MSK Flashcards
Osteoarthritis aetiology
Age
hereditary disposition
Female
Obesity
Osteophytes form in
Osteoarthritis
Also known as Heberden (DIP) and Bouchard nodes (PIP)
Osteoarthritis Sx
Joint pain & discomfort
- Gets worse with activity
Stiffness Bony swellings (herbedens and bouchards)
Osteoarthritis Ix
Often clinical diag
XRAY 4 things (LOSS)
- Loss of joint space
- Osteophytes
- Subcondral cysts
- Subarticular sclerosis
RA aetiology
AI
HLA-DR1/4 association
What is rheumatoid factor?
IgM antibody which recognises Fc portion of IgG as targen antigen
Rheumatoid arthritis Sx
SYMMETRICAL
Swollen
Painful and stiff small joints
WORSE IN MORNING - improves with movement
Warm, tender joints Fingers ulnar deviation Radial deviation of wrist Swan neck Boutonniere Z deformity Trigger finger Palmar erythema
Extra-articular features of RA
Rhematoid nodules
- firm nodules on elbows, ulnar margins, palms & extensor tendons
RA Ix
Rhematoid factor
Antinuclear antibodies
Joint X-ray (BONDS)
- Bone erosions
- Osteopaenia
- Narrowing of joint space
- Soft tissue swelling
Reactive arthritis
Inflammatory sterile arthritis following extra-articular infeciton (GI/urogenital)
Reiter’s syndrome
TRIAD
Reactive arthritis
Urethritis
Conjunctivitis
Aetiology reactive arthritis
Associated with infections
- GI (Salmonella, shigella, yersinia, C. jej)
- Urogenital (Chlam, Ureaplasma)
HLA-B27
Reactive arthritis Sx
Burning/stinging when piss Arthritis Low back pain Painful heels Conjunctivits
REactive arthritis Signs
ABCD
Arthritis (asymmetrical, often painful in morning )
Blanitis circinate (painless ulcer on penis glans)
Conjunctivitis
keratoDerma Blenorrhagica
- Brown/red macule s on soles and palms
Reactive arthritis Ix
Stool/urethral swabs & culture
Ankylosing Spondylitis aetiology
Association with HLA-B27 gene
Ankylosing Spondylitis Sx
Gradual onset back pain
Early morning stiffness with exercise
Resolution with NSAIDS
Ankylosing Spondylitis Ix
Schober’s Test
Pelvic Xray - 1st investigaion
Radiographs - MRI best at detecting early disease
Ankylosing Spondylitis Extra-articular features
5 A’s
Anterior uveitis Apical lung fibrosis Achilles tendinitis Amyloidosis Aortic regurgitaiton
Septic arthritis RFs
RA Osteoarthritis Joint prosthesis IV drug abuse Alcoholism DM Osteomyelitis
Septic arthritis causative organisms
Bacterial
- S. aureus
- TB
- N. gonorrhoea
- <4 yrs (S. pneu, S. pyoge, N. meningitid)
Viruses
- Rubella
- Mumps
- Hep B
Septic arthritis Sx
Sudden onset
Excruciating hot swollen immobile joint
Septic arthritis Ix
Joint aspiraiton
- MC&S
Bloods
- FBC
- Cultures
- Viral serology
Gout aetiology
HYPERURICAEMIA
- Increased urate intake or production
- inc diet intake purines
- inc nucleic acid turnover (haem cancers)
- Renal excretion
- Idiopathic
- Dehydration
- Alcohol excess
Gout acute attack Sx
Suddent excruciating monoarticular pain
Afects MTP of big toe (podagra)
Gout chronic Sx
Follow repeated acute attacks
Persistent fever
Polyarticualr pain
Renal calculi
Gout Ix
Arthrocentesis with synovial fluid analysis
- -ve birefringent with needle shape
Bloods - inc urate
Pseudogout crystal type
Calcium pyrophosphate dehydrate
Conditions that increase risk of psuedogout
Haemochromatosis
Hyperparathyroidism
Hypomagnaesmia
Hypophosphatasia
Pseudogout Sx
Painful, swollen joint
Pseudogout Ix
Arthrocentesis with synovial fluid analysis
- +ve birefringence rhonboid shaped crystals
Plain radiography of joint
- Chondrocalcinosis
GCA aetiology
Common with inc age
HLA-DR4
HLA-DRB1
Associated with polymyalgia rheumatica
GCA Sx
Subacute onset Headache Scalp tender (brushing hair) Jaw claudication Suddent blundness in one eye
Polymyalgia rheymatica Sx
Early morning pain and stiffness of muscles of shoulder and pelvic girdle
GCA Ix
Bloods (Inflam markers)
Temporal artery biopsy
Guidelines for diagnosis of GCA
3 of following:
Age >50 New headache ESR > 50mm/h Clincally abnormal temporal artery Biopsy showing mononuclear cell infiltration or granuloma
Rx for GCA
No visual changes - Pred
Visual Sx - Methylpred pulse theray IV
