MSK Flashcards
what is osteoarthritis?
age related reaction of a joint to insult or injury
which inflammatory mediators are seen in osteoarthritis?
IL1 and TNF-a
which type of tissue is most affected in osteoarthritis?
articular cartilage
what are the radiological features of a joint affected by osteoarthritis?
joint space narrowing osteophyte formation subchondral sclerosis subchondral cysts bone contour abnormalities
what is an osteophyte?
a bony projection associated with the degeneration of cartilage in joints
what are heberden’s nodes?
swellings of the finger joints specifically at the distal interphalangeal joints (dip)
what are bouchard’s nodes?
swellings of the finger joints specifically at the proximal interphalangeal joints (pip)
where does osteoarthritis of the knees begin?
medially
where will hip joint pain commonly be felt?
groin
what type of joint is affected by osteoarthritis?
synovial joint
what are the causes of primary and secondary osteoarthritis?
primary-idiopathic
secondary-joint disease, haemochromatosis, obesity, occupational
what are risk factors of OA?
age increase female diabetes hypermobility of joints obesity occupation inflammatory arthritis
which joints are most commonly affected in OA?
DIP joints first carpometacarpal joints (base of thumb) first metatarsophalangeal joint of foot vertebra hips knees
what is crepitus?
joint grating/crunching during movement
what is the pattern of joint stiffness and pain in OA?
joint pain made worse by movement and relieved by rest
morning stiffness lasts less than 30 mins
what is non medical treatment of OA?
weight loss if obese exercise heat/ice packs supportive footwear/joint supports acupuncture, physiotherapy
what are pharmacological managements of OA?
paracetamol
nsaids
weak opioids if necessary
corticosteroid injections- short term
what are the surgical managements of OA?
arthroscopy- removal of loose bodies from joint cavity
arthroplasty- prosthetic joint, knee/hip replacement
osteotomy- cut and realign joint (younger)
fusion- fuse joint to remove pain but also mobility
what is rheumatoid arthritis?
autoimmune disorder causing symmetrical polyarthritis
what is arthritis?
joint inflammation causing pain
what types of joints does rheumatoid arthritis affect?
synovial joints
what are the risk factors of RA?
women
family history
genetic predisposition
smoking
what is the pattern of joint stiffness and pain in RA?
morning stiffness lasts more than 30 minutes
worst in the morning and in the cold
pain eased by movement
how may an affected joint present in RA?
hot, red, swollen, tender
what are common hand deformities of RA?
ulna deviation, swan neck, z thumb, boutonniere deformity
what does rheumatoid factor show and how useful is it?
not positive in all RA patients, found in other inflammatory conditions too
what does anti ccp stand for and how useful is it?
anti cyclic citrullinated peptide
not present in all RA patients but specific for RA and indicates worse form of disease
what are the pharmacological managements for RA?
nsaids cox inhibitors-aspirin paracetamol +/- opioid corticosteroids- IM, oral, intraarticular DMARDS biological therapies
what does DMARDS stand for?
disease modifying anti-rheumatic drugs
how do dmards work?
inhibit cytokines and supress immune system
what are commonly prescribed dmards?
methotrexate, sulfasalazine, leflunomide
what are the different types of biological therapies available for RA?
interleukin blockers
b cell inhibitors
t cell blockers
TNF-a blockers
what is osteopenia?
a precursor to osteoporosis characterised by low bone density
what is osteoporosis?
systemic skeletal disease characterised by low bone mass and deterioration of bone tissue therefore increasing fragility and susceptibility to bone fracture
