MSK and Rheumatology - conditions

Question 1

what is osteoarthritis

Answer 1

cartilage loss with accompanying periarticular bone response
some articular damage accompanying
it is non-inflammatory but physiopathology can cause inflammation

Question 2

which joint and what part of this joint is most affected by osteoarthritis

Answer 2

synovial joint - articular cartilage

Question 3

epidemiology of osteoarthritis

Answer 3

age related
dynamic reaction pattern
majority of cases are primary illness
secondary cases may be with obesity, occupation
uncommon under 50years
more common in females
most common cause of disability in the wester world

Question 4

risk factors for osteoarthritis

Answer 4

joint immobility
insufficient joint repair
diabetes
increasing age
gender (female)
genetic
obesity
occupation
local trauma
inflammatory arthritis

Question 5

main features of OA pathophysiology

Answer 5

Loss of cartilage

Disordered bone repair

Question 6

what are the 4 main features to identify OA in an X-ray

LOSS

Answer 6

Narrowing margins
Osteophytes
Subchondral sclerosis
Subchondral cyst

Question 7

what are the potential pathogenesis of OA

Answer 7

Metalloproteinase - degrades collage
iL-1 and TNF-alpha - produce metalloproteinase
less growth factors - impair matrix repair
genetic - type 2 collagen gene mutation

Question 8

main symptoms of OA

Answer 8

affects many joints, mechanical pain and loss of function
gradual onset and progressive
pain - worse when moving, relieved by rest
stiffness after rest (gelling)
morning stiffness < 30min
muscles wasting around the joint
Bouchards nodes
Heberdens nodes
crunching sensation when moving the joint
joint effusion

Question 9

How are OA and RA differentiated

Answer 9

joints affected
RA is more systemic features
Morning stiffness
(Symmetrical or asymmetrical?)

Question 10

differential diagnosis: what else may cause swelling in the DIPJ?

Answer 10

psoriatic arthritis

Chronic tophaceous gout

Question 11

diagnoses of OA

Answer 11

deformity and bony enlargement of joint
CRP slightly elevated (a protein produced in response to elevation)
rheumatoid factor and antinuclear antibodies NEGATIVE (would be present in RA)
MRI = early cartilage injury
effusion = synovial fluid

Question 12

treatment: Non-pharmacological

Answer 12

lose weight if obese
heat ice pack therapy
exercise appropriately
Acupuncture, physiotherapy and occupational therapy
shock absorbing properties footwear

Question 13

treatment: Pharmacological

Answer 13

paracetamol described before NSAIDs

DIHYDROCODEINE