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Phase 2a > MSK > Flashcards

MSK Flashcards

1
Q

What is rheumatoid arthritis?

A

An autoimmune condition in which autoantibodies attack and destroy the synovial lining of synovial joints

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2
Q

What are the symptoms of rheumatoid arthritis?

A
  • Morning stiffness/pain lasting MORE than 30 mins

- Stiffness/pain EASES with use

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3
Q

Describe the physical examination results/signs of rheumatoid arthritis.

A
  • Ulnar deviation
  • Swan-neck deformity
  • Boutonierre deformity
  • Z thumb
  • Active synovitis (red, hot, swollen joints)
  • Pattern of joint involvement = symmetrical, mostly affecting wrists, hands and feet
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4
Q

What are the extra-articular manifestations of rheumatoid arthritis?

A
  • Anaemia
  • Neuropathy
  • Vasculitis
  • Lungs: Caplan’s syndrome (RA + pneumoconiosis = intrapulmonary nodules)
  • Eyes: Sjogren’s syndrome (causing severe dry eyes), scleritis
  • Felty’s syndrome: RA + splenomegaly + neutropenia
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5
Q

How is rheumatoid arthritis investigated?

A

Bloods:

  • FBC may show anaemia
  • ESR/CRP = raised
  • Autoantibody screen (rheumatoid factor and anti-CCP)

X-ray shows characteristic changes -‘LESS’:

  • Loss of joint spacing
  • Erosion
  • Soft tissue swelling
  • Soft bones (osteopenia)
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6
Q

Describe the pharmacological management of rheumatoid arthritis

A
  • 2 DMARDs, one being Methotrexate, other = Azathioprine or Sulfasalazine
  • Analgesia
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7
Q

What is osteoarthritis?

A

Degenerative condition of articular cartilage

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8
Q

Describe the pathophysiology of osteoarthritis

A
  • Loss of articular cartilage =exposure of underlying bone

- This leads to subchondral sclerosis/cysts and osteophyte formation

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9
Q

What are the risk factors for osteoarthritis?

A
  • Age (50+)
  • Obesity
  • Previous injury/trauma
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10
Q

What are the symptoms of osteoarthritis?

A
  • Morning stiffness/pain lasting LESS than 30 mins

- Pain after exercise/at the end of the day (after use)

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11
Q

Describe the physical examination results/signs of osteoarthritis

A
  • Heberden’s nodes (DIPJs)
  • Bouchard’s nodes (PIPJs)
  • Base of thumb (1st MCPJ) and base of big toe (1st MTPJ)
  • Hard, bony swelling
  • Crepitus
  • Pattern of joint involvement: asymmetrical, affecting joints which are used most (hands, feet, knees, hips)
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12
Q

How is osteoarthritis investigated?

A

Usually clinical diagnosis

X ray shows characteristic changes - ‘LOSS’:

L - Loss of joint spacing
O - Osteophytes
S - Subchondral sclerosis
S - Subchondral cysts

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13
Q

Describe the conservative management of osteoarthritis

A

Lifestyle advice: weight loss, low impact/non-weight bearing exercise

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14
Q

Describe the pharmacological management of osteoarthritis

A
  • Analgesia

- Steroid injections

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15
Q

Describe the interventional management of osteoarthritis

A

Surgery: joint replacement

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16
Q

The ‘crystal arthropathies’ include which conditions?

A

Gout (much more common)

Pseudogout

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17
Q

What are the symptoms of gout/pseudogout?

A

5 cardinal signs of inflammation in joint:

  • Calor (hot)
  • Rubor (red)
  • Dolor (painful)
  • Tumor (swollen)
  • Loss of function
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18
Q

How are gout/pseudogout investigated?

A

Joint fluid aspirate analysis
(MUST exclude septic arthritis by MC+S)

Crystals analysed by CPM (compensated polarised microscopy)

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19
Q

Which joint is most commonly affected in gout? Describe the joint distribution.

A
  • 1st MTPJ

- Usually one joint affected (monoarthropathy)

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20
Q

Describe the chemical composition and structure of the crystals present in gout

A
  • Monosodium urate

- Positive birefringence, needle-shaped crystals

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21
Q

What are the risk factors for developing gout?

A
  • Male
  • Diet high in purines (meat/seafood)
  • Excess alcohol
  • Drugs: diuretics
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22
Q

Describe the conservative management of gout

A

Lifestyle advice:

  • Weight loss
  • Reduce amount of purines in diet (meat, seafood etc.)
  • Avoid alcohol (in excess)
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23
Q

Describe the pharmacological management of gout (both for acute attacks and prevention)

A

Treatment in acute attacks:

  • NSAIDs
  • Colchicine

Prevention:

  • Stop diuretics
  • Allopurinol
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24
Q

Which joint is most commonly in pseudogout? Describe the joint distribution

A
  • Knee

- Usually more than one joint affected (polyarthropathy)

25
Q

Describe the chemical composition and structure of the crystals present in pseudogout

A
  • Calcium pyrophosphate

- Positive birefringence, rhomboid-shaped crystals

26
Q

What are the risk factors for developing pseudogout?

A
  • Elderly
  • Dehydration
  • Intercurrent illness/surgery/trauma
27
Q

Describe the pharmacological management of pseudogout

A

NSAIDs

28
Q

What is osteoporosis?

