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MedEd > MSK - Arthritides > Flashcards

MSK - Arthritides Flashcards

1
Q

What is osteoarthritis and primary cause? / RFs?

A

Asymetrical degenerative synovial disease where cartilage destruction exceeds repair = pain and instability

‘wear and tear’ cause

Obesity, age, female, occupation, hereditary predisposition?postemnopausal?

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2
Q

Secondary cause?

A

Altered joint architecture and stability = further damage.

Pre-existing condition s.e.g. Rh or septic arthritis,
developmental dyspasia o hip
Wilsons, acromegaly, haemochromotosis
Trauma

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3
Q

Presentation of osteoarthritis?

A

Morning stiffness <30mins, joint pain with gradual nset, worse with activity and better with rest
High-use and weight bearing joints HIP, KNEE, DIP, PIP, 1st CMV, wrist

Late = night pain, instability, deformity and loss of function

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4
Q

Osteoarthritis O/E?

A

SQUARING BASE OF THUMB, heberdens and bouchards nodes, effusion and erytherma

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5
Q

Ix for osteoarthritis?

A 
XRAY = LOSS
Loss of joint pasce
Osteophytes
Subarticular sclerosis
Subchondral cysts

Joint aspirationn = straw coloured aspirate with high viscosity

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6
Q

what is the management of osteoarthritis?

A 
Lifestyle + physio
Occ.therapy
Intra-articular steroids
Joint replacement 
Stepwise analgesia:
1) Oralparacetomol +- topical NSAID/capsaicin
2) Oral NSAID + PPI
3) Opiates
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7
Q

WHat is rheumatoid arthritis (RA) and Rfs?

A

Autoimmune condition causing chronic > 6weeks inflammation of the synovial lining, tendon sheaths and bursa, Characterised by symetrical polyarthritis >4 + extraarcticular manifestations

HLADR4 (common)
HLADR1
Smoking
Dhx
Women more than men in middle age
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8
Q

Articular presentation of RA?

A

small joints = wrist, ankle. MCP, PIP, MTP (knees, elbows, hips, shoulders)

DIP SPARING

rapid onset or chronic

Systemic = weight loss, fatigue, malaise

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9
Q

Signs of articular RA?

A

Swan Neck = hyperextended PIP and flexed DIP
Boutonnieres = DIP extendsion and PIP flexion

Radial deviation of wrist
Ulnar deviation at CP
Z deformity on thumb

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10
Q

Extra-articular presentation of RA?

A 
RHEUMATOID NODULES
episcleritis/scleritis
Secondary Sjorens/sicca
Lymphadenopathy
Pulmonary fibrosis/pleuritis/bronchiolitis obliterans
Pericarditis
Carpel tunnel syndrome
Tenosynovitis/bursitis

Amyloidosis, Feltys syndrome and ACD

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11
Q

What is Feltys syndrome?

A

RA, neutropenia and splenomgealy

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12
Q

Ix for RA?

A

Serology for RF Abs, CCP Abs,
Bloods = elevated CRP, ESR, anaemia and low albumin

Xray = joint space narrowing, joint destruction, deformity, boney reosions at joint margimns , periarticular osteopaenia
Soft tissue swelling

ELAR score 6+ = RA

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13
Q

Mx for RA?

A

SHort course steroids
NSAIDS/COX2 (PPIs)
Surgery
DMARDS

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14
Q

Progression of DMARDS for RA?

A

hydroxychloroquine if mild

1) Methotrextae, leflunomide, sulfasalazine
2) 2 in combo
3) methotrexate + biologic e.g. anti-TNF (infliximab/adalimumab)
4) Methotrextae + rituximab

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15
Q

Risk of rituximab and anti-TNF?

A

immunosuppression -> serious infections or TB/hep B reactivation

Rituximab can cause night sweats and thrombocytopaenia

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16
Q

what are the seronegative spondyloathropathies?

A

No Rh factor
HLA-B27 association and Men>women

PEAR
Psoriatic athritis
Enterohepatic arthritis
Ankylosing sponylitis
Reactive athritis
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17
Q

What is ankylosing athritis and RFs?

A

Inflammatory athropathy of axial skeleton and peripheral joints, tendos/ligamens and extraarticular sites

+ve FHx
HLA-B27
ERAP-1 or IL-23R genes

Early in males, usually early 20s

18
Q

What is reactive athritis?

A

Sterile, seronegative joint inflammatio n that develops in response to extra-articular infection

RFS: HLAD-B27 (70-80%)
?sexual behaviour and STIs

20-30 years M>F

19
Q

What is Reiters syndrome?

A

Triad of reactive arthritis, urethritis and conjunctivitis

20
Q

Articular presentation of AS?

A

> 3months inflammatory back pain, sacrolilac joints and axial spine>peripheral joints

Early = pain and stiffness
late = spinal fusion, kyphosis, loss of lumbar lordosis and eneck extesnion
21
Q

articular Presentation of Reactive athritis?

A

1-4 weeks post infection
GI = salmonella, shigella, yesinina, campylobacter
GU = chamydia trachomatic, gonorrhoea

Asymetrical, oligoarthritis and lower extremitis >upper

22
Q

Extraarticular presentation of AS?

