase dietary purines: red meat - Alcohol - Leukaemia - Cytotoxic drugs

What can be associated with gout?

- CVD & hypertension - Increased plasma urate - Diabetes - Chronic renal failure

What are the signs and symptoms of gout?

- Acute monoarthropathy - Severe joint inflammation - Metatarsopharyngeal of big toe

What investigations should be carried out for gout?

- Polarised light microscopy of synovial fluid | - Raised sodium uvate

What may be seen on gout x ray?

- Swelling | - Punched out aromas

How is gout managed?

- High dose NSAIDs - Allupurinol: preventative - Steroids - Rest, elevation, ice

Complications of gout?

- Tophi | - Renal disease/stones

What lifestyle changes can be made to prevent gout?

- Lose weight | - Avoid prolonged fasts, alcohol, purine rich meat and low dose aspirin