A

Progressive loss of bone mass and therefore bone strength, making bones fragile and more susceptible to fracture

29
Q

Describe the pathophysiology of osteoporosis

A

Trabecular loss

Cortical thinning

30
Q

What are the risk factors for osteoporosis?

A

‘ACCESS’

A - alcohol
C - corticosteroids
C - calcium low
E - estrogen low
S - smoking
S - sedentary lifestyle
31
Q

Which sites are most commonly affected by osteoporosis?

A
  • Vertebrae
  • Neck of femur
  • Proximal humerus
  • Distal radius
32
Q

How is osteoporosis investigated?

A 
DEXA scan for bone mineral density:
T score (difference between normal healthy adult and the result of DEXA scan) < -2.5 = osteoporosis
33
Q

Describe the conservative management of osteoporosis

A

Lifestyle advice - reduce risk factors:

  • Reduce alcohol intake
  • Adequate calcium and vitamin D intake (supplementation)
  • Stop smoking
  • Exercise
34
Q

Describe the pharmacological management of osteoporosis

A
  • Bisphosphonates, e.g. alendronic acid: inhibit action of osteoclasts, so inhibit bone resorption
  • Calcium and vitamin D supplementation, e.g. Adcal D3
35
Q

What are the side effects of the drugs used to treat osteoporosis?

A

Side effects of bisphosphonates:

  • GI disturbance
  • Oesophageal erosion
36
Q

The ‘seronegative (or spondylo-) arthrpathies’ include which conditions?

A
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Enteropathic arthritis
  • Reactive arthritis
37
Q

Ankylosing spondylitis most commonly affects…

A

Young males

38
Q

What are the symptoms of ankylosing spondylitis?

A
  • Lower back pain
  • Alternating buttock pain
  • Systemic features: fever, fatigue
39
Q

Give some extra articular features of ankylosing spondylitis

A

A’s…

  • Achilles tendinitis
  • Apical pulmonary fibrosis
  • Acute anterior uveitis
40
Q

How is ankylosing spondylitis investigated?

A

Bloods:

  • CRP/ESR raised
  • Autoantibody screen (RF, anti-CCP) is negative

X-ray = Bamboo spine - ‘BOSS’:

B - blurring
O - ossification of spinal ligaments
S - sclerosis
S - syndesmophyte fusion

41
Q

Enteropathic arthritis is associated with…

A

IBD

42
Q

Describe the skin changes (signs) which may be present in enteropathic arthritis

A
  • Erythema nodusum

- Pyoderma gangrenosum

43
Q

What is reactive arthritis?

A

Inflammatory arthritis occurring 1-6 weeks after a GU/GI infection

44
Q

Which bacteria most commonly cause reactive arthritis?

A

GI: Campylobacter, Salmonella, Shigella
GU: Chlamydia

45
Q

Which syndrome is associated withe reactive arthritis?

A

Reiter’s syndrome: arthritis, urethritis, conjunctivitis

46
Q

What is septic arthritis?

A

Inflammation of a joint caused by bacterial infection

47
Q

What are the symptoms/signs of septic arthritis?

A

5 cardinal signs of inflammation:

  • Rubor (red)
  • Calor (hot)
  • Dolor (pain)
  • Tumor (swollen)
  • Loss of function

Systemic features: fever
Mostly monoarthopathy

48
Q

How is septic arthritis investigated?

A

Joint fluid aspirate analysis (MC+S)

49
Q

Which bacteria are commonly associated with septic arthritis?

A
  • Staph aureus (MOST COMMON)

- Group A and B streptococci

50
Q

Describe the pharmacological management of septic arthritis

A
  • Commence Abx (guided by MC+S) and stop any immunosuppression, e.g. DMARDs, temporarily
  • Analgesia
51
Q

Describe the interventional management of septic arthritis

A

Surgical joint washout if symptoms persist despite pharmacological therapy

52
Q

What does SLE stand for and what is it?

A

SLE = systemic lupus erythematosus

Lupus is a chronic inflammatory autoimmune condition that causes inflammation of the joints, skin and other organs

53
Q

Describe the pathophysiology of lupus

A
  • Type 3 hypersensitivity reaction

- Causes deposition of immune complexes in different body tissues leading to inflammation

54
Q

What are the symptoms and signs of lupus?

A

Symptoms:

  • Fatigue
  • Arthralgia/myalgia
  • Chest pain
  • SOB
  • Photosensitivity

Signs:

  • Pale mucous membranes (anaemia)
  • Oral ulcers
  • Malar rash
  • Discoid rash
55
Q

How is lupus investigated?

A

Bloods:

  • FBC: anaemia
  • ESR/CRP raised
  • Autoantibody screen (many different ones present, e.g. ANA, anti-dsDNA, antiphospholipid antibodies
  • Biopsies of kidney and skin - show deposition of IgG and complement
56
Q

Describe the conservative management of lupus

A

Avoid sunlight

57
Q

Describe the pharmacological management of lupus

A
  • NSAIDs for pain

- Immunosuppression, i.e. steroids and DMARDs

58
Q

Give some common complications of lupus

A
  • CVD
  • Depression
  • Osteoporosis

Phase 2a (16 decks)

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