MSK and Rheum - Raynaud's, Osteomalacia, Septic Arthritis

Question 1

Raynaud’s phenomenon - what is it?

Answer 1

VASOSPASM of small arteries and arterioles that DECREASE blood flow to the skin

Question 2

Raynaud’s phenomenon - what are the two types?

Answer 2

Primary: Raynaud’s Disease

Secondary: Raynaud’s Phenomenon

Question 3

Raynaud’s Disease - how does it present?

Answer 3

It characteristically presents:

1. BILATERAL symptoms
2. In women under 30yo

Question 4

Raynaud’s Phenomenon - how does it present?

Answer 4

It characteristically presents:

1. UNILATERAL symptoms
2. Secondary to another cause

Question 5

Raynaud’s phenomenon - what are the secondary causes of Raynaud’s Phenomenon?

Answer 5

Connective tissue disorders:

• scleroderma (most common)
• rheumatoid arthritis
• systemic lupus erythematosus

leukaemia

use of vibrating tools

drugs: oral contraceptive pill, ergot

Can be idiopathic

Question 6

Raynaud’s phenomenon - what are the factors suggesting that there is an underlying connective tissue disease?

Answer 6

1. Onset after 40 years
2. Unilateral symptoms
3. Rashes
4. Presence of autoantibodies
5. Features suggesting RA or SLE
6. Digital Ulcers

Question 7

Raynaud’s phenomenon - management?

Answer 7

1ST LINE - CCBs, NIFEDIPINE:
- reduce both frequency and severity of attacks

IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months

Patients with suspected secondary Raynaud’s phenomenon should be referred to secondary care

Question 8

Osteomalacia - what is it?

Answer 8

Softening of the bones secondary to low vitamin D levels, that in turn leads to reduced bone mineral content

Question 9

Osteomalacia - what is it called in children?

Answer 9

Rickets

Question 10

Osteomalacia - what are the causes?

Answer 10

Vit D deficiency:

1. Lack of sunlight
2. Diet
3. Malabsorption

CKD

Liver disease - liver cirrhosis

Drug induced - anticonvulsants

Question 11

Osteomalacia - what are the clinical features?

Answer 11

Proximal myopathy - lead to waddling gait

Bone pain

Fractures - especially at femoral neck

Question 12

Osteomalacia - what are the investigations?

Answer 12

Bloods:

1. RAISED ALP
2. Low VitD levels
3. Low Calcium and phosphate levels

XRAY:
1. Translucent bands (Looser’s zones or pseudofractures)

Question 13

Septic Arthritis - what is it?

Answer 13

Joint infection caused by bacteria or a virus that spreads to the fluid surrounding the joint

Needs to be treated immediately

Question 14

Septic Arthritis - what is the most common causative organism overall?

Answer 14

Staphylococcus aureus

Question 15

Septic Arthritis - what is the most common causative organism in people who are young and sexually active?

Answer 15

Neisseria gonorrhoeae

Question 16

Septic Arthritis - what is the most common cause of spread?

Answer 16

Hematogenous spread

Question 17

Septic Arthritis - what is the most common location in adults?

Answer 17

Knee

Question 18

Septic Arthritis - what are the clinical features?

Answer 18

1. Acute, swollen joint
   - Warm
   - Restricted movement
   - Fluctuant
2. Fever
3. Systemically unwell

Question 19

Septic Arthritis - what are the investigations?

Answer 19

1. Synovial fluid sampling - fluid will appear turbid and yellow
2. Blood cultures
3. Joint imaging
4. Bloods - ESR/CRP raised

Question 20

Septic Arthritis - management?

Answer 20

1. IV Antibiotics that cover Gram-positive cocci are indicated
   - BNF currently recommends flucloxacillin or clindamycin if penicillin allergic
   - given for 6-12 weeks
2. needle aspiration should be used to decompress the joint
3. arthroscopic lavage may be required