MSK Flashcards
Definition of OA
Disorder of synovial joints which occurs when damage triggers repair processes leading to structural changes within a joint
Risk factors of OA
Genetic Biological - increasing age - female sex - obesity - high/low bone density Biomechanical - joint injury and damage - joint laxity and reduced muscle strength - joint malalignment - exercise stresses - occupational stresses
Complications of OA
Joint deformity - Herberden's nodes - DIPJ - Bouchard's nodes - PIPJ Functional impairment Psychosocial impact Occupational impact Falls Chronic pain syndrome
Clinical presentation of OA
Activity-related joint pain No morning stiffness Functional impairment Bony swelling and joint deformity Joint effusions Joint warmth Muscle wasting and weakness Restricted ROM, crepitus Joint instability
X-ray features of OA
Loss of joint space
Bony spurs
Subchondral sclerosis
Osteophytes
Differential diagnosis of OA
Inflammatory arthropathy Septic joint Fracture Malignancy Ganglion Sciatica Spinal stenosis Iliotibial band syndrome Meniscal tear
Management of OA
Self-care management - recommended weight loss - local muscle strengthening Simple analgesia - paracetamol - NSAIDs - topical Oral NSAIDs Oral codeine Topical capsaicin
Definition of RA
Chronic systemic inflammatory disease
- typically affects small joints of hands and feet
Complications of RA
Amyloidosis Anaemia Dry eye syndrome Fatigue Increased mortality ILD Neuropathy Carpal tunnel syndrome Increased joint replacement Tendon rupture Vasculitis Weight loss CVD Depression Lymphomas Serious infections
Complications of drug treatment of RA
GI affects - NSAIDs Infection - glucocorticoids - immunosuppressants Liver toxicity - methotrexate Malignancy - TNF alpha inhibitor Osteoporosis
Clinical features of RA
Pain - worse at rest Swelling Stiffness - early morning over 1 hour Rheumatoid nodules Extra-articular features - vasculitis Systemic features - malaise - fatigue - fever - sweats - weight loss Family history of RA
Differential diagnosis of RA
Connective tissue disorder Fibromyalgia Infectious arthritis OA Polyarticular gout Polymyalgia rheumatica Psoriatic arthritis Reactive arthritis Sarcoidosis Septic arthritis Seronegative spondyloarthritis
Management of RA
DMARD - methotrexate - leflunomide - sulfasalazine - hydroxychloroquine - palindromic disease Glucocorticoids - bridging
Define spondyloarthritis
Group of clinically heterogeneous inflammatory rheumatologic conditions
Define ankylosing spondylitis
Axial spondyloarthritis characterised by sacroiliitis on x-ray
Features of ankylosing spondyliitis
Chronic back pain - stiffness that improves with exercise Sacroiliac joint and spinal fusion Arthritis and enthesitis Dactylitis Fatigue Extra-articular manifestations
Complications of ankylosing spondyliitis
Ankylosis or spinal fusion Spinal fractures Hip involvement Anterior uveitis Osteoporosis Cardiac complications - CVD disease Lung involvement Neurological involvement Adverse effects from drugs Decreased QoL and work productivity
Differential diagnosis of ankylosing spondyliitis
Degenerative or mechanical problems - degenerative disc disease - spondylosis - congenital vertebral anomalies - degenerative changes in intervertebral joints - OA of sacroiliac joints Fractures Infectious sacroiliitis Bone metastasis Primary bone tumours Spinal stenosis Hypermobility
Management of ankylosing spondyliitis
Exercise/streches
NSAIDs
Biological DMARDs - anti-TNFs
- infliximab
Define polymyalgia rheumatica
Chronic, systemic rheumatic inflammatory disease characterised by aching and morning stiffness in neck, shoulders and pelvic girdle in people older than 50 years
Risk factors for polymyalgia rheumatica
Older age
Female gender
Northern European ancestry
Infection
Complications of polymyalgia rheumatica
Giant cell arteritis
Complications of long term steroids
Clinical features of polymyalgia rheumatica
Bilateral shoulder and/or pelvic girdle pain
Stiffness lasting for at least 45 mins after waking or rest
Low grade fever, fatigue, anorexia, weight loss and depression
Bilateral upper arm tenderness
Carpal tunnel syndrome
Peripheral arthritis
Swelling with pitting oedema of hands, wrists, feet and ankles
Muscle strength not impaired
Differential diagnosis of polymyalgia rheumatica
Degenerative disorders - OA - bilateral adhesive capsulitis - cervical and lumbar spondylosis Endocrine - thyroid disease - parathyroid disease Infection - viral illness - chronic osteomyelitis - TB - infective endocarditis Inflammatory disorders - RA - SLE Cancer - multiple myeloma - acute leukaemia - lymphoma - lung carcinoma Drug-related adverse effects - myositis or myalgia Osteomalacia Fibromyalgia Chronic fatigue syndrome
Management of polymyalgia rheumatica
Oral prednisolone - reduce in line with symptoms