A

Anterior uveitis >40%
Apical lung fibrosis and aortic regurgitation

Psoriasis
IBD symptoms

23
Q

Reactive Arthritis extra-articular presentation?

A

Reitiers = urethritis + conunctivitis

Keratoderman blenorrhagicum

Circinate balantis

oral ulcers
Cystitis/prostatis

24
Q

How to test for AS?

A

Schobers Test = lumbar mobility
Tragus to wall (increased in AS)

Stress tests e.g. Gaenslens = sacrolilac joint pain

25
Q

Xray features or psoriatic arthitis and Eneterohepatic arthritis?

A 
P = pencil-in-cup appearance
E = marginal syndesmophytes
26
Q

Ix for reactive arthritis?

A

Joint aspiration gram stain, culture and sensitivies to rule out septic joint and cyrstal athropathices

27
Q

Types of amyloidosis?

A

Primary = deposit of immunoglobulin light chains.
Associated with MM, lymphoma, waldenstrons macroglobulinaemia

Secondary = Serum amyloid A
Association with RA, IBC< chronic infections e.g. TB

28
Q

Ix for amyloidosis?

A

Apple green birenfringence under polarised light - congo red stain

29
Q

Presentation of amyloidosis?

A 
Periorbital purpura
Carpal tunnel syndrome
Hepatomegaly
Nephrotic syndrome
Peripheral neuropathy

Primary as well = macroglossia and restrictive cardiomyopathy

30
Q

What is septic arthritis and features?

A

Acute monoarthritis - very painful, erythermatous, swollen, restricted ROm and fever

Caused by current infection S.Aureus >30, Neisseria gonorrhoea<30

31
Q

What is Gout and what causes it?

A

Acute monoarthritis, 1st MTP is podagra

Precipitated by trauma or infection. Crystal is monosodium urate adn caused bu hyperuricaemia from increased intake, increased production and decreased excretion

32
Q

Specific causes of hyperuricaemia?

A

High pruine diet and alcohol, malignancy e.g. tumour lysis syndrome

33
Q

What is pseudogout?

A

Acute monoarthritis of large joints e.g. knee. Can be polyarticular if chronic

Precipitated by illness of trauma.
Calcium pyrophsophate crystals

34
Q

Causes of psuedogout?

A

Idiopathic, hyperPTH, hyperPO4, hypoMg, metabolic e.g. haemochromotosis, wilsons and acromegaly

35
Q

RFs and Ix for septic athritis?

A

IV drug use, DM< immunosuppression,

Joint damage: RA, prosthetic joint or gout

Aspirate = tubid yellow low viscosirt fluid. Raised WCC 90% neutrophils
MC&S organsim
Bloods for elevated WCC and CRP

36
Q

Gout RFs and Ix?

A

Alcohol, high purine diet, obesity, male and diabetes

Aspirate -> yellow, turbid, low viscosity with raised WCC (neutrophils). Needle shaped vely birefringent crystals

Bloods = elevated WCC, CRP and uric acid

XR = rat bite erosions

37
Q

Pseudogout RFs and Ix?

A

Elderly and female

Aspirate -> turbid yellow low viscosity fluid. WCC (neutrophils). Rhomboid shaped, +vly birefringent crystals

Bloods = elevated WCC and CRP

Xray = chondrocalconosis

38
Q

Mx for septic, gout and pseudogout?

A

SA = IV Abx for 2 weeks and 4 weeks oral and stop biologic therapies

Got acute : NSAIDS +- PPI, colchicine, corticosteroids

Gout prophylaxis: allopurinaol (dont give in acute) . febuxostat, probenecid

Pseudogout: intra-articular coritcosteroids +-paracetomol

Polyarticular = NSAIDS +-colchicine +-paracetomil

39
Q

What is osteomyelitis?

A

Infection of bone from haematogenous spread, contiguous spread and direct inoaculation

Haematogenous = IVDU, immunosuppression, DM and Sickle cell

Contiguus = cellulitis and localised infection

Direct - penetrating injury, ulcers and surgery

Leads to inflammation, necrosis and new bone formation.
Mostly Staph A, Potts diease if TB

40
Q

presentation of ostemyelitis?

A

Nonspecific pain in affected area, fever, malaise, rigors, preceding skin lesion, sore throat trauma or operation

O/E = localised erytherma, swellign and warmth, reduced ROM, and discharge from wound or affected area

41
Q

Ix for osteomyelitis?

A

Raised WCC and CRP/ESR

No chnages onxray 1st 2 weeks then darkening and periosteal thickening

Bone culture = +ve culture

42
Q

Causative organisms in osteomyelitis>

A

Here is a breakdown of most common causative organisms of Osteomyelitis by age group (Source BMJ Best practice):
Infants: S aureus, Group B streptococci, Aerobic gram-negative bacilli (e.g.,Escherichia coli), Candida albicans.
Children 3 months – 5 years: S aureus, Kingella kingae(increased incidence in children <4 years), Group A streptococcus, Streptococcus pneumoniae, Haemophilus influenzae(if not vaccinated), Pseudomonas(from foot puncture wounds).
Children > 5 years: Staph aureus, Group A streptococcus
Adults: Staph aureus, Coagulase negative staphylococci, aerobic gram negatives, anaerobic gram positive Peptostreptococcus spp.
Elderly: Gram negative bacilli

MedEd (32 decks)

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